summary: An officer received a call in reference to the caller’s grandson. The caller advised the officer that her grandson was being held there, and she was unable to get a hold of anyone at the facility. The officer relayed the message to a staff member at the facility.

raw_content:
Incident # 23-00367 Bono Police Department Report Date 06/29/23
Page 1 of 2 Incident Report Report Time 10:33 PM
Status Exception Clearance Date Reporting Officer ORI/Agency
Not Applicable 528 Morgan, Don AR0160700
Active
Assigned Officer Entered By Approving Officer
dmorgan
Assisting Officers
Complainant
SSN/ID/TIN Title Name DOB Age Sex Resident Status
U Unknown
Race Unknown Ethnicity DL (#, ST) Email
Unknown ,
Home Phone Work Phone Other Phone Personal Cell Work Cell
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
Work Address Occupation
Offenses
Incident Location Zone
211 Church ST Bono, AR 72416
Earliest Possible Date Time Latest Possible Date Time
06/29/2023 15:15 06/29/2023 15:45
# Statute/Code Description Fel/Misd Att/Comp Loc Bias Wpn CATypes
1 INFO General Information Report Completed 15 88 99
MO Method Of Entry # Prems
n/a 0
Location Types 13 Hway/Road/Alley 37 Abandoned/Condemned 48 Industrial Site Bias Motivation Codes
14 Hotel/Motel Structure 49 Military Installation 43Lesbian, Gay, Bisexual,
0 0 0 0 0 0 0 0 0 1 1 1 1 2 3 4 5 6 7 8 9 0 1 2 A B B C C C C D D F G G i i a a h o o o e r o r e r u o n r / u m n n p v l B / g d c k N t r s v t / m / e c u / / t e P D S W i S r h r s g n e u u y t i & / / s h r o i S r c T / b e / S c c L t o D t r l y n i i o i C a u o d a c n r c u i p n s l l a n e O / u B n e O g S b t T l f S r d / f f m S i T / e f t t g H o e t r B e a o m r o m l r e r d s k e i p n g p e l a t e l 1 1 1 1 1 F 2 2 2 2 2 5 6 7 8 9 0 1 3 4 5 a c J L L P R R R S S U i a l a i a e p e e e n i q t i k r r e y n s s k l u / k v e i t c n P t o d i a i a / i n c o W r r a e u l e i g w s S l n S r t / a a o y n G L c t t t o n n o / e o e S a O r t r / t r e s a t H / w t o G h g S o r a e a e e m t y r a ra e ti g o e n 3 3 g 4 4 N 4 4 4 M 4 4 8 9 r 0 1 2 4 5 6 7 e o o w A A A C D D F G d u A a a / n r T u a a o a U m e l r d t M m y c m o m n T s s u c k a p e b e / a / s D S C W F / / d l r e r S C i e e m e n a o m h p a t a g c l a i F i a a l n e m s i e d l a r r i a e n r f t i a p c / y u s l u t F t g i h m m P e l r i r i t e o a p y / f F r i u r g o k a n h m i d r t/ Bank 5 5 5 C 5 E 5 M 5 5 5 5 0 1 2 3 4 5 6 7 8 l o i e s l C m l s P R S S S S T C e i y r e o g a c c h h e o i b h h b n n e r e o s m e k o o a t / / t l p t a H U / r m o o e l A P p s r o n L l l r i p y u r l n a m i e - - a / - a n v g S y a n c e i e g t e d M e y r l r c e s s o C a o i s t u l y n s e l n d n d a te ry r A 1 1 A 1 A 1 1 1 O 2 2 N 1 2 3 4 5 6 1 2 m l t a h T W M J C B A A s e e N e k I l m s r a r u a h - a i w a i c t P l a c i e t h t t a i i N i k n e s v a r o - n i r h e c a c l o a i i a c t r f c H i i n v c e A a e s I f I w n r s , i d a c l G a a i i a i n r a n o n d n u e o p o r r r 2 2 2 2 2 3 3 3 L 4 4 3 4 5 6 7 1 2 3 a 1 2 t P I O M A A G L H N in s e r t r i o l t a o u h s o a a h s t y l p e t b m e b t H e i a i ( - r i s s i a m r i n c R s t e t n / i a a p A l c ( e i M n g l a g l e o i t i n g u n o ) r i i s o u c L o l s s a i n o m t t i g r i c n ) ro o up o G 4 4 5 5 6 6 7 7 8 9 r 4 5 1 2 1 2 1 2 8 9 r o T H B P M M F T G N U u r e r i h a e o n e e a p s a m y n t n k n n l e n e e ( s n s e d t x L a s r a g o o e u D G l g l e e w s r a e i D B s n e l N n n a i T d x s d o b e u ) a e n i r a l b r - , i l t C i M y li o ty i n xe fo d rming
Facility/Casino/Race Track
Suspected Of Using Criminal Activity Types Weapon Type(s) 20 Knife/Cutting Instr 65 Fire/Incendiary Device
None B P B P u o y s i s n e g s / s R in e g ce /C iv o in n g cealing C O C O u p l e ti r v a a t t in in g g / / P M ro a m nu o f t / i P n u g b /A li s s s h i i s n t g ing 1 1 1 2 F H i a re n a d r g m u n (A (A ut u o t ) o) 3 3 0 5 B M l o u t n o t r O V b e j h e i c c t le 7 8 0 5 D As ru p g h s y / x N ia a t r i c o . n /Sleeping Pills
D Distributing/Selling T Transport/Import/Transmit 13 Rifle (Auto) 40 Personal Weapons 90 Other
E Exploiting Children U Using/Consuming 14 Shotgun (Auto) 50 Poison 95 Unknown
15 Other Firearm 60 Explosives 99 None
A Simple/Gross Neglect I Intentional Abuse & Torment
F Organized Abuse S Sexual Animal Abuse
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 7/18/2023 12:25:53 PM

Incident # 23-00367 Bono Police Department Report Date 06/29/23
Page 2 of 2 Incident Report Report Time 10:33 PM
Associated Person #1 Child
SSN/ID/TIN Title Name DOB Age Sex Resident Status
U Unknown
Race Unknown Ethnicity DL (#, ST) Email
Unknown ,
Home Phone Work Phone Other Phone Personal Cell Work Cell
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
211 Church ST,Bono, AR 72416
Work Address Occupation
Narrative & Statements
Narrative - Morgan, Don - 6/29/2023 10:38:52 PM (Initial)
On 6/29/2023 I Officer Morgan received a call from in reference to her son being in Methodists
Rehabilitation Center in Bono. advised that her grandson was being held there and she was unable to get
ahold of anybody there. I went by and relayed a message for to have one of the staff members to give her a
call. Nothing further to report.
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 7/18/2023 12:25:53 PM


state: AR

facility_name: United Methodist Children's Home - Dacus (Bono)

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

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Dacus RTC
Facility Number: 108
Licensee Address: 211 CHURCH STREET
BONO AR 72146
Licensing Specialist: Kendra Rice
Person In Charge: Waynette Banks
Record Visit Date: 6/22/2023
Home Visit Date: 6/22/2023
Purpose of Visit: Subsequent Building and Grounds
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Time of visit: 12:45 pm to 2:15 pm
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 3

Census: 11
Licensing Specialist completed buildings and grounds and observed the following areas: front office
(administration), day area, dining area, nurse’s station, classroom hall, big boys and little boys hallway.
Licensing Specialist was escorted by Ms. Banks, Program Director. Ms. Banks provided the Licensing
Specialist with a copy of the scheduled outings for the residents. Licensing Specialist observed a staff member
and resident preparing for a visit, ratio 1:1 and a family session in the day area, ratio 1:2.
Licensing Specialist observed the big boys sitting at desks in their classroom, ratio 1:3. The little boys were
also sitting at desks with one resident sitting by the teacher’s desk, ratio, 1:6. The classroom hallway,
classrooms, and bathroom were clean and organized. Licensing Specialist observed a water fountain for
residents’ water supply.
Licensing Specialist observed the following areas: Priv Room and Client Prep. Residents can go to the Priv
Room when they earn privileges. The Priv Room has two (2) televisions and two (2) video games systems for
the residents. The Client Storage Room, where residents’ personal activity boxes are stored..
Big Boys Hall: No residents were present during the walkthrough. Licensing Specialist observed the
following bedrooms: 117, 118, 119, and 120. All bedrooms and bathroom were clean and organized. Little
Boys Hall: Licensing Specialist observed the following bedrooms: 126, 128, and 130. All bedrooms and
bathroom were clean and organized. Licensing Specialist also observed the laundry rooms, library, and
seclusion room.
Licensing Specialist observed the following documentation on the walls: day room schedule and emergency
evacuation plans. Licensing Specialist observed the fire extinguishers on the walls during the walkthrough.
Licensing Specialist reviewed MARs for the following residents:
CT 1/26/2007
KS 11/26/2009
RK 5/15/2008
KJ 3/8/2007
JD 7/31/2010
All initialed and up to date.
Provider Comments:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 3

CCL Staff Signature : Date: 8/17/2023
Provider Signature : Date: 8/17/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 3 of 3

doc_type: Compliance Report


summary: A resident lost a tooth after the resident was punched in the face several times by a peer.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 5/22/2023
Date Received by DCCECE: 5/22/2023
Facility Name: Dacus RTC
Facility Number: 108
Facility Type:
Incident Type: Licensing
Report Description: Client: Date of Birth: Caresource State custody
Guardian: Pulaski County DHS-caseworker Treva Crockett Staff present: Yasmine Prater
and Elisha Brewer Date of Incident: 5/22/2023 Client threatened to harm staff. Client
attempted to stab staff with a color pencil. Client got into a verbal altercation with peers.
Peer tried to get the pencil away from Client. When Peer was unable to do this. Peer pushed
the Client. Client punched peer several times with closed fist. Peer punched Client. While
staff was trying to separate the two, another Peer punched the Client several times with
closed fist in the face until Staff was able to separate them. Client was assessed by nurse and
it was noted Client was missing right front tooth. Tooth confiscated and appears clearly
intact. Bleeding easily ceased with gauze pressure. Pain reported 6 out of 10. Superficial
abrasion noted to left forearm from client scratching at arm. Area without bleeding or open
areas.
Interim Action Narrative:
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: 5/26/23- Licensing reviewed the camera footage on site at the facility.
The facility was given guidance on transitioning one group at a time through the transition
hall to avoid large gatherings of children in the small transition hall.

doc_type: Notice of Incident


summary: Officers were dispatched to the facility in response to a juvenile hitting a staff member in the face with a closed fist. The officer was informed that the juvenile did the same thing the day before to another staff member.

raw_content:
Incident # 23-00252 Bono Police Department Report Date 05/01/23
Page 1 of 2 Incident Report Report Time 8:11 AM
Status Exception Clearance Date Reporting Officer ORI/Agency
Not Applicable 527 Mccracken, Joel AR0160700
Active
Assigned Officer Entered By Approving Officer
JMcCracken
Assisting Officers
Complainant
Name Contact Name
Methodist Family Health Wazeunna Kimbrough
Business Address Business Phone
211 W Church ,Bono, AR 72416 8709328880
Offenses
Incident Location Zone
211 W Chruch Bono, AR 72416
Earliest Possible Date Time Latest Possible Date Time
05/01/2023 07:30 05/01/2023 08:00
# Statute/Code Description Fel/Misd Att/Comp Loc Bias Wpn CATypes
1 5-13-203A(1) BATTERY - 3RD DEGREE / PURPOSE OF CAUSING INJURY, CAUSES INJURY Misd Completed 25 88 99
MO Method Of Entry # Prems
13 year old hit staff member n/a 0
Location Types 13 Hway/Road/Alley 37 Abandoned/Condemned 48 Industrial Site Bias Motivation Codes
14 Hotel/Motel Structure 49 Military Installation 43Lesbian, Gay, Bisexual,
0 0 0 0 0 0 0 0 0 1 1 1 1 2 3 4 5 6 7 8 9 0 1 2 A B B C C C C D D F G G i i a a h o o o e r o r e r u o n r / u m n n p v l B / g d c k N t r s v t / m / e c u / / t e P D S W i S r h r s g n e u u y t i & / / h s r o i S r c T / b e / S c c L t o D t r l y n i i o i C a u o d a c n r c u i p n s l l a n e O / u B n e O g S b t T l f S r d / f f m i S T / e f t t g H o e t r B e a o m r o m l r e r d s k e i p n g p e l a t e l 1 1 1 1 1 F 2 2 2 2 2 5 6 7 8 9 0 1 3 4 5 a c J L L P R R R S S U i a l a i a e p e e e n i q t i k r r e y n s s k l u / k v e i t c n P t o d i a i a / i n c o W r r a e u l e i g w s S l n S r t / a a o y n G L c t t t o n n o / e o e S a O r t r / t r e s a t H / w t o G h g S o r a e a e e m t y r a ra e ti g o e n 3 3 g 4 4 N 4 4 4 M 4 4 8 9 r 0 1 2 4 5 6 7 e o o w A A A C D D F G d u A a a / n r T u a a o a U m e l r d t M m y c m o m n T s s u c k a p e b e / a / s D S C W F / / d l r e r S C i e e m e n a o m h p a t a g c l a i F i a a l n e m s i e d l a r r i a e n r f t i a p c / y u s l u t F t g i h m m P e l r i r i t e o a p y / f F r i u r g o k a n h m i d r t/ Bank 5 5 5 C 5 E 5 M 5 5 5 5 0 1 2 3 4 5 6 7 8 l o i e s l C m l s P R S S S S T C e i y r e o g a c c h h e o i b h h b n n e r e o s m e k o o a t / / t l p t a H U / r m o o e l A P p s r o n L l l r i p y u r l n a m i e - - a / - a n v g S y a n c e i e g t e d M e y r l r c e s s o C a o i s t u l y n s e l n d n d a te ry r A 1 1 A 1 A 1 1 1 O 2 2 N 1 2 3 4 5 6 1 2 m l t a h T W M J C B A A s e e N e k I l m s r a r u a h - a i w a i c t P l a c i e t h t t a i i N i k n e s v a r o - n i r h e c a c l o a i i a c t r f c H i i n v c e A a e s I f I w n r s , i d a c l G a a i i a i n r a n o n d n u e o p o r r r 2 2 2 2 2 3 3 3 L 4 4 3 4 5 6 7 1 2 3 a 1 2 t P I O M A A G L H N in s e r t r i o l t a o u h s o a a h s t y l p e t b m e b t H e i a i ( - r i s s i a m r i n c R s t e t n / i a a p A l c ( e i M n g l a g l e o i t i n g u n o ) r i i s o u c L o l s s a i n o m t t i g r i c n ) ro o up o G 4 4 5 5 6 6 7 7 8 9 r 4 5 1 2 1 2 1 2 8 9 r o T H B P M M F T G N U u r e r i h a e o n e e a p s a m y n t n k n n l e n e e ( s n s e d t x L a s r a g o o e u D G l g l e e w s r a e i D B s n e l N n n a i T d x s d o b e u ) a e n i r a l b r - , i l t C i M y li o ty i n xe fo d rming
Facility/Casino/Race Track
Suspected Of Using Criminal Activity Types Weapon Type(s) 20 Knife/Cutting Instr 65 Fire/Incendiary Device
None B P B P u o y s i s n e g s / s R in e g ce /C iv o in n g cealing C O C O u p l e ti r v a a t t in in g g / / P M ro a m nu o f t / i P n u g b /A li s s s h i i s n t g ing 1 1 1 2 F H i a re n a d r g m u n (A (A ut u o t ) o) 3 3 0 5 B M l o u t n o t r O V b e j h e i c c t le 7 8 0 5 D As ru p g h s y / x N ia a t r i c o . n /Sleeping Pills
D Distributing/Selling T Transport/Import/Transmit 13 Rifle (Auto) 40 Personal Weapons 90 Other
E Exploiting Children U Using/Consuming 14 Shotgun (Auto) 50 Poison 95 Unknown
15 Other Firearm 60 Explosives 99 None
A Simple/Gross Neglect I Intentional Abuse & Torment
F Organized Abuse S Sexual Animal Abuse
Victim #1 Event #s Related 1
SSN/ID/TIN Title Name DOB Age Sex Resident Status
Kimbrough, Wazeunna 05/16/1996 26 F Unknown
Race Black / African Ethnicity DL (#, ST) Email
American Not Hispanic/Latino ,
Home Phone Work Phone Other Phone Personal Cell Work Cell
(870)776-6149 (870)932-8800
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
Methodist Family Health
Work Address Occupation
211 W Chruch ,Bono, AR 72416
Victim Type Injury Type Aggravated Assault/Homicide Circumstances Relationship To Suspect
Individual None, None #1 N/A
Justifiable Homicide Circumstances Taken to: (Hospital Name)
None
Injury Description
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 5/16/2023 11:13:55 AM

Incident # 23-00252 Bono Police Department Report Date 05/01/23
Page 2 of 2 Incident Report Report Time 8:11 AM
Victim #2 Event #s Related 1
SSN/ID/TIN Title Name DOB Age Sex Resident Status
Lloyd, Octavia U Unknown
Race Unknown Ethnicity DL (#, ST) Email
Unknown ,
Home Phone Work Phone Other Phone Personal Cell Work Cell
(870)932-8880
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
Methodist Family Health
Work Address Occupation
211 W Church ,Bono, AR 72416
Victim Type Injury Type Aggravated Assault/Homicide Circumstances Relationship To Suspect
Individual None, None #1 N/A
Justifiable Homicide Circumstances Taken to: (Hospital Name)
None
Injury Description
Suspect #1
SSN/ID/TIN Title Name DOB Age Sex Resident Status
12 U Unknown
Race Unknown Ethnicity DL (#, ST) Email
Unknown ,
Home Phone Work Phone Other Phone Personal Cell Work Cell
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
211 W Church ,Bono, AR 72416
Work Address Occupation
Height Weight Eyes Build AKA
- -
Narrative & Statements
Narrative - Mccracken, Joel - 5/1/2023 8:20:39 AM (Initial)
I was dispatched on 5/1/23 at 0730 hours to Methodist Family Health in reference to a Juvenile hitting a staff
member. Suspect 1 had hit Wazeunna Kimbrough in the face with a closed fist. I was also informed that he had done
the same thing the day before (3/30/23) to Octavia Lloyd. We talked to suspect one about the incident. He said he
was angry and didn't want to be there. We contacted Juvenile probation who said to let him stay there and not take
him to jail.
Suspect 1 is in DHS Custody (Treva Crockett 501-554-9357).
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 5/16/2023 11:13:55 AM

doc_type: Police Report


summary: A resident attacked staff, wrapped a hoodie around his neck, then scratched himself on the arm with a piece of broken plastic.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 4/30/2023
Date Received by DCCECE: 5/1/2023
Facility Name: Dacus RTC
Facility Number: 108
Facility Type:
Incident Type: Licensing
Report Description: Client Birthdate: Caresource Staff Present: Erica
Bonner and Octavia Lloyd Date of Incident: 4/30/2023 Client threw items at the tv, peers,
and staff. Client broke the remote and a chair. Client attacked staff by punching staff with
closed fist. Client was placed in a TCP from 6:14pm-6:15pm. Client continued to throw items
at staff. Staff observed client through the window of the door for safety measures. Client
took a hoodie and wrapped it around his neck. Client picked up a piece of broken plastic
and scratched himself with it on his arm. Client had redden marks on anterior of neck and
superficial scratches on right forearm. No active bleeding. Client denied pain. Client was
placed on assault precautions, suicide precautions and 60k focus.
Interim Action Narrative: Resident was assessed staff. He was placed on assault
precautions, suicide precautions, and 60k focus.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed provider reported incident. Licensing
Specialist will inquire about the broken piece of plastic. Licensing Specialist informed that
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

the broken piece of plastic came from the remote when the resident broke the remote.
5/26/23- Licensing reviewed camera footage of the incident. The resident was with one
other peer in the activities room along with one staff. The residents were on restriction so
they could not join their peers upstairs for regular activities such as playing on the gaming
system. The resident can be seen pacing the room when he begins to act out, throw things,
and get violent. The peer is removed from the room as the resident continues to try and
assault the two female staff now in the room. The resident is placed in a brief restraint hold,
but eventually let go. The resident continues to act aggressively and at one point throws a
battery at the staff hitting her in the forehead causing her head to bleed. At 6:16PM you can
see what appears to be the resident attempting to self-harm on his arm. The nurse appears
in the room to assess his injuries from self-harming at 6:28PM. Licensing discussed with the
direct care staff supervisor the need for staff to still be interacting and programming with
the residents that are on restriction instead of having them sit in a room. The supervisor
states that staff are suppose to program with the kids on restriction during this time, but the
resident in question is often sexually inappropriate without warning and they only had one
female staff available to be in the room. Licensing encouraged the supervisor to discuss
continuing to program with this staff and working on ways to redirect the resident when he
is inappropriate.


raw_content:
521 Visit Compliance Report

Licensee: Dacus RTC

Facility Number: 108

Licensee Address: 211 CHURCH STREET
BONO AR 72146

Licensing Specialist: Kendra Rice
Person In Charge: Waynette Banks
Record Visit Date: 4/18/2023
Home Visit Date: 4/18/2023

Purpose of Visit: Subsequent Building and Grounds

Regulations Out of Compliance:

Regulations Needing Technical Assistance:

Regulation Not Applicable:

Regulations Not Correctable:

Narrative:

Time of visit: 12:45 pm to 1:45 pm

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

ARKANSAS
) DEPARTMENT OF

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

P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550

Page 1 of 3

Census: 12

Licensing Specialist completed buildings and grounds.

Ms. Waynette, Program Director, escorted Licensing Specialist around the grounds of the facility. Licensing
Specialist met two (2) maintenance workers by the maintenance shed. The facility’s grounds were clean with
no debris. Licensing Specialist observed basketballs around the fenced in basketball court.

Licensing Specialist observed the dayroom where a family session was taken place. Ratio 1:3, including the
resident and his parents. The dining room area was clean. Licensing Specialist observed the staff members’
lounge, combination locks are still be utilized for staff to lock up their belongings.

Licensing Specialist observed the classrooms. Big Boys Classroom — Ratio 3:6. Two (2) staff members and a
teacher were observed. The residents were sitting at their desks facing the front of the class. Little Boys
Classroom — Ratio 2:5. One teacher and one staff member were observed. Both classrooms were neat and
organized.

Licensing Specialist observed the emergency escape plan on different walls throughout the facility. Fire
extinguishers were observed in red metal cases. Licensing Specialist observed water fountains in the facility
for residents to have drinking water.

Licensing Specialist reviewed the MARs for the following residents:

All initialed and up to date.

Provider Comments:

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

CCL Staff Signature : Date: 6/15/2023

Provider Signature : Date: 6/15/2023

| My 4 y
Lyte

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


summary: A resident was placed on suicide precautions after trying to choke himself.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 3/29/2023
Date Received by DCCECE: 3/30/2023
Facility Name: Dacus RTC
Facility Number: 108
Facility Type: Residential
Incident Type: Licensing
Report Description: Client: Birthdate: Arkansas Total Care
Staff Present: and Date of Incident: 3/29/2023 Client
) placed his hands around his neck and tried to choke himself. Client ( ) was
placed on Suicide Precautions (SP) as well as Line of Sight (LOS) to be directly supervised
by staff at all times.
Interim Action Narrative: Resident was placed on suicide precautions and Line of Sight to
be directly supervised by staff at all times.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed provider reported incident. Licensing
Specialist will follow-up with facility on location of incident, nursing notes, guardianship,
and camera footage. Licensing Specialist informed that incident took place in the resident's
bedroom and bedroom hallway. There is no camera footage showing where resident placed
his hands around his neck due to incident taking place inside of his bedroom. The ratio was
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

2:5 at the time of the incident. 4/4/2023, Licensing Specialist received and reviewed
documentation of order and nursing note. No licensing concerns noted.


summary: A resident was transported to Northeast Arkansas Baptist ER after falling down the stairs and landing on his face.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 3/16/2023
Date Received by DCCECE: 3/16/2023
Facility Name: Dacus RTC
Facility Number: 108
Facility Type: Residential
Incident Type: Licensing
Report Description: Client: Birth date: Summit Community Care
Private pay Guardian: mother- Staff present: , Date of
Incident: 3/16/2023 Client was transitioning to the gym. Client did not
use stair protocol and ran down the stairs. Client fell down the last three steps
and landed on the right side of his face, causing approx. .
Client was taken to the NEA Baptist ER. Client ) had
The skin was glued. The x-ray revealed no fractures, no air-fluid levels, and
the paranasal was clear. Client ( l) was prescribed for pain as needed.
Client ( ) was reminded of the importance of following stair protocol and the
dangers of not following stair protocol upon return to the facility.
Interim Action Narrative: Resident was transported to NEA Baptist ER for further
evaluation. Skin was glued. Resident was reminded of stair protocol upon return to the
facility.
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing Specialist will inquire about camera footage. 3/21/2023,
Licensing Specialist reviewed camera footage. No licensing concerns observed.


summary: Licensing visited the facility to review personnel files and children’s records.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Dacus RTC
Facility Number: 108
Licensee Address: 211 CHURCH STREET
BONO AR 72146
Licensing Specialist: Kendra Rice
Person In Charge: Shannon Rouse
Record Visit Date: 3/16/2023
Home Visit Date: 3/16/2023
Purpose of Visit: Personnel Records
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Time of Visit: 2:00 pm to 2:30 pm
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Census: 13
Licensing Specialist reviewed three (3) personnel files:
L. Carter – Registered Nurse
J. Sims – Maintenance
S. Span – Behavioral Instructor
All personnel files reviewed complied with the minimum licensing standards.
Provider Comments:
CCL Staff Signature : Date: 3/16/2023
Provider Signature : Date: 3/16/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident was placed on suicide precautions after wrapping a cord around his neck.

raw_content:
classroom to downstairs. Licensing Specialist will schedule a day to view camera footage.
3/9/2023, Licensing Specialist reviewed camera footage.


summary: A resident wrapped his shirt around his neck in an attempt to choke himself after an altercation with a peer.

raw_content:
Licensing Narrative:Licensing Specialist reviewed provider reported incident. Licensing
Specialist will inquire about restrictions/precautions for peer involved. Licensing Specialist
informed the peer involved was placed on assault precautions. No licensing concerns noted.


summary: An officer interviewed a staff member in response to an incident at the facility. The staff member stated that he was only trying to gain control of the child and take away items that could be used to harm himself or others.

raw_content:
Incident # 23-00111 Bono Police Department Report Date 02/23/23
Page 1 of 2 Incident Report Report Time 10:39 AM
Status Exception Clearance Date Reporting Officer ORI/Agency
Not Applicable 1096 Kennedy, Jordon Lee AR0160700
Active
Assigned Officer Entered By Approving Officer
jkennedy
Assisting Officers
Complainant
Name Contact Name
Arkansas State Police (Crimes Against Children Rebecca Cunningham
Business Address Business Phone
Offenses
Incident Location Zone
211 Church ST Bono, AR 72416
Earliest Possible Date Time Latest Possible Date Time
02/23/2023 10:39 02/23/2023 10:39
# Statute/Code Description Fel/Misd Att/Comp Loc Bias Wpn CATypes
1 5-13-203A(2) BATTERY - 3RD DEGREE / RECKLESSLY CAUSES INJURY Misd Completed 25 88 99
MO Method Of Entry # Prems
n/a 0
Location Types 13 Hway/Road/Alley 37 Abandoned/Condemned 48 Industrial Site Bias Motivation Codes
14 Hotel/Motel Structure 49 Military Installation 43Lesbian, Gay, Bisexual,
0 0 0 0 0 0 0 0 0 1 1 1 1 2 3 4 5 6 7 8 9 0 1 2 A B B C C C C D D F G G i i a a h o o o e r o r e r u o n r / u m n n p v l B / g d c k N t r s v t / m / e c u / / t e P D S W i S r h r s g n e u u y t i & / / s h r o i S r c T / b e / S c c L t o D t r l y n i i o i C a u o d a c n r c u i p n s l l a n e O / u B n e O g S b t T l f S r d / f f m S i T / e f t t g H o e t r B e a o m r o m l r e r d s k e i p n g p e l a t e l 1 1 1 1 1 F 2 2 2 2 2 5 6 7 8 9 0 1 3 4 5 a c J L L P R R R S S U i a l a i a e p e e e n i q t i k r r e y n s s k l u / k v e i t c n P t o d i a i a / i n c o W r r a e u l e i g w s S l n S r t / a a o y n G L c t t t o n n o / e o e S a O r t r / t r e s a t H / w t o G h g S o r a e a e e m t y r a ra e ti g o e n 3 3 g 4 4 N 4 4 4 M 4 4 8 9 r 0 1 2 4 5 6 7 e o o w A A A C D D F G d u A a a / n r T u a a o a U m e l r d t M m y c m o m n T s s u c k a p e b e / a / s D S C W F / / d l r e r S C i e e m e n a o m h p a t a g c l a i F i a a l n e m s i e d l a r r i a e n r f t i a p c / y u s l u t F t g i h m m P e l r i r i t e o a p y / f F r i u r g o k a n h m i d r t/ Bank 5 5 5 C 5 E 5 M 5 5 5 5 0 1 2 3 4 5 6 7 8 l o i e s l C m l s P R S S S S T C e i y r e o g a c c h h e o i b h h b n n e r e o s m e k o o a t / / t l p t a H U / r m o o e l A P p s r o n L l l r i p y u r l n a m i e - - a / - a n v g S y a n c e i e g t e d M e y r l r c e s s o C a o i s t u l y n s e l n d n d a te ry r A 1 1 A 1 A 1 1 1 O 2 2 N 1 2 3 4 5 6 1 2 m l t a h T W M J C B A A s e e N e k I l m s r a r u a h - a i w a i c t P l a c i e t h t t a i i N i k n e s v a r o - n i r h e c a c l o a i i a c t r f c H i i n v c e A a e s I f I w n r s , i d a c l G a a i i a i n r a n o n d n u e o p o r r r 2 2 2 2 2 3 3 3 L 4 4 3 4 5 6 7 1 2 3 a 1 2 t P I O M A A G L H N in s e r t r i o l t a o u h s o a a h s t y l p e t b m e b t H e i a i ( - r i s s i a m r i n c R s t e t n / i a a p A l c ( e i M n g l a g l e o i t i n g u n o ) r i i s o u c L o l s s a i n o m t t i g r i c n ) ro o up o G 4 4 5 5 6 6 7 7 8 9 r 4 5 1 2 1 2 1 2 8 9 r o T H B P M M F T G N U u r e r i h a e o n e e a p s a m y n t n k n n l e n e e ( s n s e d t x L a s r a g o o e u D G l g l e e w s r a e i D B s n e l N n n a i T d x s d o b e u ) a e n i r a l b r - , i l t C i M y li o ty i n xe fo d rming
Facility/Casino/Race Track
Suspected Of Using Criminal Activity Types Weapon Type(s) 20 Knife/Cutting Instr 65 Fire/Incendiary Device
None B P B P u o y s i s n e g s / s R in e g ce /C iv o in n g cealing C O C O u p l e ti r v a a t t in in g g / / P M ro a m nu o f t / i P n u g b /A li s s s h i i s n t g ing 1 1 1 2 F H i a re n a d r g m u n (A (A ut u o t ) o) 3 3 0 5 B M l o u t n o t r O V b e j h e i c c t le 7 8 0 5 D As ru p g h s y / x N ia a t r i c o . n /Sleeping Pills
D Distributing/Selling T Transport/Import/Transmit 13 Rifle (Auto) 40 Personal Weapons 90 Other
E Exploiting Children U Using/Consuming 14 Shotgun (Auto) 50 Poison 95 Unknown
15 Other Firearm 60 Explosives 99 None
A Simple/Gross Neglect I Intentional Abuse & Torment
F Organized Abuse S Sexual Animal Abuse
Victim #1 Event #s Related 1
SSN/ID/TIN Title Name DOB Age Sex Resident Status
14 M Unknown
Race Black / African Ethnicity DL (#, ST) Email
American Not Hispanic/Latino ,
Home Phone Work Phone Other Phone Personal Cell Work Cell
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
211 Church ST,Bono, AR 72416
Work Address Occupation
Victim Type Injury Type Aggravated Assault/Homicide Circumstances Relationship To Suspect
Individual None, None #1 N/A
Justifiable Homicide Circumstances Taken to: (Hospital Name)
None
Injury Description
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 3/16/2023 1:19:17 PM

Incident # 23-00111 Bono Police Department Report Date 02/23/23
Page 2 of 2 Incident Report Report Time 10:39 AM
Suspect #1
SSN/ID/TIN Title Name DOB Age Sex Resident Status
30 M Resident
Race White Ethnicity DL (#, ST) Email
Not Hispanic/Latino
Home Phone Work Phone Other Phone Personal Cell Work Cell
(
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
Dacus Rtc
Work Address Occupation
211 Church ,Bono, AR 72416
Height Weight Eyes Build AKA
- -
Narrative & Statements
Narrative - Kennedy, Jordon Lee - 2/23/2023 10:41:50 AM (Initial)
On Thursday February 23, 2023 I interviewed in reference to an incident that occurred at
Dacus RTC. gave a statement in reference to his involvement stating that he was only trying to gain control
of the child and take away items that could be used to harm himself or others.
Narrative - Kennedy, Jordon Lee - 3/8/2023 10:40:58 AM (Initial)
On Wednesday March 8, 2023 I watched the video of the alleged incident. I did not witness any criminal
behavior on the part of .
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 3/16/2023 1:19:17 PM


raw_content:
521 Visit Compliance Report

Licensee: Dacus RTC

Facility Number: 108

Licensee Address: 211 CHURCH STREET
BONO AR 72146

Licensing Specialist: Kendra Rice
Person In Charge: Waynette Banks
Record Visit Date: 2/23/2023
Home Visit Date: 2/23/2023

Purpose of Visit: Subsequent Building and Grounds

Regulations Out of Compliance:

Regulations Needing Technical Assistance:

Regulation Not Applicable:

Regulations Not Correctable:

Narrative:

Time of visit: 11:15 am to 12:15 pm

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

ARKANSAS
) DEPARTMENT OF

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

P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550

Page 1 of 3

Census: 13

Licensing Specialist completed a buildings and grounds walkthrough. Licensing Specials observed the
following areas: activity room, dining room, nurse’s station, big boy hall, little boy hall, library, seclusion
room, staff breakroom, and classrooms.

Activity and dining rooms were clean. No residents were present in these two rooms. Licensing Specialist
observed the nursing station and reviewed the MAR’s. Licensing Specialist observed a fire extinguisher on the
wall in a metal case that was locked.

Big boys hall; bedrooms 117, 118, 119, and 120 were clean with some beds made and others were empty.
Licensing Specialist observed the emergency escape plan on the wall in each bedroom. Bathrooms on the big
boy hall were clean, no odor detected. Little boys hall; bedrooms 126, 128, and 130 were clean and organized.
Bathrooms were clean, no odor detected.

Licensing Specialist observed two classrooms and the staff breakroom. Big boy classroom ratio 2:5 and little
boy classroom ratio 2:4. Bathroom on the classroom hall was clean. Other residents was on an educational
outing.

All initialed and up to date.

Licensing Specialist and Ms. Banks (Program Director) discussed the repairs and replacement to the fence
leading to and around the gym.

Provider Comments:

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

CCL Staff Signature : Date: 2/23/2023

Provider Signature : Date: 2/23/2023

| fy
| , ; (

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


summary: Caller reported she had picked up her grandson today, and when she pulled into the parking lot, the juvenile took off walking, and she lost sight of him. The juvenile was located by Jonesboro PD the same day and transported back to the facility.

raw_content:
Incident # 23-00084 Bono Police Department Report Date 02/12/23
Page 1 of 2 Incident Report Report Time 6:30 PM
Status Exception Clearance Date Reporting Officer ORI/Agency
Not Applicable 523 Simino, Shannon AR0160700
Active
Assigned Officer Entered By Approving Officer
simino
Assisting Officers
Complainant
SSN/ID/TIN Title Name DOB Age Sex Resident Status
** MASKED ** Frost, Sandra E 02/08/1967 56 F Nonresident
Race White Ethnicity DL (#, ST) Email
Not Hispanic/Latino ** MASKED **
Home Phone Work Phone Other Phone Personal Cell Work Cell
(870)421-6560
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
143 Maple ST,Lafe, AR 72436
Work Address Occupation
Offenses
Incident Location Zone
211 Church ST Bono, AR 72416
Earliest Possible Date Time Latest Possible Date Time
02/12/2023 16:30 02/12/2023 19:11
# Statute/Code Description Fel/Misd Att/Comp Loc Bias Wpn CATypes
1 GENERAL INFO RUNAWAY JUVENILE Misd Completed 25 88 99 P
MO Method Of Entry # Prems
Juvenile ran away from grandmother while dropping him off at the school on church street n/a 1
Location Types 13 Hway/Road/Alley 37 Abandoned/Condemned 48 Industrial Site Bias Motivation Codes
14 Hotel/Motel Structure 49 Military Installation 43Lesbian, Gay, Bisexual,
0 0 0 0 0 0 0 0 0 1 1 1 1 2 3 4 5 6 7 8 9 0 1 2 A B B C C C C D D F G G i i a a h o o o e r o r e r u o n r / u m n n p v l B / g d c k N t r s v t / m / e c u / / t e P D S W i S r h r s g n e u u y t i & / / h s r o i S r c T / b e / S c c L t o D t r l y n i i o i C a u o d a c n r c u i p n s l l a n e O / u B n e O g S b t T l f S r d / f f m i S T / e f t t g H o e t r B e a o m r o m l r e r d s k e i p n g p e l a t e l 1 1 1 1 1 F 2 2 2 2 2 5 6 7 8 9 0 1 3 4 5 a c J L L P R R R S S U i a l a i a e p e e e n i q t i k r r e y n s s k l u / k v e i t c n P t o d i a i a / i n c o W r r a e u l e i g w s S l n S r t / a a o y n G L c t t t o n n o / e o e S a O r t r / t r e s a t H / w t o G h g S o r a e a e e m t y r a ra e ti g o e n 3 3 g 4 4 N 4 4 4 M 4 4 8 9 r 0 1 2 4 5 6 7 e o o w A A A C D D F G d u A a a / n r T u a a o a U m e l r d t M m y c m o m n T s s u c k a p e b e / a / s D S C W F / / d l r e r S C i e e m e n a o m h p a t a g c l a i F i a a l n e m s i e d l a r r i a e n r f t i a p c / y u s l u t F t g i h m m P e l r i r i t e o a p y / f F r i u r g o k a n h m i d r t/ Bank 5 5 5 C 5 E 5 M 5 5 5 5 0 1 2 3 4 5 6 7 8 l o i e s l C m l s P R S S S S T C e i y r e o g a c c h h e o i b h h b n n e r e o s m e k o o a t / / t l p t a H U / r m o o e l A P p s r o n L l l r i p y u r l n a m i e - - a / - a n v g S y a n c e i e g t e d M e y r l r c e s s o C a o i s t u l y n s e l n d n d a te ry r A 1 1 A 1 A 1 1 1 O 2 2 N 1 2 3 4 5 6 1 2 m l t a h T W M J C B A A s e e N e k I l m s r a r u a h - a i w a i c t P l a c i e t h t t a i i N i k n e s v a r o - n i r h e c a c l o a i i a c t r f c H i i n v c e A a e s I f I w n r s , i d a c l G a a i i a i n r a n o n d n u e o p o r r r 2 2 2 2 2 3 3 3 L 4 4 3 4 5 6 7 1 2 3 a 1 2 t P I O M A A G L H N in s e r t r i o l t a o u h s o a a h s t y l p e t b m e b t H e i a i ( - r i s s i a m r i n c R s t e t n / i a a p A l c ( e i M n g l a g l e o i t i n g u n o ) r i i s o u c L o l s s a i n o m t t i g r i c n ) ro o up o G 4 4 5 5 6 6 7 7 8 9 r 4 5 1 2 1 2 1 2 8 9 r o T H B P M M F T G N U u r e r i h a e o n e e a p s a m y n t n k n n l e n e e ( s n s e d t x L a s r a g o o e u D G l g l e e w s r a e i D B s n e l N n n a i T d x s d o b e u ) a e n i r a l b r - , i l t C i M y li o ty i n xe fo d rming
Facility/Casino/Race Track
Suspected Of Using Criminal Activity Types Weapon Type(s) 20 Knife/Cutting Instr 65 Fire/Incendiary Device
None B P B P u o y s i s n e g s / s R in e g ce /C iv o in n g cealing C O C O u p l e ti r v a a t t in in g g / / P M ro a m nu o f t / i P n u g b /A li s s s h i i s n t g ing 1 1 1 2 F H i a re n a d r g m u n (A (A ut u o t ) o) 3 3 0 5 B M l o u t n o t r O V b e j h e i c c t le 7 8 0 5 D As ru p g h s y / x N ia a t r i c o . n /Sleeping Pills
D Distributing/Selling T Transport/Import/Transmit 13 Rifle (Auto) 40 Personal Weapons 90 Other
E Exploiting Children U Using/Consuming 14 Shotgun (Auto) 50 Poison 95 Unknown
15 Other Firearm 60 Explosives 99 None
A Simple/Gross Neglect I Intentional Abuse & Torment
F Organized Abuse S Sexual Animal Abuse
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 2/17/2023 8:23:09 AM

Incident # 23-00084 Bono Police Department Report Date 02/12/23
Page 2 of 2 Incident Report Report Time 6:30 PM
Suspect #1
SSN/ID/TIN Title Name DOB Age Sex Resident Status
****** INDIVIDUAL INFORMATION MASKED ****** 14 M Resident
Race White Ethnicity DL (#, ST) Email
Not Hispanic/Latino
Home Phone Work Phone Other Phone Personal Cell Work Cell
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
Work Address Occupation
Height Weight Eyes Build AKA
5' 10" 230 Blue Medium
Appearance HairColor Hair Style Teeth Beard/Facial Hair Demeanor Speech Voice
Conservative Brown Straight
Dexterity Hair Length Complexion
Short Light
Narrative & Statements
Narrative - Simino, Shannon - 2/12/2023 7:34:53 PM (Initial)
On 2/12/2023 I was dispatched to 211 Church in reference to a run away juvenile. Upon arrival I made
contact with Complaint. Complaint advised she had picked her grandson up today. She stated when she pulled in the
parking lot he decided to take off walking headed around the fence in the parking lot through a yard. Complaint lost
site of him. She called to report it. I took the information and checked the area he was last seen. A little while later
dispatch advised the juvenile was seen on the Hwy headed towards Jonesboro area around by the Jordan's gas
station . I drove south on Hwy 63N checking the roadside. I checked all the way to the Washington exit . Unable to
locate the juvenile. I then proceed back to enter the report in ACIC.
While working on the report dispatch advised the male was located by Jonesboro Police department , they
transported him back to the School on church street. I then notified the Complaint.
Nothing further at this time.
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 2/17/2023 8:23:09 AM


summary: Officers made contact with the complainant who reported that a juvenile client punched her in the eye the day prior.

raw_content:
Incident # 23-00072 Bono Police Department Report Date 02/09/23
Page 1 of 2 Incident Report Report Time 12:19 PM
Status Exception Clearance Date Reporting Officer ORI/Agency
Not Applicable 1096 Kennedy, Jordon Lee AR0160700
Active
Assigned Officer Entered By Approving Officer
jkennedy
Assisting Officers
Complainant
SSN/ID/TIN Title Name DOB Age Sex Resident Status
** MASKED ** Kimbrough, Yazevnna Keshunna 05/16/1996 26 F Unknown
Race Black / African Ethnicity DL (#, ST) Email
American Unknown ** MASKED **
Home Phone Work Phone Other Phone Personal Cell Work Cell
(870)776-6149
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
1107 Cobb ST,Jonesboro, AR 72401 Dacus Rtc
Work Address Occupation
211 Church ST,Bono, AR 72416
Offenses
Incident Location Zone
211 Church ST Bono, AR 72416
Earliest Possible Date Time Latest Possible Date Time
02/08/2023 15:00 02/08/2023 15:00
# Statute/Code Description Fel/Misd Att/Comp Loc Bias Wpn CATypes
1 5-13-203A(1) BATTERY - 3RD DEGREE / PURPOSE OF CAUSING INJURY, CAUSES INJURY Misd Completed 25 88 99
MO Method Of Entry # Prems
n/a 0
Location Types 13 Hway/Road/Alley 37 Abandoned/Condemned 48 Industrial Site Bias Motivation Codes
14 Hotel/Motel Structure 49 Military Installation 43Lesbian, Gay, Bisexual,
0 0 0 0 0 0 0 0 0 1 1 1 1 2 3 4 5 6 7 8 9 0 1 2 A B B C C C C D D F G G i i a a h o o o e r o r e r u o n r / u m n n p v l B / g d c k N t r s v t / m / e c u / / t e P D S W i S r h r s g n e u u y t i & / / h s r o i S r c T / b e / S c c L t o D t r l y n i i o i C a u o d a c n r c u i p n s l l a n e O / u B n e O g S b t T l f S r d / f f m i S T / e f t t g H o e t r B e a o m r o m l r e r d s k e i p n g p e l a t e l 1 1 1 1 1 F 2 2 2 2 2 5 6 7 8 9 0 1 3 4 5 a c J L L P R R R S S U i a l a i a e p e e e n i q t i k r r e y n s s k l u / k v e i t c n P t o d i a i a / i n c o W r r a e u l e i g w s S l n S r t / a a o y n G L c t t t o n n o / e o e S a O r t r / t r e s a t H / w t o G h g S o r a e a e e m t y r a ra e ti g o e n 3 3 g 4 4 N 4 4 4 M 4 4 8 9 r 0 1 2 4 5 6 7 e o o w A A A C D D F G d u A a a / n r T u a a o a U m e l r d t M m y c m o m n T s s u c k a p e b e / a / s D S C W F / / d l r e r S C i e e m e n a o m h p a t a g c l a i F i a a l n e m s i e d l a r r i a e n r f t i a p c / y u s l u t F t g i h m m P e l r i r i t e o a p y / f F r i u r g o k a n h m i d r t/ Bank 5 5 5 C 5 E 5 M 5 5 5 5 0 1 2 3 4 5 6 7 8 l o i e s l C m l s P R S S S S T C e i y r e o g a c c h h e o i b h h b n n e r e o s m e k o o a t / / t l p t a H U / r m o o e l A P p s r o n L l l r i p y u r l n a m i e - - a / - a n v g S y a n c e i e g t e d M e y r l r c e s s o C a o i s t u l y n s e l n d n d a te ry r A 1 1 A 1 A 1 1 1 O 2 2 N 1 2 3 4 5 6 1 2 m l t a h T W M J C B A A s e e N e k I l m s r a r u a h - a i w a i c t P l a c i e t h t t a i i N i k n e s v a r o - n i r h e c a c l o a i i a c t r f c H i i n v c e A a e s I f I w n r s , i d a c l G a a i i a i n r a n o n d n u e o p o r r r 2 2 2 2 2 3 3 3 L 4 4 3 4 5 6 7 1 2 3 a 1 2 t P I O M A A G L H N in s e r t r i o l t a o u h s o a a h s t y l p e t b m e b t H e i a i ( - r i s s i a m r i n c R s t e t n / i a a p A l c ( e i M n g l a g l e o i t i n g u n o ) r i i s o u c L o l s s a i n o m t t i g r i c n ) ro o up o G 4 4 5 5 6 6 7 7 8 9 r 4 5 1 2 1 2 1 2 8 9 r o T H B P M M F T G N U u r e r i h a e o n e e a p s a m y n t n k n n l e n e e ( s n s e d t x L a s r a g o o e u D G l g l e e w s r a e i D B s n e l N n n a i T d x s d o b e u ) a e n i r a l b r - , i l t C i M y li o ty i n xe fo d rming
Facility/Casino/Race Track
Suspected Of Using Criminal Activity Types Weapon Type(s) 20 Knife/Cutting Instr 65 Fire/Incendiary Device
None B P B P u o y s i s n e g s / s R in e g ce /C iv o in n g cealing C O C O u p l e ti r v a a t t in in g g / / P M ro a m nu o f t / i P n u g b /A li s s s h i i s n t g ing 1 1 1 2 F H i a re n a d r g m u n (A (A ut u o t ) o) 3 3 0 5 B M l o u t n o t r O V b e j h e i c c t le 7 8 0 5 D As ru p g h s y / x N ia a t r i c o . n /Sleeping Pills
D Distributing/Selling T Transport/Import/Transmit 13 Rifle (Auto) 40 Personal Weapons 90 Other
E Exploiting Children U Using/Consuming 14 Shotgun (Auto) 50 Poison 95 Unknown
15 Other Firearm 60 Explosives 99 None
A Simple/Gross Neglect I Intentional Abuse & Torment
F Organized Abuse S Sexual Animal Abuse
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 2/17/2023 8:22:56 AM

Incident # 23-00072 Bono Police Department Report Date 02/09/23
Page 2 of 2 Incident Report Report Time 12:19 PM
Victim #1 Is Complainant Event #s Related 1
SSN/ID/TIN Title Name DOB Age Sex Resident Status
** MASKED ** Kimbrough, Yazevnna Keshunna 05/16/1996 26 F Unknown
Race Black / African Ethnicity DL (#, ST) Email
American Unknown ** MASKED **
Home Phone Work Phone Other Phone Personal Cell Work Cell
(870)776-6149
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
1107 Cobb ST,Jonesboro, AR 72401 Dacus Rtc
Work Address Occupation
211 Church ST,Bono, AR 72416
Victim Type Injury Type Aggravated Assault/Homicide Circumstances Relationship To Suspect
Individual None, None #1 N/A
Justifiable Homicide Circumstances Taken to: (Hospital Name)
None
Injury Description
Suspect #1
SSN/ID/TIN Title Name DOB Age Sex Resident Status
****** INDIVIDUAL INFORMATION MASKED ****** 13 M Unknown
Race White Ethnicity DL (#, ST) Email
Unknown
Home Phone Work Phone Other Phone Personal Cell Work Cell
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
Work Address Occupation
Height Weight Eyes Build AKA
- -
Narrative & Statements
Narrative - Kennedy, Jordon Lee - 2/9/2023 12:28:10 PM (Initial)
On Thursday February 9, 2023 I was contacted by Yazenna Kimbrough in reference to an assault that had
already occurred. When I arrived on scene I made contact with Kimbrough and she advised me that a juvenile client
had punched her in the eye the day prior. I advised Kimbrough of the affidavit process.
Jordon Kennedy 524
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 2/17/2023 8:22:56 AM


summary: A staff member was observed performing an improper restraint on a resident. The facility was cited 109.1.g and 905.4.g as a result of this incident.

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Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 2/8/2023
Date Received by DCCECE: 2/8/2023
Facility Name: Dacus RTC
Facility Number: 108
Facility Type:
Incident Type: Licensing
Report Description: Client: Birth date: Insurance: Summit
Community Care Guardian: Arkansas County DHS (foster care) Staff member
: Staff member witness 1: Staff member witness 2:
Date of Incident: 2/8/2023 Client ( ) took staff's walkie and would not give it
back. Staff member 1 ( ) performed an improper restraint on Client ( ) while
attemping to retrieve the walkie from 2:57pm to 2:58pm. At 3:01pm, a peer gave the Client
( ) a sharp piece of plastic. Staff member ( ) put the Client ( ) in an
improper restraint while trying to retrieve the object. The Client recieved a minor injury to
his finger. Client recieved a bandage for it. No outside medical treatment was necessary.
The staff member is was asked to leave the facility after camera footage was reviewed.
Hotline was completed.
Interim Action Narrative: Resident was assessed and received a bandage for his injured
finger. Staff member was asked to leave the facility after camera review. called.
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing Specialist contacted the facility to obtain the referral
number. Licensing Specialist informed by Ms. Shelly (nurse) that call was not
accepted. Licensing Specialist reviewed camera footage. Licensing Specialist called the AR
. 2/10/2023, Licensing Specialist will inquire if
call was accepted and if investigator has been assigned. called accepted and
investigator assigned. 2/13/2023, Licensing Specialist spoke with Ms. Banks, Program
Director, who reported she faxed in the report. Licensing Specialist informed Ms.
Banks that when reporting a call more details needed to be provided. Ms. Banks
informed Licensing Specialist that she was informed by the CEO to keep things simple but
would provide more details when reporting to the . Licensing Specialist requested
nursing notes. Licensing Specialist reached out to Investigator Cunningham. Licensing
Specialist received a copy of the facility's policy regarding emergency safety interventions.
2/15/2023, Licensing Specialist inquired about witness statements. Licensing Specialist
received a witness statement. 2/16/2023, Licensing Specialist received another witness
statement. 3/8/2023, Licensing Specialist emailed Investigator Cunningham for an update.
Licensing Specialist informed that case is still pending. 3/22/2023, Licensing Specialist
emailed Investigator Cunningham for an update. Automatic reply stated investigator will be
out of the office until 3/27/2023. 4/4/2023, Licensing Specialist emailed Investigator
Cunningham for an update. Licensing Specialist informed that case found unsubstantiated
on 3/11/2023.

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Dacus RTC
Facility Number: 108
Licensee Address: 211 CHURCH STREET
BONO AR 72146
Licensing Specialist: Kendra Rice
Person In Charge: Waynette Banks
Record Visit Date: 2/9/2023
Home Visit Date: 2/9/2023
Purpose of Visit: Complaint Visit
Regulations Out of Compliance:
Regulation Number: 1. 109. 1 .g
Regulation Description: Unprofessional conduct in the practice of child welfare activities shall include, but not
limited to the following:
Findings Description: Staff member engaged in behavior that could be viewed was physically harmful to the
resident.
Action Due Date:
Action Due Description:
Comply Date:
Sub Regulation Description:
Regulation Number: 9. 905. 4 .g
Regulation Description: The following actions shall not be used, including as discipline:
Findings Description: Staff displayed disciplinary action that could cause physical injury or threat of bodily harm
to resident.
Action Due Date:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Action Due Description:
Comply Date:
Sub Regulation Description:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Provider Comments:
CCL Staff Signature : Date: 2/9/2023
Provider Signature : Date: 2/9/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2

artlrtlt
@
rDrP/lttnt!al ot
HUTAII
IENvlCEI
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 50'1.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Dacus RTC
Facility Number: 108
Licensee Address: 21'l CHURCH STREET
BONO AR 72146
Licensing Specialist: Kendra Rice
Person ln Charge: Waynette Banks
Record Visit Date: 41412023
Home Visit Dalei 41412023
Purpose of Visit: Complaint Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Gorrectable:
Narrative:
REVISED:
www.a rka n sas .gov/dhs
Serving more than one million Arkansans each year ?age 1 ol 2

No in-person Iicensing visit completed on 4/4/2023.
Licensing Specialist received a complaint on 2,812023.
This complaint has beenFOUNDEDby licensing. The facility was cited for 109.1.g and 905.4.g on 21912023.
Provider Comments:
CCL Staff Signature : Date: 611912023
,,:1.
Provider Signature : Date. 611912023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year ?age 2 ol 2


summary: Two residents eloped from the facility by breaking through a gym door and climbing a fence. The residents were returned to the facility by Bono police.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 1/22/2023
Date Received by DCCECE: 1/23/2023
Facility Name: Dacus RTC
Facility Number: 108
Facility Type: Residential
Incident Type: Licensing
Report Description: Client: Summit Community Care Guardian: foster
child- Arkansas County DHS- Staff: Date of Incident:
1/22/2023 Client ( ) broke through gym door. Client ( ) and a peer climbed
over the fence and eloped from the facility property. Bono police were called at 2:15pm. The
police brought Client ( ) and peer back to the facility at approximately 9:30pm. The
client was placed on elopement precautions. Client did not have any visible markings or
verbalize having any pain.
Interim Action Narrative: Police were called and resident was returned. Resident was
assessed by the nurse and placed on elopement precautions.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed Provider Reported Incident and inquired
about damages. Licensing Specialist informed no property damage.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 1/22/2023
Date Received by DCCECE: 1/23/2023
Facility Name: Dacus RTC
Facility Number: 108
Facility Type: Residential
Incident Type: Licensing
Report Description: Client: Summit Community Care Guardian: private
pay- Guardian-mother Staff: Date of Incident: 1/22/2023
Client ( ) ran through the gym door after peer broke it open. Client ( ) and a
peer climbed over the fence and eloped from the facility's property. Bono police were called
at 2:15pm. The police brought Client ( and peer back to the facility at
approximately 9:30pm. The client was placed on elopement precautions. Client did not have
any visible markings or pain.
Interim Action Narrative: The police were called resident was returned by the police.
Resident was assessed by the nurse and placed on elopement precautions.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed Provider Reported Incident and will
inquire about any damages. Licensing Specialist informed no property damage.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Officers were dispatched in response to two residents who ran away from the facility.

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Incident # 23-00035 Bono Police Department Report Date 01/22/23
Page 1 of 2 Incident Report Report Time 5:26 PM
Status Exception Clearance Date Reporting Officer ORI/Agency
Not Applicable 522 Bishop, Douglas R AR0160700
Active
Assigned Officer Entered By Approving Officer
dbishop
Assisting Officers
Complainant
Name Contact Name
Dacus Residential Treatment Center
Business Address Business Phone
211 N Church ,Bono, AR 72416 8709328808
Offenses
Incident Location Zone
211 Church ST Bono, AR 72416
Earliest Possible Date Time Latest Possible Date Time
01/22/2023 17:26 01/22/2023 17:26
# Statute/Code Description Fel/Misd Att/Comp Loc Bias Wpn CATypes
1 GENERAL INFO RUNAWAY JUVENILE Misd Completed 25 88 99
MO Method Of Entry # Prems
n/a 0
Location Types 13 Hway/Road/Alley 37 Abandoned/Condemned 48 Industrial Site Bias Motivation Codes
14 Hotel/Motel Structure 49 Military Installation 43Lesbian, Gay, Bisexual,
0 0 0 0 0 0 0 0 0 1 1 1 1 2 3 4 5 6 7 8 9 0 1 2 A B B C C C C D D F G G i i a a h o o o e r o r e r u o n r / u m n n p v l B / g d c k N t r s v t / m / e c u / / t e P D S W i S r h r s g n e u u y t i & / / h s r o i S r c T / b e / S c c L t o D t r l y n i i o i C a u o d a c n r c u i p n s l l a n e O / u B n e O g S b t T l f S r d / f f m i S T / e f t t g H o e t r B e a o m r o m l r e r d s k e i p n g p e l a t e l 1 1 1 1 1 F 2 2 2 2 2 5 6 7 8 9 0 1 3 4 5 a c J L L P R R R S S U i a l a i a e p e e e n i q t i k r r e y n s s k l u / k v e i t c n P t o d i a i a / i n c o W r r a e u l e i g w s S l n S r t / a a o y n G L c t t t o n n o / e o e S a O r t r / t r e s a t H / w t o G h g S o r a e a e e m t y r a ra e ti g o e n 3 3 g 4 4 N 4 4 4 M 4 4 8 9 r 0 1 2 4 5 6 7 e o o w A A A C D D F G d u A a a / n r T u a a o a U m e l r d t M m y c m o m n T s s u c k a p e b e / a / s D S C W F / / d l r e r S C i e e m e n a o m h p a t a g c l a i F i a a l n e m s i e d l a r r i a e n r f t i a p c / y u s l u t F t g i h m m P e l r i r i t e o a p y / f F r i u r g o k a n h m i d r t/ Bank 5 5 5 C 5 E 5 M 5 5 5 5 0 1 2 3 4 5 6 7 8 l o i e s l C m l s P R S S S S T C e i y r e o g a c c h h e o i b h h b n n e r e o s m e k o o a t / / t l p t a H U / r m o o e l A P p s r o n L l l r i p y u r l n a m i e - - a / - a n v g S y a n c e i e g t e d M e y r l r c e s s o C a o i s t u l y n s e l n d n d a te ry r A 1 1 A 1 A 1 1 1 O 2 2 N 1 2 3 4 5 6 1 2 m l t a h T W M J C B A A s e e N e k I l m s r a r u a h - a i w a i c t P l a c i e t h t t a i i N i k n e s v a r o - n i r h e c a c l o a i i a c t r f c H i i n v c e A a e s I f I w n r s , i d a c l G a a i i a i n r a n o n d n u e o p o r r r 2 2 2 2 2 3 3 3 L 4 4 3 4 5 6 7 1 2 3 a 1 2 t P I O M A A G L H N in s e r t r i o l t a o u h s o a a h s t y l p e t b m e b t H e i a i ( - r i s s i a m r i n c R s t e t n / i a a p A l c ( e i M n g l a g l e o i t i n g u n o ) r i i s o u c L o l s s a i n o m t t i g r i c n ) ro o up o G 4 4 5 5 6 6 7 7 8 9 r 4 5 1 2 1 2 1 2 8 9 r o T H B P M M F T G N U u r e r i h a e o n e e a p s a m y n t n k n n l e n e e ( s n s e d t x L a s r a g o o e u D G l g l e e w s r a e i D B s n e l N n n a i T d x s d o b e u ) a e n i r a l b r - , i l t C i M y li o ty i n xe fo d rming
Facility/Casino/Race Track
Suspected Of Using Criminal Activity Types Weapon Type(s) 20 Knife/Cutting Instr 65 Fire/Incendiary Device
None B P B P u o y s i s n e g s / s R in e g ce /C iv o in n g cealing C O C O u p l e ti r v a a t t in in g g / / P M ro a m nu o f t / i P n u g b /A li s s s h i i s n t g ing 1 1 1 2 F H i a re n a d r g m u n (A (A ut u o t ) o) 3 3 0 5 B M l o u t n o t r O V b e j h e i c c t le 7 8 0 5 D As ru p g h s y / x N ia a t r i c o . n /Sleeping Pills
D Distributing/Selling T Transport/Import/Transmit 13 Rifle (Auto) 40 Personal Weapons 90 Other
E Exploiting Children U Using/Consuming 14 Shotgun (Auto) 50 Poison 95 Unknown
15 Other Firearm 60 Explosives 99 None
A Simple/Gross Neglect I Intentional Abuse & Torment
F Organized Abuse S Sexual Animal Abuse
Suspect #1
SSN/ID/TIN Title Name DOB Age Sex Resident Status
****** INDIVIDUAL INFORMATION MASKED ****** 17 U Unknown
Race Black / African Ethnicity DL (#, ST) Email
American Unknown
Home Phone Work Phone Other Phone Personal Cell Work Cell
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
Work Address Occupation
Height Weight Eyes Build AKA
- -
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 2/17/2023 8:22:44 AM

Incident # 23-00035 Bono Police Department Report Date 01/22/23
Page 2 of 2 Incident Report Report Time 5:26 PM
Suspect #2
SSN/ID/TIN Title Name DOB Age Sex Resident Status
****** INDIVIDUAL INFORMATION MASKED ****** 14 M Unknown
Race Black / African Ethnicity DL (#, ST) Email
American Not Hispanic/Latino
Home Phone Work Phone Other Phone Personal Cell Work Cell
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
Work Address Occupation
Height Weight Eyes Build AKA
- -
Narrative & Statements
Narrative - , - 1/22/2023 5:36:36 PM (Initial)
On 01/22/2023 and ran away from the Methodist Family Health Center located
at 211 Church street in Bono Ar. 72416. The Dacus Center could not give a direction of travel.
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 2/17/2023 8:22:44 AM


summary: Staff advised officer that a juvenile got upset when he was not allowed to make a phone call and became aggressive with staff. Staff stated he attempted to approach the juvenile to cool the situation down, and the juvenile began swinging at him. Staff stated he grabbed the juvenile and took him to the floor, and the juvenile then bit him on the arm. The juvenile stated he bit staff because of the way staff grabbed him and pulled him to the floor.

raw_content:
Incident # 23-00029 Bono Police Department Report Date 01/20/23
Page 1 of 2 Incident Report Report Time 6:44 PM
Status Exception Clearance Date Reporting Officer ORI/Agency
Not Applicable 522 Bishop, Douglas R AR0160700
Active
Assigned Officer Entered By Approving Officer
dbishop
Assisting Officers
Complainant
SSN/ID/TIN Title Name DOB Age Sex Resident Status
** MASKED ** Mr Perkins, Cody Lee 08/24/1992 30 M Resident
Race White Ethnicity DL (#, ST) Email
Not Hispanic/Latino ** MASKED **
Home Phone Work Phone Other Phone Personal Cell Work Cell
(870)810-1711
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
Dacus Rtc
Work Address Occupation
Offenses
Incident Location Zone
211 Church ST Bono, AR 72416
Earliest Possible Date Time Latest Possible Date Time
01/21/2023 10:53 01/21/2023 10:53
# Statute/Code Description Fel/Misd Att/Comp Loc Bias Wpn CATypes
1 5-13-207 ASSAULT - 3RD DEGREE / CREATES APPREHENSION OF IMMINENT INJURY Misd Completed 11 88 99
MO Method Of Entry # Prems
n/a 0
Location Types 13 Hway/Road/Alley 37 Abandoned/Condemned 48 Industrial Site Bias Motivation Codes
14 Hotel/Motel Structure 49 Military Installation 43Lesbian, Gay, Bisexual,
0 0 0 0 0 0 0 0 0 1 1 1 1 2 3 4 5 6 7 8 9 0 1 2 A B B C C C C D D F G G i i a a h o o o e r o r e r u o n r / u m n n p v l B / g d c k N t r s v t / m / e c u / / t e P D S W i S r h r s g n e u u y t i & / / h s r o i S r c T / b e / S c c L t o D t r l y n i i o i C a u o d a c n r c u i p n s l l a n e O / u B n e O g S b t T l f S r d / f f m i S T / e f t t g H o e t r B e a o m r o m l r e r d s k e i p n g p e l a t e l 1 1 1 1 1 F 2 2 2 2 2 5 6 7 8 9 0 1 3 4 5 a c J L L P R R R S S U i a l a i a e p e e e n i q t i k r r e y n s s k l u / k v e i t c n P t o d i a i a / i n c o W r r a e u l e i g w s S l n S r t / a a o y n G L c t t t o n n o / e o e S a O r t r / t r e s a t H / w t o G h g S o r a e a e e m t y r a ra e ti g o e n 3 3 g 4 4 N 4 4 4 M 4 4 8 9 r 0 1 2 4 5 6 7 e o o w A A A C D D F G d u A a a / n r T u a a o a U m e l r d t M m y c m o m n T s s u c k a p e b e / a / s D S C W F / / d l r e r S C i e e m e n a o m h p a t a g c l a i F i a a l n e m s i e d l a r r i a e n r f t i a p c / y u s l u t F t g i h m m P e l r i r i t e o a p y / f F r i u r g o k a n h m i d r t/ Bank 5 5 5 C 5 E 5 M 5 5 5 5 0 1 2 3 4 5 6 7 8 l o i e s l C m l s P R S S S S T C e i y r e o g a c c h h e o i b h h b n n e r e o s m e k o o a t / / t l p t a H U / r m o o e l A P p s r o n L l l r i p y u r l n a m i e - - a / - a n v g S y a n c e i e g t e d M e y r l r c e s s o C a o i s t u l y n s e l n d n d a te ry r A 1 1 A 1 A 1 1 1 O 2 2 N 1 2 3 4 5 6 1 2 m l t a h T W M J C B A A s e e N e k I l m s r a r u a h - a i w a i c t P l a c i e t h t t a i i N i k n e s v a r o - n i r h e c a c l o a i i a c t r f c H i i n v c e A a e s I f I w n r s , i d a c l G a a i i a i n r a n o n d n u e o p o r r r 2 2 2 2 2 3 3 3 L 4 4 3 4 5 6 7 1 2 3 a 1 2 t P I O M A A G L H N in s e r t r i o l t a o u h s o a a h s t y l p e t b m e b t H e i a i ( - r i s s i a m r i n c R s t e t n / i a a p A l c ( e i M n g l a g l e o i t i n g u n o ) r i i s o u c L o l s s a i n o m t t i g r i c n ) ro o up o G 4 4 5 5 6 6 7 7 8 9 r 4 5 1 2 1 2 1 2 8 9 r o T H B P M M F T G N U u r e r i h a e o n e e a p s a m y n t n k n n l e n e e ( s n s e d t x L a s r a g o o e u D G l g l e e w s r a e i D B s n e l N n n a i T d x s d o b e u ) a e n i r a l b r - , i l t C i M y li o ty i n xe fo d rming
Facility/Casino/Race Track
Suspected Of Using Criminal Activity Types Weapon Type(s) 20 Knife/Cutting Instr 65 Fire/Incendiary Device
None B P B P u o y s i s n e g s / s R in e g ce /C iv o in n g cealing C O C O u p l e ti r v a a t t in in g g / / P M ro a m nu o f t / i P n u g b /A li s s s h i i s n t g ing 1 1 1 2 F H i a re n a d r g m u n (A (A ut u o t ) o) 3 3 0 5 B M l o u t n o t r O V b e j h e i c c t le 7 8 0 5 D As ru p g h s y / x N ia a t r i c o . n /Sleeping Pills
D Distributing/Selling T Transport/Import/Transmit 13 Rifle (Auto) 40 Personal Weapons 90 Other
E Exploiting Children U Using/Consuming 14 Shotgun (Auto) 50 Poison 95 Unknown
15 Other Firearm 60 Explosives 99 None
A Simple/Gross Neglect I Intentional Abuse & Torment
F Organized Abuse S Sexual Animal Abuse
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 2/17/2023 8:22:28 AM

Incident # 23-00029 Bono Police Department Report Date 01/20/23
Page 2 of 2 Incident Report Report Time 6:44 PM
Victim #1 Is Complainant Event #s Related 1
SSN/ID/TIN Title Name DOB Age Sex Resident Status
** MASKED ** Mr Perkins, Cody Lee 08/24/1992 30 M Resident
Race White Ethnicity DL (#, ST) Email
Not Hispanic/Latino ** MASKED **
Home Phone Work Phone Other Phone Personal Cell Work Cell
(870)810-1711
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
Dacus Rtc
Work Address Occupation
211 Church ,Bono, AR 72416
Victim Type Injury Type Aggravated Assault/Homicide Circumstances Relationship To Suspect
Individual Minor Injury, None #1 N/A
Justifiable Homicide Circumstances Taken to: (Hospital Name)
None
Injury Description
Suspect #1
SSN/ID/TIN Title Name DOB Age Sex Resident Status
****** INDIVIDUAL INFORMATION MASKED ****** 15 M Unknown
Race Black / African Ethnicity DL (#, ST) Email
American Not Hispanic/Latino
Home Phone Work Phone Other Phone Personal Cell Work Cell
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
Work Address Occupation
Height Weight Eyes Build AKA
- -
Narrative & Statements
Narrative - , - 1/21/2023 11:01:29 AM (Initial)
On 01/20/2023 at 16:18 I was I received a call from the Bono City Hall that told me that there was a disturbance at
the Dacus Center involving a staff member and one of the clients at the center by the name of . Cody
Perkins told me that got upset when he was not allowed to make a phone call. Mr. Perkins told me that
after got aggressive with other staff members he decided to approach him to see if he cool the situation
down and that's when started swinging at Mr. perkins . Mr. Perkins said that he grabbed and
took him to the floor was very upset about this and he bit Mr. Perkins on his left arm. said that
he bit Mr. Perkins because of the way that Mr. Perkins had grabbed him and pulled him to the floor>
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 2/17/2023 8:22:28 AM


summary: Staff advised officer that a juvenile punched him several times in the head as he attempted to keep the juvenile from attacking a peer. The facility was advised to contact the juvenile’s caseworker, as the jail was currently full.

raw_content:
Incident # 23-00019 Bono Police Department Report Date 01/14/23
Page 1 of 2 Incident Report Report Time 1:31 PM
Status Exception Clearance Date Reporting Officer ORI/Agency
Not Applicable 1096 Kennedy, Jordon Lee AR0160700
Active
Assigned Officer Entered By Approving Officer
jkennedy
Assisting Officers
Complainant
Name Contact Name
Dacus Residential Treatment Center
Business Address Business Phone
211 N Church ,Bono, AR 72416 8709328808
Offenses
Incident Location Zone
Earliest Possible Date Time Latest Possible Date Time
01/13/2023 15:30 01/13/2023 15:40
# Statute/Code Description Fel/Misd Att/Comp Loc Bias Wpn CATypes
1 5-13-203A(1) BATTERY - 3RD DEGREE / PURPOSE OF CAUSING INJURY, CAUSES INJURY Misd Completed 25 88 99
MO Method Of Entry # Prems
n/a 0
Location Types 13 Hway/Road/Alley 37 Abandoned/Condemned 48 Industrial Site Bias Motivation Codes
14 Hotel/Motel Structure 49 Military Installation 43Lesbian, Gay, Bisexual,
0 0 0 0 0 0 0 0 0 1 1 1 1 2 3 4 5 6 7 8 9 0 1 2 A B B C C C C D D F G G i i a a h o o o e r o r e r u o n r / u m n n p v l B / g d c k N t r s v t / m / e c u / / t e P D S W i S r h r s g n e u u y t i & / / s h r o i S r c T / b e / S c c L t o D t r l y n i i o i C a u o d a c n r c u i p n s l l a n e O / u B n e O g S b t T l f S r d / f f m S i T / e f t t g H o e t r B e a o m r o m l r e r d s k e i p n g p e l a t e l 1 1 1 1 1 F 2 2 2 2 2 5 6 7 8 9 0 1 3 4 5 a c J L L P R R R S S U i a l a i a e p e e e n i q t i k r r e y n s s k l u / k v e i t c n P t o d i a i a / i n c o W r r a e u l e i g w s S l n S r t / a a o y n G L c t t t o n n o / e o e S a O r t r / t r e s a t H / w t o G h g S o r a e a e e m t y r a ra e ti g o e n 3 3 g 4 4 N 4 4 4 M 4 4 8 9 r 0 1 2 4 5 6 7 e o o w A A A C D D F G d u A a a / n r T u a a o a U m e l r d t M m y c m o m n T s s u c k a p e b e / a / s D S C W F / / d l r e r S C i e e m e n a o m h p a t a g c l a i F i a a l n e m s i e d l a r r i a e n r f t i a p c / y u s l u t F t g i h m m P e l r i r i t e o a p y / f F r i u r g o k a n h m i d r t/ Bank 5 5 5 C 5 E 5 M 5 5 5 5 0 1 2 3 4 5 6 7 8 l o i e s l C m l s P R S S S S T C e i y r e o g a c c h h e o i b h h b n n e r e o s m e k o o a t / / t l p t a H U / r m o o e l A P p s r o n L l l r i p y u r l n a m i e - - a / - a n v g S y a n c e i e g t e d M e y r l r c e s s o C a o i s t u l y n s e l n d n d a te ry r A 1 1 A 1 A 1 1 1 O 2 2 N 1 2 3 4 5 6 1 2 m l t a h T W M J C B A A s e e N e k I l m s r a r u a h - a i w a i c t P l a c i e t h t t a i i N i k n e s v a r o - n i r h e c a c l o a i i a c t r f c H i i n v c e A a e s I f I w n r s , i d a c l G a a i i a i n r a n o n d n u e o p o r r r 2 2 2 2 2 3 3 3 L 4 4 3 4 5 6 7 1 2 3 a 1 2 t P I O M A A G L H N in s e r t r i o l t a o u h s o a a h s t y l p e t b m e b t H e i a i ( - r i s s i a m r i n c R s t e t n / i a a p A l c ( e i M n g l a g l e o i t i n g u n o ) r i i s o u c L o l s s a i n o m t t i g r i c n ) ro o up o G 4 4 5 5 6 6 7 7 8 9 r 4 5 1 2 1 2 1 2 8 9 r o T H B P M M F T G N U u r e r i h a e o n e e a p s a m y n t n k n n l e n e e ( s n s e d t x L a s r a g o o e u D G l g l e e w s r a e i D B s n e l N n n a i T d x s d o b e u ) a e n i r a l b r - , i l t C i M y li o ty i n xe fo d rming
Facility/Casino/Race Track
Suspected Of Using Criminal Activity Types Weapon Type(s) 20 Knife/Cutting Instr 65 Fire/Incendiary Device
None B P B P u o y s i s n e g s / s R in e g ce /C iv o in n g cealing C O C O u p l e ti r v a a t t in in g g / / P M ro a m nu o f t / i P n u g b /A li s s s h i i s n t g ing 1 1 1 2 F H i a re n a d r g m u n (A (A ut u o t ) o) 3 3 0 5 B M l o u t n o t r O V b e j h e i c c t le 7 8 0 5 D As ru p g h s y / x N ia a t r i c o . n /Sleeping Pills
D Distributing/Selling T Transport/Import/Transmit 13 Rifle (Auto) 40 Personal Weapons 90 Other
E Exploiting Children U Using/Consuming 14 Shotgun (Auto) 50 Poison 95 Unknown
15 Other Firearm 60 Explosives 99 None
A Simple/Gross Neglect I Intentional Abuse & Torment
F Organized Abuse S Sexual Animal Abuse
Victim #1 Event #s Related 1
SSN/ID/TIN Title Name DOB Age Sex Resident Status
Sigman, Charles 01/24/1966 56 M Resident
Race White Ethnicity DL (#, ST) Email
Not Hispanic/Latino , AR
Home Phone Work Phone Other Phone Personal Cell Work Cell
(501)580-0804
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
2100 Boulder CV,Jonesboro, AR 72404
Work Address Occupation
Victim Type Injury Type Aggravated Assault/Homicide Circumstances Relationship To Suspect
Individual None, None #1 N/A
Justifiable Homicide Circumstances Taken to: (Hospital Name)
None
Injury Description
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 1/20/2023 4:38:01 PM

Incident # 23-00019 Bono Police Department Report Date 01/14/23
Page 2 of 2 Incident Report Report Time 1:31 PM
Suspect #1
SSN/ID/TIN Title Name DOB Age Sex Resident Status
****** INDIVIDUAL INFORMATION MASKED ****** 15 M Nonresident
Race White Ethnicity DL (#, ST) Email
Not Hispanic/Latino
Home Phone Work Phone Other Phone Personal Cell Work Cell
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
Work Address Occupation
Height Weight Eyes Build AKA
- -
Narrative & Statements
Narrative - Kennedy, Jordon Lee - 1/14/2023 1:34:11 PM (Initial)
On Friday January 13, 2023 I was dispatched to 211 Church Street in reference to an assault that had
already occurred. When I arrived on scene I made contact with Charles Sigman. Sigman advised me that a male
juvenile had punched him several times in the top of the head as he attempted to keep the subject from attacking
another juvenile. I contacted Amy Powell and she advised that the jail was currently full and the facility needed to
contact DCFS in reference to the juvenile client. I advised the staff of this and the became upset stating that the
suspect had a continuing behavior of assaulting staff and other clients. I advised them that there was nothing that I
could do and once again to contact the case worker in charge of the suspect. I spoke with the suspect and he
seemed to be calm. He stated that he was going to keep acting out until he was transferred to another facility. I
advised him that the staff was trying to have him removed and to give them a few days to do so. He agreed to
behave as long as he didn't have to stay there anymore.
Jordon Kennedy 524
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 1/20/2023 4:38:01 PM


facility_name: United Methodist Children's Home - Little Rock

summary: A complaint received alleges that nursing staff are being pulled away from their duties to be used as ratio staff because there are not enough direct care staff to maintain required staffing ratios.

raw_content:
Division of Provider Services & Quality Assurance
Office of Long-Term Care
P.O. Box 8059, Slot S404, Little Rock, AR 72203-1437
R
Notice of Serious Incident
Case Number: 032210
Date of Incident: 08/19/2025
Date Received: 08/19/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Incident Type: DPSQA - Complaint
Case Status: Not Submitted
DPSQA - Complaint
Report Description: An anonymous report was received regarding the ratio, supervision, and
quality of care of resident at the PRTF program. The complainant reported that nursing
staff are frequently being pulled away from their nursing duties to be used as ratio staff as
there are often not enough direct care staff (BHAs) to maintain ratio. The complainant
states that nursing staff are unable to complete their normal job duties and maintain the
required documentation for nursing duties. The complainant reported that the agency is
cutting BHA staff and relying on nurses to be counted in ratio instead of maintaining or
hiring more BHA staff to provide direct care for the residents. Additionally, when nursing
needs assistance from BHA staff to help escort or draw blood from a resident, no one is
available because of the lack of staff. The complainant is concerned that with the agency
relying more on nurses to count in ratio, the nurses will be unable to provide the medical
care necessary to the residents.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

PRINTED: 09/16/2025
FORM APPROVED
Arkansas State Agency
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING: ______________________
3005 B. WING _____________________________ 08/22/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
2002 S FILLMORE ST
UNITED METHODIST CHILDRENS HOME
LITTLE ROCK, AR 72214
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
- 000 Initial Comment - 000
The facility was in compliance with Title 20,
Chapter 10. Office of Long Term Care, Division of
Provider Services and Quality Assurance,
Department of Human Services Part 415,
Psychiatric Residential Treatment Facility
Providers.
Case 032210
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE
Administrator 9-25-2025
STATE FORM 6899 C7S011 If continuation sheet 1 of 1


summary: An x-ray was ordered after a resident struck his toe against the wall while playing kickball.

raw_content:
Division of Provider Services & Quality Assurance
Office of Long-Term Care
P.O. Box 8059, Slot S404, Little Rock, AR 72203-1437
R
Notice of Serious Incident
Case Number: 032255
Date of Incident: 08/19/2025
Date Received: 08/20/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Incident Type: DPSQA - Incident & Accident - OLTC
Case Status: Complete
DPSQA - Incident & Accident - OLTC
Report Description: On 8/19/25 at approximately 9:36 a.m., was participating in
Recreational Therapy while playing kickball. During the activity, he was running the bases
and attempted to slide, which resulted in him striking his left great toe against the wall.
Nurse was called to assess injury. Following her assessment, she notified
the on-call physician, who ordered an x-ray for further evaluation. The x-ray results
indicated no evidence of an acute fracture or dislocation.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent for acute care after he charged at a teacher and made statements about his desire to harm himself and others.

raw_content:
Division of Provider Services & Quality Assurance
Office of Long-Term Care
P.O. Box 8059, Slot S404, Little Rock, AR 72203-1437
R
Notice of Serious Incident
Case Number: 032379
Date of Incident: 08/18/2025
Date Received: 08/22/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Incident Type: DPSQA - Complaint
Case Status: Not Submitted
DPSQA - Complaint
Report Description: The guardian reported that the member became upset after informing
the teacher that other students were using inappropriate language in class. In response, the
teacher attempted to move the member to a different seat, which the member perceived as a
disciplinary action. The member refused to move and engaged in a verbal altercation with
the teacher. When he eventually agreed to move, the teacher informed him it was too late,
prompting the member to charge at the teacher. The guardian is unsure whether physical
contact occurred. The member was then escorted to the office, where he made statements
about a desire to harm himself and others. Upon the guardian?s arrival, the member became
further escalated, did not respond well to what was being said, and charged at his mother.
Emergency medical personnel, who were already on site, administered a sedative to calm
the member. The member was then admitted to
for further care.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: An x-ray was ordered after a resident complained of hand pain following a physical altercation with a peer.

raw_content:
Division of Provider Services & Quality Assurance
Office of Long-Term Care
P.O. Box 8059, Slot S404, Little Rock, AR 72203-1437
R
Notice of Serious Incident
Case Number: 032121
Date of Incident: 08/13/2025
Date Received: 08/14/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Incident Type: DPSQA - Incident & Accident - OLTC
Case Status: Complete
DPSQA - Incident & Accident - OLTC
Report Description: On August 14, 2025, at approximately 6:23 p.m., had
just completed personal hygiene and was waiting in the foyer area to transition back to the
dayroom. (peer) was seated in the foyer at the time. Video footage later
showed striking in the face without apparent provocation. Following the
incident, reported soreness in his right hand to nursing staff. The nurse contacted
the on-call physician, who ordered an X-ray. The imaging was completed on August 13,
2025, and results showed no acute fracture or dislocation.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: An x-ray was ordered after a resident twisted her ankle while playing kickball.

raw_content:
Division of Provider Services & Quality Assurance
Office of Long-Term Care
P.O. Box 8059, Slot S404, Little Rock, AR 72203-1437
R
Notice of Serious Incident
Case Number: 032075
Date of Incident: 08/12/2025
Date Received: 08/13/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Incident Type: DPSQA - Incident & Accident - OLTC
Case Status: Complete
DPSQA - Incident & Accident - OLTC
Report Description: On August 12, 2025, at approximately 1:10 p.m., was
participating in a kickball game during recreational therapy in the gym. While running to a
base, she slid and landed on her left ankle, resulting in a twist injury. was observed
limping upon standing. Staff immediately contacted the nurse, who assessed her ankle. The
on-call medical doctor was notified and ordered an X-ray. Imaging results indicated no
evidence of an acute fracture.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Division of Provider Services & Quality Assurance
Office of Long-Term Care
P.O. Box 8059, Slot S404, Little Rock, AR 72203-1437
R
Notice of Serious Incident
Case Number: 032046
Date of Incident: 08/12/2025
Date Received: 08/13/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Incident Type: DPSQA - Complaint
Case Status: Not Submitted
DPSQA - Complaint
Report Description: Client was in gym playing kickball during recreational therapy. While
client was running to bus, client slid and landed on her left ankle twisting it. Client was
observed limping. Client was assessed by nursing. Will continue to monitor injury and x-ray
was ordered on 8/12/2025. No findings of acute fracture.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: An x-ray was ordered after a resident became agitated and punched a door.

raw_content:
Division of Provider Services & Quality Assurance
Office of Long-Term Care
P.O. Box 8059, Slot S404, Little Rock, AR 72203-1437
R
Notice of Serious Incident
Case Number: 032032
Date of Incident: 08/11/2025
Date Received: 08/12/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Incident Type: DPSQA - Incident & Accident - OLTC
Case Status: Under Review
DPSQA - Incident & Accident - OLTC
Report Description: became upset after a peer reported to staff that he was
picking at sores on his arm. He exited the cafeteria and sat near the cafeteria door. Without
warning, stood up, walked to the hallway door, and struck it with his fist. Medical
Assessment & Findings: was promptly assessed by the nurse, who noted rapid
swelling, moderate discomfort, and reduced range of motion with stiffness in his right hand.
reported a prior fracture in the same hand several years ago. was notified,
and an x-ray of the right hand (three views) was ordered along with a medical consult.
guardian and the Program Director were also notified. Diagnostic Results:
ClearView Imaging arrived within minutes, as they were already scheduled to x-ray another
client.
Follow-Up Actions: The guardian, Program Director, , and the Nurse
Practitioner were informed of the results. issued an order for to be
transported to the for further assessment and treatment.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


raw_content:
Division of Provider Services & Quality Assurance
Office of Long-Term Care
P.O. Box 8059, Slot S404, Little Rock, AR 72203-1437
R
Notice of Serious Incident
Case Number: 032021
Date of Incident: 08/11/2025
Date Received: 08/12/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Incident Type: DPSQA - Incident & Accident - OLTC
Case Status: Under Review
DPSQA - Incident & Accident - OLTC
Report Description: On 8/11/25, was participating in a basketball game in the gym
with several peers. During play, (client) fouled In response,
struck in the face with a closed fist. Both clients were evaluated by the nurse
following the incident. reported pain in his right hand. An X-ray was performed on
8/11/2025, which revealed no acute fracture.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Division of Provider Services & Quality Assurance
Office of Long-Term Care
P.O. Box 8059, Slot S404, Little Rock, AR 72203-1437
R
Notice of Serious Incident
Case Number: 032296
Date of Incident: 08/11/2025
Date Received: 08/21/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Incident Type: DPSQA - Complaint
Case Status: Not Submitted
DPSQA - Complaint
Report Description: Client was in the gym playing basketball when I peer puched him for
fouling him. Client was not physically aggressive back with the peer. Peer problem solved
by leaving the gym with staff.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Division of Provider Services & Quality Assurance
Office of Long-Term Care
P.O. Box 8059, Slot S404, Little Rock, AR 72203-1437
R
Notice of Serious Incident
Case Number: 032299
Date of Incident: 08/11/2025
Date Received: 08/21/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Incident Type: DPSQA - Complaint
Case Status: Not Submitted
DPSQA - Complaint
Report Description: peer punched another peer when he filed him during basketball.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Due to a failed restraint attempt, a resident “made contact” with the wall. Multiple deficiencies were cited as a result of this incident.

raw_content:
Division of Provider Services & Quality Assurance
Office of Long-Term Care
P.O. Box 8059, Slot S404, Little Rock, AR 72203-1437
R
Notice of Serious Incident
Case Number: 032012
Date of Incident: 08/10/2025
Date Received: 08/11/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Incident Type: DPSQA - Incident & Accident - OLTC
Case Status: Under Review
DPSQA - Incident & Accident - OLTC
Report Description: At approximately 5:45 p.m., staff member entered the
cafeteria and engaged in a verbal altercation with a peer. Staff instructed to calm
down and relax; however, he refused and continued the verbal exchange. (staff) asked
to step into the hallway to de-escalate, but declined and questioned the
request. (staff) attempted to address negative behaviors using the
Teaching Family Model. then stood up, exited to the hallway, and forcefully
slammed the door. Staff allowed him a few minutes to calm down before attempting to re-
engage. Upon re-entering the cafeteria, continued to display agitation. When
approached by she determined he was still not calm enough to rejoin the group and
informed . began using profanity toward staff, verbally refusing directives,
and making statements about what he would not do. attempted to speak with
again, but continued cursing and calling staff derogatory names. then
pushed . and attempted to place him in a two-person restraint; however,
was unable to maintain hold, causing and to make contact with the
wall during the restraint attempt. was released from the restraint and exited the
cafeteria, forcefully kicking open the classroom doors. He continued yelling and
subsequently activated the fire alarm.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Approved 9/17/2025 CV

9/09/2025

8/18/2025

9/11/2025

Approved 9/17/2025 CV
9/09/2025

8/18/20259/9/2025

8/18/2025


summary: A resident was attacked by a peer.

raw_content:
Division of Provider Services & Quality Assurance
Office of Long-Term Care
P.O. Box 8059, Slot S404, Little Rock, AR 72203-1437
R
Notice of Serious Incident
Case Number: 032143
Date of Incident: 07/27/2025
Date Received: 08/15/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Incident Type: DPSQA - Complaint
Case Status: Not Submitted
DPSQA - Complaint
Report Description: Client was in hallway by the cafeteria when his peer ran out of day room
and attacked him. Client was moved to the unit by staff to be accessed by nursing.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident injured his ankle while trying to get out of the way of his peers who were fighting.

raw_content:
Division of Provider Services & Quality Assurance
Office of Long-Term Care
P.O. Box 8059, Slot S404, Little Rock, AR 72203-1437
R
Notice of Serious Incident
Case Number: 031831
Date of Incident: 07/26/2025
Date Received: 08/04/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Incident Type: DPSQA - Complaint
Case Status: Not Submitted
DPSQA - Complaint
Report Description: Client hurt his ankle trying to get out of the way of his peers fighting.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: The facility was found in compliance during a revisit survey completed on 7/16/2025.

raw_content:
Division of Provider Services
& Quality Assurance
P.O. Box 8059, Slot S404
Little Rock, AR 72203-8059
July 22, 2025
Craig Gammon, Administrator
United Methodist Childrens Home
2002 S Fillmore St
Little Rock, AR 72214-4848
Dear Mr. Gammon:
During the Complaint Investigation,Follow-Up/Revisit Survey conducted on July 16, 2025, your
facility was found to be in compliance with program requirements. Please email the signed CMS 2567
breanna.marengo@dhs.arkansas.gov.
If you have any questions, please contact your reviewer:Breanna Marengo at 501-320-6280 or email
to breanna.marengo@dhs.arkansas.gov.
Sincerely,
for Jeff Rosenbaum
Breanna Marengo, RN QA Reviewer
DPSQA/Office of Long Term Care
Survey and Certification Section
bbm

PRINTED: 07/22/2025
DEPARTMENT OF HEALTH AND HUMAN SERVICES FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING ______________________
R-C
04L106 B. WING _____________________________ 07/16/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
2002 S FILLMORE ST
UNITED METHODIST CHILDRENS HOME
LITTLE ROCK, AR 72214
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETION
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
{N 000} Initial Comments {N 000}
Note: The CMS-2567 (Statement of Deficiencies)
is an official, legal document. All information must
remain unchanged except for entering the plan of
correction, correction dates, and the signature
space. Any discrepancy in the original deficiency
citation(s) will be reported to the Dallas Regional
Office (RO) for referral to the Office of the
Inspector General (OIG) for possible fraud. If
information is inadvertently changed by the
provider/supplier, the State Survey Agency (SA)
should be notified immediately.Census 26
A revisit was conducted on July 16, 2025, for all
deficiencies cited on May 20,2025. All
deficiencies have been corrected, and no new
noncompliance was found. The facility is in
compliance with all regulations surveyed.
The facility was in compliance with §483, Subpart
G - Conditions of Participation for Psychiatric
Residential Treatment Center.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that
other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days
following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14
days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued
program participation.
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID:6ZZR13 Facility ID: 3005 If continuation sheet Page 1 of 1

doc_type: Revisit Survey


summary: A resident scratched her neck with a pen she took from staff.

raw_content:
R
Notice of Incident
Case Number: 031428
Date of Incident: 7/14/2025
Date Received: 7/17/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Report Description: Client grabbed a staff pen and tried to self-harm. Client scratched her neck.
Staff was able to grab pen from the client. She had about a 1/2 inch scratch on her neck.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

ARKANSAS DEPARTMENT OF HUMAN SERVICES
STATEMENT OF DEFICIENCIES STATE VENDOR NUMBER: DATE SURVEY COMPLETED
AND PLAN OF CORRECTION 7/22/25
3005
Total # of Page(s): 1
NAME OF PROVIDER OR SUPPLIER PHYSICAL STREET ADDRESS, CITY, STATE, ZIP
United Methodist Children's Home-LR 2002 S. Fillmore St. Little Rock, AR 72204
ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER’S PLAN OF CORRECTION
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE
TAG REGULATORY OR LSC IDENTIFYING TAG CROSS-REFERENCED TO THE
INFORMATION) APPROPRIATE DEFICIENCY)
A survey was conducted on
7/22/2025 for the following cases:
Incident and Accident case
031330- In compliance
Complaint case:
031428- In compliance
The facility was in compliance with
Title 20, Chapter X Part 417 at the
time of the survey.
7/30/25
ADMINISTRATOR/DESIGNEE DATE
Survey.
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summary: A resident eloped off campus. Staff members and police officers worked to retrieve the resident.

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Notice of Incident
Case Number: 031200
Date of Incident: 7/13/2025
Date Received: 7/14/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Report Description: Client ran off the campus immediately after exiting MBH DOORS and went
into the woods, client then crossed the intersection, staff, police, consultant combined to precent
client from going any further in the woods. client then left and agreed to get in the car.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was found in the bathroom with a jacket around her neck in an effort to self-harm.

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Division of Provider Services & Quality Assurance
Office of Long-Term Care
P.O. Box 8059, Slot S404, Little Rock, AR 72203-1437
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Notice of Serious Incident
Case Number: 031097
Date of Incident: 07/07/2025
Date Received: 07/10/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Incident Type: DPSQA - Incident & Accident - OLTC
Case Status: Complete
Report Description:
On July 7, 2025, was completing her morning hygiene routine. Due to
being on suicide precautions, the bathroom door was left slightly ajar for supervision. Staff
provided with five-minute and two-minute warnings to inform her that her hygiene
time was nearing completion. When prompted to exit the restroom, delayed
complying. Staff member Latasha Thompson entered the bathroom to check on her and
observed that had placed a jacket around her neck in an apparent attempt to harm
herself. Latasha immediately intervened and removed the jacket. The nurse was contacted
and responded promptly to assess . Upon evaluation, the nurse observed red marks
around neck, consistent with pressure from the jacket. was removed from the
restroom and the on-call medical doctor was notified. Following consultation, was
transported to for evaluation and treatment related to a
suicide attempt.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident punched a peer several times after the peer threw a checker at the resident’s arm.

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Notice of Incident
Case Number: 031007
Date of Incident: 6/30/2025
Date Received: 7/8/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Report Description: On Monday, June 30, 2025 @ 1636 client was hit with a checker in the arm
thrown by his peer. Client immediately attacked his peer, punching him several times. Staff did
intervene. Upon camera review client was hitting the peer multiple times in the leg without
staff noticing.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov