summary: A resident reported that a staff member grabbed her by the arm, pulled her out of her chair, slammed her into two desks and then onto the ground. The staff member was terminated. The facility was cited 905.4.g and 905.10 as a result of this incident.

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
R
Notice of Serious Incident
Date of Incident: 9/15/2023
Date Received by DCCECE: Delta Family Health and Fitness for Children
Facility Name: Delta Family Health and Fitness for Children
Facility Number: 172
Incident Type: Dual
Report Description: AV currently resides at Delta Family Center; on 9/15/23
she was placed in a restraint by AO . AV said the AO came into the classroom,
told her he was tired of her and was going to punch her in the face. AV said grabbed her by
the arm to take her to a timeout, but she did not want to go with him because he said he was
going to punch her; she said he pulled her out of her chair, slammed her into two desks and
then onto the ground. AV said after she was released from the hold and she had showered,
she noticed a bruise on the inside of her right thigh, she attempted to show the nurse and
she told her she could not do anything about it.
Interim Action Narrative: Staff will be suspended pending investigation. Email
received from Becky Brooks of Delta 9/20/23: Staff has been suspended from
DFC until an investigative determination is made in regards to
reference
Maltreatment Narrative: AV currently resides at Delta Family Center; on
9/15/23 she was placed in a restraint by AO . AV said the AO came into the
classroom, told her he was tired of her and was going to punch her in the face. AV said
grabbed her by the arm to take her to a timeout, but she did not want to go with him
because he said he was going to punch her; she said he pulled her out of her chair, slammed
her into two desks and then onto the ground. AV said after she was released from the hold
and she had showered, she noticed a bruise on the inside of her right thigh, she attempted
to show the nurse and she told her she could not do anything about it. Ref#
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing received complaint 9/19/23 as follows: AV
currently resides at Delta Family Center; on 9/15/23 she was placed in a restraint by AO
. AV said the AO came into the classroom, told her he was tired of her and was
going to punch her in the face. AV said grabbed her by the arm to take her to a timeout, but
she did not want to go with him because he said he was going to punch her; she said he
pulled her out of her chair, slammed her into two desks and then onto the ground. AV said
after she was released from the hold and she had showered, she noticed a bruise on the
inside of her right thigh, she attempted to show the nurse and she told her she could not do
anything about it. Facility visited 9/18/23 for unrelated incident. CACD Investigator Staci
Tumey was interviewing client when she disclosed this information. Licensing specialist
sat in for interview. A bruise was noted on the right inner thigh of client stated that
this was from " ". stated that staff stated to her "I'm tired of you...I'll
punch you in your face...this is not a threat but a promise". stated that staff pulled
her out of her seat and threw her on the ground. stated this happened in " "
classroom on 9/15/23 between 2:30PM and 3:30PM. stated that staff " " was
there. Facility visited 9/20/23 in response to complaint from client that staff
caused a bruise on leg during a restraint that occurred in a classroom on 9/15/23.
Video reviewed from 9/15/23. No audio. Client is seen sitting in a chair inside a 1/2
kiosk pushed against a wall. Staff is seen approaching the desk is sitting in. Staff
is standing less than a foot from the desk. continues to remain seated. is not
seen harming herself, someone else, or property. Physical contact is made between staff
and while is sitting down. Camera angle and lighting does not yield who made
physical contact first. Staff takes out of her seat, over a desk that falls over and to
the ground for a hold. Additional staff are seen assisting with the hold. seems to calm
down without further incident. Licensing present for staff interview by
CACD Investigator Staci Tumey. Staff stated that asked for a time out but was
not allowed one. At this time staff stated she was leaving the classroom, and is
seen on camera leaving the room before staff is seen entering the room. Staff
stated that upon arriving to the classroom, staff made a threatening
statement to client referencing being quiet. Then staff asked to go to time
out. stated she did not want to go to time out with staff At this time staff physical
confrontation between staff and ensued, leading to a desk falling over and ending
with a restraint on client Facility cited 905.4g: The following disciplinary actions shall
not be used: Physical injury or threat of bodily harm. 905.10, for initiating a physical restraint
while the client was not a danger to herself, others or property. Received email from Becky
Brooks of Delta 9/20/23: Staff has been suspended from DFC until an
investigative determination is made in regards to reference
Received email 11/10/23 that maltreatment report was founded. Email sent to facility
11/13/23 to ascertain employment status of staff . Misty Winters of Delta
emailed that staff remains on suspension as of 11/13/23 pending maltreatment
findings.

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: Delta Family Health and Fitness for Children
Facility Number: 172
Licensee Address: 815 EAST SAINT LOUIS STREET
HAMBURG AR 71646
Licensing Specialist: Clayton DeBoer
Person In Charge:
Record Visit Date: 9/20/2023
Home Visit Date: 9/20/2023
Purpose of Visit: Complaint Visit
Regulations Out of Compliance:
Regulation Number: 9.905.4.g
Regulation Description: The following actions shall not be used, including as discipline:
Finding Description: Client sustained injury from physical confrontation with staff
Action Due Date:
Action Due Description:
Comply Date:
Sub-Regulation Level 1 Description: Physical injury or threat of bodily harm;
Action Due Description:
Regulation Number: 9.905.10
Regulation Description: Physical restraint shall be initiated only by staff trained by a certified instructor in a
nationally recognized curriculum, and only to prevent injury to the child, other people or property, and shall not be
initiated solely as a form of discipline. The agency shall maintain documentation that staff is deemed competent in
physical restraint.
Finding Description: Staff initiated a restraint on client without client being a threat to herself,
others or property.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 3

Action Due Date:
Action Due Description:
Comply Date:
Action Due Description:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Facility visited 9/20/23 in response to complaint from client that staff caused a bruise on leg during a
restraint that occurred in a classroom on 9/15/23. Video reviewed from 9/15/23. No audio. Client is seen sitting in a chair
inside a 1/2 kiosk pushed against a wall. Staff is seen approaching the desk is sitting in. Staff is standing
less than a foot from the desk. continues to remain seated. is not seen harming herself, someone else, or property.
Physical contact is made between staff and while is sitting down. Camera angle and lighting does not yield who
made physical contact first. Staff takes out of her seat, over a desk that falls over and to the ground for a hold.
Additional staff are seen assisting with the hold. seems to calm down without further incident.
Licensing present for staff interview by CACD Investigator Staci Tumey. Staff stated that
asked for a time out but was not allowed one. At this time staff stated she was leaving the classroom and is seen on
camera leaving the room before staff is seen entering the room. Staff stated that upon arriving to the
classroom, staff made a threatening statement to client referencing being quiet. Then staff asked to
go to time out. stated she did not want to go to time out with staff At this time staff physical confrontation between
staff and ensued, leading to a desk falling over and ending with a restraint on client Facility cited 905.4g: The
following disciplinary actions shall not be used: Physical injury or threat of bodily harm. 905.10, for initiating a physical
restraint while the client was not a danger to herself, others or property.
Provider Comments:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 3

CCL Staff Signature : Date: 11/27/2023
Provider Signature : Date: 11/27/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 3 of 3


state: AR

facility_name: Delta Family Services

summary: Three residents eloped from the facility by jumping a fence. The residents were later found and returned by 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: 9/4/2023
Date Received by DCCECE:9/5/2023
Facility Name: Delta Family Health and Fitness for Children
Facility Number: 172
Incident Type: Licensing
Report Description: What was the staff/client ratio at the time of the elopement? Yes 3
coaches Did staff allow them to ?jump? the fence to retrieve balls? No the balls are in the
fence. Were the clients seen by the nurse upon returning to the facility? If so, can you send
me the nursing notes? Yes, notes will be emailed How long from time of elopement was the
Hamburg Police Department called? The boys jumped the fence at 10:40 and a staff
member, Mrs. Felicia, was on break outside and called HPD as soon as she saw the boys
jump. , DCFS: Treva Crockett (Pulaski County ) On
September 4 at 10:40 am while clients were getting ready to return inside from outside
activity, client , Proceeded to jump the fence, Client
asked staff Brianna and Edward "do we need to pick up the balls and that's when client
jumped the fence, behavior coach Edward notified other staff members we
had runners, that's when shift leader Marquita was sitting in class and heard the nose and
started running behind coach Edward ran through the front door out into his vehicle
behavior coach Edward saw client sitting on the fence line on the right side of the highway
when behavior coach Edward turned around to approach them they ran across the highway
down a trail to a creek. Police were notified and participated in the search. Dea Hill, Dr.
Vora, and On Call DCFS: Client was found and returned by police at 13:12
, DCFS: Quincy Smith (Crittenden County) On 9/4/23 @
10:40am, group of boys were outside playground. They were getting ready to return inside,
and 2 male peers jumped the outside fence, Client asked staff, "Do we
need to pick up the balls?" prior to eloping. BC Edward Thomas and BC Marquitta
Williams ran back inside and out front door. Mr. Edward got in his vehicle, he saw clients
sitting on the fence line on the right side of the highway. Mr. Edward turned around to
approach the 3 boys and they ran across the highway down a trail to a creek. Hamburg City
Police were notified. Dea Hill, Dr. Vora, and Crittenden County DCFS on call Jessica
Mielke notified. Client was found and returned by police at 13:12 : DOB:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Parental/Private Placement: (dad) On September 4 at 10:40am, while
clients were getting ready to return inside from outside activity, client proceeded
to jump the fence. Client asked staff Brianna and Edward "do we need to
pick up the balls" Client proceeded to pick up the balls and that's when client
jumped the fence. Behavior coach Edward notified other staff we had runners, that's when
shift leader Marquitta was sitting in class and heard the noise and started running behind
coach Edward. Coach Edward ran through the front door got into his vehicle behavior
coach saw client sitting on side of the highway so when behavior coach Edward turned
around to approach them they ran across the highway down a trail that led to a creek. Police
were notified and participated in the search. Dea Hill, Dr. Vora, and (dad) were
notified. Client was found and returned by police at 13:12 13:12: , Cont: When cts
were found and returned to DFC, BCTL was on Hall 1 and hear ct say he 's been wanting to
kill his stepmom for 3 years he said he imagine waiting on his mom to pull in the yard while
he has a pocket knife in his lap.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: On September 4 at 10:40AM while client were getting ready to return
inside from outside activity, client asked staff if he needed to pick up
the balls which were located inside facility fence. Clients , and
jumped the fence. Staff Mrs. Felicia was on break outside and called Fordyce Police
Department when she saw the clients jump the fence. Behavior Coach Edward notified
other staff that we had runners. That?s when Shift Leader Marquitta was sitting in class and
heard the noise and started running behind Coach Edward who ran through the front door
and got into his vehicle. Coach Edward saw clients sitting on the fence line to the right side
of the highway. Coach Edward turned around to approach them and they ran across
highway down a trail that led to a creek. Police participated in the search. Dean Hill, Dr.
Vora, and Hamburg Police Department notified. Clients found and returned by
Police and 1:12PM. All clients assessed by nursing and placed on precautions. Email sent to
facility 9/5/23 for incident details and nursing notes. Incident details entered in ELS and
nursing notes emailed to licensing 9/5/23. Staff on break outside facility notified Hamburg
Police Department when they saw clients jump the fence. Clients asked staff to retrieve balls
inside the fenced area before traversing fence. Staff/client ratio at the time of this incident
was 2:8. No supervision issues noted from report. 9/6/2023-Program Coordinator sent a

FOIA request for the police report to the Hamburg City PD. Police Report received 9/6/23
and uploaded to attached inspection. Case closed 9/7/23.

doc_type: Notice of Incident


summary: Officers were dispatched to the facility in response to 3 juveniles who escaped.

raw_content:
Incident #__23-00184 Hamburg Police Dept Report Date __ 09/05/23

Page 1 of 3 Incident Report Report Time 10:22 AM
Status Exception Clearance Date Reporting Officer ORI/Agency
Active Not Applicable 886 Huante, Julian AR0020200

Assigned Officer Entered By | Approving Officer
Admin
Assisting Officers

SSN/ID/TIN Title DOB Age Sex [Resident Status
U Unknown

Race Unknown Ethnicity DL (#, ST)
Unknown ,

Work Phone Other Phone Personal Cell Work Cell
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer

_ Offenses
Incident Location
815E St Louis ST Hamburg, AR 71646

Earliest Possible Date Time Latest Possible Date Time
09/05/2023 10:45 09/05/2023 10:45

T1010 |ronanave swam ——SSSCSCSCSC~C~SCSCS~«d opts 25 [wT C«d OY
2 [53-3078 [rexeonisrcTiREATENnG-av0 OEGREETIREATENG PROPERTYOAMGE MBS [Completed] 25] 68___[ 08]

Method Of Entry # Prems
nla 0

Location Types 13 Hway/Road/Alley 37 Abandoned/Condemned 48 Industrial Site Bias Motivation Codes 5 i
14 Hotel/Motel Structure 49 Military Installation ANTI- 43 Lesbian, Gay penal
01 Air/Bus/Train Terminal 15 Jail/Prison 38 Amusement Park 50 Park/Playground 23 Protestant or Transgender, Mixes
02 Bank/S&L 16 Lake/Walerway 39 Arena/Stadium/Fair 51 Rest Area 11 White 24 Islamic (Muslim) Group (LGBT)
03 Bar/Night Club 17 Liquor Store grounds/Coliseum 52 School - 12 Black or African 25 Other Religion ag neetueexuel
04 Church/Synag/Temple 18 Parking LovVGarage 40 ATM Separate from Bank College/University American 26 Multi-religious group 51 phe bk bil
05 CommercialiOff Bldg 19 Rental Storage 41 Auto Dealership 53 School - 13 American Indianor 27 AtheistAgnostic 52M ys Toi Ei
06 Construction Site Facility New/Used Elementary/Secondary Alaska Native 31 Arab amen Disability
07 Convenience Store 20 Residence/Home 42 Camp/Campground 54 Shelter - 14 Asian 32 Hispanic or Latino 61 Male
08 Dept/Discount Store 21 Restaurant 44 Daycare Facility Mission/Homeless 15 Multi-races, Group 33 Not Hispanic or oe Femate
09 Drug Str/Dr Off/Hosp 23 Service/Gas Station 45 Dock/Wharf/Freight’ 55 Shopping Mall 16 Native Hawaiian or Latino ta Fanagenver ein
10 Field/Woods 24 Specialty Store Modal Terminal 56 Tribal Lands Other Pacific Islander 41 Gay (male) Gender Non-Conforming
11 GovuPublic Bldg 25 Unknown/Other 46 Farm Facility 57 Community Center 21 Jewish 42 Lesbian 88 None
12 Grocery/Supermarket 47 Gambling 58 Cyberspace 22 Catholic 99 Unknown
Facility/Casino/Race Track

Suspected Of Using Criminal Activity Types Weapon Type(s) 20 Knife/Cutting Instr 65 Fire/Incendiary Device
None B Buying/Receiving C Cultivating/Manuf/Publishing 11 Firearm (Auto) 30 rote nana 70 Drugs/Narc./Sieeping Pills
P Possessing/Concealing O Operating/Promating/Assisting 12 Handgun (Auto) 35 Motor Vehicle 85 Asphyxiation
D Distributing/Selling T Transport/ImportTransmit 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 Simpie/Gross Neglect | Intentional Abuse & Torment

F Organized Abuse S Sexual Animal Abuse

Copyright Relalivity Inc.© - RPS(Relativity Public Safety)
Printed : 08/05/23 10:52:23 AM

Incident #__23-00184 Hamburg Police Dept Report Date __ 09/05/23
Page 2 of 3 Incident Report Report Time 10:22 AM

SSN/ID/TIN

ani inal lam
Race Black / African Ethnicity DL (#, ST) Email
American Unknown \
Work Phone Other Phone Personal Cell Work Cell
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Work Address Occupation

SSN/ID/TIN
Ethnicity DL (#, ST)
Unknown ,
Work Phone Other Phone
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes

Addras Employer

Race Black / African
American

Home Phone

Work Address Occupation
SSN/ID/TIN Title x |Resident Status
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

Copyright Retalivity Inc.© - RPS(Reialivity Public Safely)
Printed : 09/05/23 10:52:23 AM

Incident # _23-00184 Hamburg Police Dept Report Date __ 09/05/23
Page 3 of 3 Incident Report Report Time 10:22 AM

FN tae a ee EA Fil peas pa = ae
Witness # laa les oF a

P " A = tar =, |
SSN/ID/TIN ~ Title ‘Name DOB Age Sex |Resident Status :
eer romas, edward —

American Unknown ;
Legal Alien Immig Doc # Nationality
es

Home Address

Fi
B|
4
4
Vy
\*

Employer

Work Address Occupation

Narrative - Huante, Julian - 09/04/23 10:33:14 AM (initial)

ON TODAYS DATE OF 09-04-23, |, OFFICER JULIAN HUANTE WAS DISPATCHED TOT HE DELTA FAMILY
HEALTH & FITNESS IN REFERENCE TO 3 JUVENILES WHO ESCAPED. MYSELF, PORTLAND POLICE CHIEF
CHRISTOPHER RIORDAN, ASHLEY COUNTY DEPUTIES AMADO MONDRAGON, LEVETTE WHITFIELD, AND
MICHAEL VORHEASE ARRIVED AT THE FACILITY. | RETRIEVED THE NAMES OF THE JUVENILES ALONG
WITH THEIR PERSONAL INFORMATION AND QUESTIONED THE STAFF THAT ALLEGEDLY CHASED AFTER
THEM.

ONE OF THE STAFF MEMBERS THAT | SPOKE TO STATED HE SAW THEM GO OVER THE FENCE AND WAS
THE FIRST TO GIVE CHASE, HIS NAME IS EDWARD THOMAS. HE STATED HE WAS OUTSIDE WITH A
GROUP OF JUVENILES FOR THEIR REGULARLY SCHEDULED OUTSIDE TIME. HE STATED HE BECAME
DISTRACTED WITH SOMETHING ELSE WHEN THE JUVENILES DECIDED TO GO OVER THE FENCE AND
STATED HE CAUGHT THEM AS THEY WERE CROSSING AND TOLD THEM TO STOP AS THE LAST JUVENILE
WAS CROSSING. THEN HE STATED THIS IS WHEN HE GAVE CHASE AND MOTIONED FOR ANOTHER
STAFF MEMBER TO FOLLOW HIM.

HE STATED HE SAW THE JUVENILES CROSS HIGHWAY 82 EAST AND HEAD INTO THE WOODS. MYSELF
AND CHIEF RIORDAN WENT DOWN THE STREETS THAT WERE ADJACENT TO THE AREA TO ATTEMPT TO
CUT THEM OFF. SHORTLY THEREAFTER, DEPUTIES MICHAEL VORHEASE AND AMADO MONDRAGON
ASSISTED US WITH ATTEMPTING TO LOCATE THE JUVENILES WITHOUT SUCCESS. WE ALL EVENTUALLY
MET BACK UP AT DFC WHERE WE WERE MET BY HAMBURG CHIEF OF POLICE JOHNNY OLIVER WITH
HAMBURG OFFICERS NICOLE CARTER, BRANDON KELLEY AND PART TIME OFFICER DANNY LEPHIEW.

AT APPROXIMATELY 1:20 PM, AN AMBULANCE UNIT CAME ON THE RADIO AND INFORMED US THAT THEY
SPOTTED ALL 3 JUVENILES BACK ON HIGHWAY 82 EAST AND HAVE THEM STOPPED FOR US. SERGEANT
NICOLE CARTER ARRIVED ON SCENE FIRST AND ASKED FOR HANDCUFFS TO DETAIN THEM. MYSELF
AND BRANDON KELLEY ARRIVED SHORTLY AND PLACED HANDCUFFS ON THE JUVENILES. AFTERWARD,
THE JUVENILES WERE TRANSPORTED BACK TO THE FACILITY BY MYSELF AND BRANDON KELLEY
WHERE WE MADE SURE THEY WERE SECURE AND SAFE.

AFTER THE JUVENILES WERE RETURNED TO THE FACILITY, ONE OF THEM BY THE NAME OF iii
STARTED MAKING COMMENTS ABOUT HIS STEP-MOTHER AND HOW SINCE HE WAS 14 YEARS OLD HE
WAS BEEN WANTING TO KILL HER. HE ALSO STATED THAT HE IS DUE TO BE RELEASED IN A COUPLE OF
WEEKS AND WOULD ATTEMPT TO KILL HIS STEP-MOTHER AS SOON AS HE WAS RELEASED. HE STATED
"CONSIDERING ITS NOT ILLEGAL TO BE WAITING ON YOUR STEP-MOM TO ARRIVE AT HOME WITH A
POCKET KNIFE IN YOU LAP. SAYING YOU WANT TO MURDER YOUR STEP-MOM. I'VE TOLD THE JUDGE!
THERESA FRENCH! THAT A BUNCH OF TIMES, THAT I'VE WANTED TO DO IT FOR 3 YEARS!" "| SHOULD'VE
BEEN PUT IN A STRAIGHT JACKET! FOR WANTING TO MURDER PEOPLE!"

Copyright Retativity Inc.© - RPS(Relativity Public Safety)
Printed : 09/05/23 10:52:23 AM

doc_type: Police Report


summary: Licensing visited the facility to review video of the early morning hours for 8/28/23 – 8/30/23. The facility was cited 907.6 due to issues observed during the review.

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
Delta Family Health and Fitness for Children Clayton DeBoer
815 EAST SAINT LOUIS STREET Donaghey Plaza
HAMBURG AR 71646 P.O. Box 1437
Little Rock, AR. 72203
Facility Visit Compliance Notice
__________________________________________________________________________
Facility#: 172
Date of Visit: 9/1/2023
Visit Type(s): Monitor Visit
Time: 9:00 AM - 9:44 AM
__________________________________________________________________________
Regulation# 9 . 907 . 6
Result : Non-Compliant
Action Due Date : _______________Date Corrected:
Action Due :
Comment : 37 minutes in between night visual checks.
_______________________________________________________________________________________________
Visit Comment :
Facility visited and video reviewed for the early morning hours of August 28th, 29th and 30th, 2023.
8/28/23-
Hall 1 visual checks conducted at 2:04AM, 2:15AM and 2:30AM
Hall 2 visual checks conducted at 2:33AM, 2:50AM and 3:01AM
Hall 6 visual checks conducted at 3:04AM, 3:30AM and 3:40AM
8/29/23-
Hall 1 visual checks conducted at 2:17AM, 2:33AM and 2:52AM
Hall 2 visual checks conducted at 3:02AM, 3:20AM and 3:31AM
Page 1 of 2

Hall 6 visual checks conducted at 4:02AM, 4:23AM and 4:43AM
8/30/23-
Hall 1 visual checks conducted at 5:01AM, 5:37AM and 5:58AM. 36 minutes in between two checks. Facility
cited 907.6: Supervision during sleeping hours shall include a visual check on each child at least every thirty
(30) minutes.
Hall 2 visual checks conducted at 3:34AM, 3:46AM and 3:52AM
Hall 6 visual checks conducted at 4:02AM, 4:23AM and 4:37AM
CCL Staff Signature : Date: 9/1/2023
Provider Signature : Date: 9/1/2023
Your Signature indicates that this form has been reviewed with you; it does not imply your agreement with
it.
Right to Appeal: For more information on how to appeal these findings, refer to the minimum Licensing
Requirements or contact your Licensing Specialist.
Page 2 of 2

doc_type: Compliance Report


summary: A resident was transported for acute care after he hit his wall numerous times, attempted to tie his sheet around his neck, and put his head in a sink of water. The facility was cited 110.17 for late reporting.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 8/7/2023
Date Received by DCCECE: 8/9/2023
Facility Name: Delta Family Health and Fitness for Children
Facility Number: 172
Incident Type: Licensing
Report Description: August 9, 2023 On August 7, 2023 at approximately 19:25
was upset with a peer?s behavior; went into his room and hit his wall
numerous times. When Shift leader attempted to redirect , he
punched in the face and he was placed in the physical restraint. At 19:52
had just been released and evaluated after being released from a physical hold by the nurse
on duty LPN and the RN on call came out to evaluate the client. Once the
restraint was over Behavior Coach was doing visual checks she noticed client
sitting on the bed attempting to tie his sheet around his neck. Shift leader
came to assist and client proceeded to go into his bathroom. Once
Shift leader opened the door had his head in a sink of water and his sheet
around his neck. was able to remove the sheet and was escorted to
timeout where he began crying. The nurse on duty was notified and the RN on call came
out to evaluate . Psychiatrist Dr. Vora, was notified and placed on
1:1 precautions. On August 8, 2023 was sent to acute care at Pinnacle Pointe.
Once is released from acute care he will return to DFC. LaChandra Williams,
LPC\CRC\Program Director
Interim Action Narrative:
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing received facility report 8/9/23 of incident that client suicide
attempt that occurred 8/7/23. Facility visited 8/9/23 in response to facility reported
incident that on 8/7/23 client made a suicide attempt. This incident occurred on
8/7/23 and was reported to Licensing 8/9/23. Facility cited 110.17: The agency shall notify
the Licensing Unit by the next business day of serious injuries requiring emergency medical
treatment, agency vehicle accidents, arrests, elopements, suicide attempts, or deaths and
maintain documentation of the incident and notification. No video footage was available to
review as incident occurred in client's bedroom. Staff most directly involved in this incident,
and , interviewed. stated she was
outside client's bedroom watching him, as he ( ) was dysregulated. When began to
punch the walls and windows a "code yellow" was called. Staff attempted to prevent
client from continuing to punch the windows and walls at which time staff stated
she was struck in the right jaw. Staff relieved and managed to deescalate the
situation. Client was evaluated by the nurse and allowed to return to his room. Later,
while staff was conducting visual checks, she ( noticed client had a sheet and
was making the motion as to tie it around his neck. Staff then called for assistance and
client went in the bathroom, which is located inside of the bedroom. Staff then
assisted staff to remove the sheet from client . Client was reevaluated by the
nurse and after consultation with Unit Physician, placed on 1:1 Observation until acute
placement was found on 8/8/23.

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: Delta Family Health and Fitness for Children
Facility Number: 172
Licensee Address: 815 EAST SAINT LOUIS STREET
HAMBURG AR 71646
Licensing Specialist: Clayton DeBoer
Person In Charge: Dean Hill II
Record Visit Date: 8/9/2023
Home Visit Date: 8/9/2023
Purpose of Visit: Self Report Visit
Regulations Out of Compliance:
Regulation Number: 1. 110. 17
Regulation Description: The agency shall notify the Licensing Unit by the next business day of serious injuries
requiring emergency medical treatment, agency vehicle accidents, arrests, elopements, suicide attempts, or
deaths, and maintain documentation of the incident and notification.
Findings Description: Client suicide attempt 8/7/23 was reported to Licensing 8/9/23.
Action Due Date:
Action Due Description:
Comply Date:
Sub Regulation Description:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Regulations Not Correctable:
Narrative:
Facility visited 8/9/23 in response to facility reported incident that on 8/7/23 client made a suicide attempt. This incident
occurred on 8/7/23 and was reported to Licensing 8/9/23. Facility cited 110.17: The agency shall notify the Licensing Unit by
the next business day of serious injuries requiring emergency medical treatment, agency vehicle accidents, arrests,
elopements, suicide attempts, or deaths and maintain documentation of the incident and notification.
No video footage was available to review as incident occurred in client's bedroom. Staff most directly involved in this
incident, and , interviewed. stated she was outside client's bedroom
watching him, as he ( ) was dysregulated. When began to punch the walls and windows a "code yellow" was called.
Staff attempted to prevent client from continuing to punch the windows and walls at which time staff stated she
was struck in the right jaw. Staff relieved and managed to deescalate the situation. Client was evaluated by the
nurse and allowed to return to his room. Later, while staff was conducting visual checks, she ( ) noticed client had
a sheet and was making the motion as to tie it around his neck. Staff then called for assistance and client went in the
bathroom, which is located inside of the bedroom. Staff then assisted staff to remove the sheet from client . Client
was reevaluated by the nurse and after consultation with Unit Physician, placed on 1:1 Observation until acute placement
was found on 8/8/23.
Provider Comments:
CCL Staff Signature : Date: 8/22/2023
Provider Signature : Date: 8/22/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: Licensing visited the facility to review video for the early morning hours of 7/31/23 – 8/2/23. The facility was cited 907.6 for issues identified during the review.

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: Delta Family Health and Fitness for Children
Facility Number: 172
Licensee Address: 815 EAST SAINT LOUIS STREET
HAMBURG AR 71646
Licensing Specialist: Clayton DeBoer
Person In Charge: Dean Hill II
Record Visit Date: 8/3/2023
Home Visit Date: 8/3/2023
Purpose of Visit: Revisit Complaint
Regulations Out of Compliance:
Regulation Number: 9. 907. 6
Regulation Description: Supervision during sleeping hours shall include a visual check on each child at least
every thirty (30) minutes.
Findings Description: 7/31/23 staff conducted night visual checks at 1:16AM, and the next one at 1:49AM, 33
minutes apart.
Action Due Date: 8/17/2023
Action Due Description: Staff will be retrained/counseled on night supervision checks.
Comply Date: 8/2/2023
Sub Regulation Description:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 3

Regulations Not Correctable:
Narrative:
Facility visited and camera footage reviewed for the early morning hours of 7/31/23, 8/1/23 and 8/2/23.
7/31/23:
Hall 1 visual checks conducted at 1:16AM, 1:49AM, 2:01AM and 2:16AM, 33 minutes in between two
checks observed. Facility cited 907.6: Supervision during sleeping hours shall include a visual check on each
child at least every thirty (30) minutes. 3 follow up checks observed by the same staff on the same hall the
same night were all done with facility expected 15 minutes.
Hall 2 visual checks conducted at 12:43AM, 1:02AM and 1:07AM.
Hall 6 visual checks conducted at 1:14AM, 1:28AM and 1:47AM.
8/1/23:
Hall 1 visual checks conducted at 1:46AM, 2:04AM and 2:17AM.
Hall 2 visual checks conducted at 2:20AM, 2:47AM and 3:14AM.
Hall 6 visual checks conducted at 1:03AM, 1:18AM and 1:32AM.
8/2/23:
Hall 1 visual checks conducted at 12:42AM, 1:09AM and 1:29AM.
Hall 2 visual checks conducted at 1:42AM, 2:01AM and 2:20AM.
Hall 6 visual checks conducted at 2:32AM, 2:36AM and 2:57AM.
All staff observed to be awake and attentive.
Provider Comments:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 3

CCL Staff Signature : Date: 8/22/2023
Provider Signature : Date: 8/22/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 3 of 3


summary: Licensing reviewed video footage for early morning hours of 7/9/23 – 7/10/23. The facility was cited 907.6 for issues identified during the review.

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: Delta Family Health and Fitness for Children
Facility Number: 172
Licensee Address: 815 EAST SAINT LOUIS STREET
HAMBURG AR 71646
Licensing Specialist: Clayton DeBoer
Person In Charge: Dean Hill II
Record Visit Date: 7/12/2023
Home Visit Date: 7/12/2023
Purpose of Visit: Revisit Complaint
Regulations Out of Compliance:
Regulation Number: 9. 907. 6
Regulation Description: Supervision during sleeping hours shall include a visual check on each child at least
every thirty (30) minutes.
Findings Description: Video of Hall 1 7/9/23 showed staff conducting checks at 1:20AM and not another check
until 2:03AM, 43 minutes in between checks.
Action Due Date: 7/19/2023
Action Due Description: Staff will be counseled on the importance of nightly visual checks being conducted in a
timely manner.
Comply Date:
Sub Regulation Description:
Regulations Needing Technical Assistance:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Video footage reviewed of the early morning hours of 7/9/23 and 7/10/23. All staff viewed in video were
awake and performed visual checks.
7/9/23
Hall 1: Visual checks conducted at 1:00AM, 1:20AM and 2:03AM. 43 minutes in between two checks.
Facility cited 907.6: Supervision during sleeping hours shall include a visual check on each child at least
every thirty (30) minutes.
Hall 2: Visual checks conducted at 2:05AM, 2:20AM and 2:31AM
Hall 6: Visual checks conducted at 1:13AM, 1:30AM and 1:45AM.
7/10/23
Hall 1: Visual checks conducted at 2:04AM, 2:17AM and 2:37AM
Hall 2: Visual checks conducted at 1:14AM, 1:23AM and 1:39AM
Hall 6: Visual checks conducted at 1:45AM, 2:04AM and 2:18AM.
Provider Comments:
CCL Staff Signature : Date: 8/22/2023
Provider Signature : Date: 8/22/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Delta Family Health and Fitness for Children
Facility Number: 172
Licensee Address: 815 EAST SAINT LOUIS STREET
HAMBURG AR 71646
Licensing Specialist: Clayton DeBoer
Person In Charge: Dean Hill II
Record Visit Date: 7/12/2023
Home Visit Date: 7/12/2023
Purpose of Visit: Monitor Visit
Regulations Out of Compliance:
Regulation Number: 9. 911. 6
Regulation Description: All buildings and furnishings shall be safe, clean, and in good repair.
Findings Description: Several building areas needing repair noted in today's visit.
Action Due Date: 8/12/2023
Action Due Description: Areas noted needing repair in today's visit will be repaired.
Comply Date:
Sub Regulation Description:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 3

Regulations Not Correctable:
Narrative:
Buildings & Grounds conducted from 12:00PM-2:00PM. Census: 19. Two groups of clients observed in the
cafeteria, both staff/client ratios: 1:6. Cafeteria observed to be clean, sanitary and in good repair.
Hall 1, 2 and 6 observed. Hall 1, Room 2 had a hole in the bathroom door and a hole in the bathroom wall.
The seal around the A/C unit was not completed.This issue was addressed before the conclusion of today's
visit.Hall 1, Room 6 had torn baseboard trim around the corner of the entrance. Hall 2, Room 23 and a hole in
the bathroom wall. Hall 6, Room 69 had a broken light switch cover in the bathroom, no wires exposed. One
ceiling drop tile was missing over the School Hall, due to a recent leak that was currently being worked on.
All other areas clean, safe and in good repair. Bathrooms clean and sanitary. Grounds clean and free of safety
hazards.
MAR checked for:
All initialed and up to date.
Facility cited 911.6: All buildings and furnishings shall be clean, safe and in good repair.
Provider Comments:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 3

CCL Staff Signature : Date: 8/22/2023
Provider Signature : Date: 8/22/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 3 of 3


summary: Licensing visited the facility to review video for the early morning hours of 6/23/23 – 6/25/23. 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: Delta Family Health and Fitness for Children
Facility Number: 172
Licensee Address: 815 EAST SAINT LOUIS STREET
HAMBURG AR 71646
Licensing Specialist: Clayton DeBoer
Person In Charge:
Record Visit Date: 6/26/2023
Home Visit Date: 6/26/2023
Purpose of Visit: Monitor Visit;Revisit Complaint
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Facility visited 6/26/23 and video reviewed of Halls 1, 2 and 6 for the early morning hours of 6/23/23, 6/24/23
and 6/25/23.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

6/23/23:
Hall 1 checks observed: 1:16AM, 1:31AM and 1:40AM
Hall 2 checks observed: 1:50AM, 2:18AM and 2:31AM
Hall 6 checks observed: 2:45AM, 2:59AM and 3:14AM
6/24/23:
Hall 1 checks observed: 3:43AM, 4:03AM and 4:22AM
Hall 2 checks observed: 2:02AM, 2:19AM and 2:33AM
Hall 6 checks observed: 3:15AM, 3:22AM and 3:36AM
6/25/23:
Hall 1 checks observed: 3:23AM, 3:43AM and 4:04AM
Hall 2 checks observed: 2:39AM, 2:59AM and 3:09AM
Hall 6 checks observed: 4:06AM, 4:11AM and 4:24AM
All checks observed today conducted within 30 minutes.
Provider Comments:
CCL Staff Signature : Date: 8/22/2023
Provider Signature : Date: 8/22/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: Licensing visited the facility to review camera footage of the early morning hours of 6/10/23 – 6/12/23. The facility was cited 907.6 and 907.3 for issues identified during the review.

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: Delta Family Health and Fitness for Children
Facility Number: 172
Licensee Address: 815 EAST SAINT LOUIS STREET
HAMBURG AR 71646
Licensing Specialist: Clayton DeBoer
Person In Charge: Dean Hill II
Record Visit Date: 6/13/2023
Home Visit Date: 6/13/2023
Purpose of Visit: Revisit Complaint
Regulations Out of Compliance:
Regulation Number: 9. 907. 6
Regulation Description: Supervision during sleeping hours shall include a visual check on each child at least
every thirty (30) minutes.
Findings Description: On 6/10/23 staff T. Bankston completed supervision check at 2:46AM and the next one at
3:17AM.
Action Due Date:
Action Due Description:
Comply Date:
Sub Regulation Description:
Regulation Number: 9. 907. 3
Regulation Description: Staff/child ratio shall be at least 1:6 during waking hours and 1:8 during sleeping hours.
Findings Description: On 6/12/23 staff T. Bankston left Hall 6 unattended from 2:41AM until 3:09AM.
Action Due Date:
Action Due Description:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 3

Comply Date:
Sub Regulation Description:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Facility visited 6/13/23 and camera footage reviewed of the early morning hours of 6/10/23, 6/11/23 and
6/12/23.
6/10/23
Hall 1 supervision checks seen completed at: 3:16AM, 3:32AM, 3:47AM
Hall 2 supervision checks completed at: 2:01AM, 2:17AM, 2:41AM
Hall 6 checks completed at: 2:16AM, 2:46AM, 3:17AM. Staff Tina Bankston took 31 minutes between
checks this morning.
6/11/23
Hall 1 supervision checks completed at: 12:46AM, 1:03AM, 1:31AM
Hall 2 checks completed: 1:35AM, 1:55AM, 2:02AM
Hall 6 checks completed: 2:23AM, 2:36AM, 2:54AM
6/12/23
Hall 1 checks completed: 2:18AM, 2:31AM, 2:46AM
Hall 2 checks completed: 1:22AM, 1:42AM, 2:02AM
Hall 6 checks completed: 2:39AM, 3:09AM, 3:39AM. Checks were made in 30 minutes. However, staff Tina
Bankston is seen leaving Hall 6 from 2:41AM until 3:09AM. The nurse's station camera footage was reviewed
which determined the nurse was not watching Hall 6 while staff was not on the hall.
Facility cited 907.3 for ratio for staff leaving Hall 6 on 6/12/23 for an extended period of time. Facility cited
907.6 for visual checks being conducted over 30 minutes on Hall 6 on 6/10/23.
Provider Comments:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 3

CCL Staff Signature : Date: 8/22/2023
Provider Signature : Date: 8/22/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 3 of 3


summary: Licensing visited the facility to review camera footage for the early morning hours of 5/26/23, 5/28/23, and 5/30/23. 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: Delta Family Health and Fitness for Children
Facility Number: 172
Licensee Address: 815 EAST SAINT LOUIS STREET
HAMBURG AR 71646
Licensing Specialist: Clayton DeBoer
Person In Charge: Dean Hill II
Record Visit Date: 5/31/2023
Home Visit Date: 5/31/2023
Purpose of Visit: Revisit Complaint
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Facility visited 5/31/23 and camera reviewed for the early morning hours of 5/26/23, 5/28/23 and 5/30/23.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Camera footage for 5/26/23:
Hall 1 observation checks completed at 1:02AM, 1:17AM and 1:33AM.
Hall 2 observation checks completed at 1:47AM, 2:00AM and 2:16AM.
Hall 6 observation checks completed at 2:23AM, 2:33AM and 2:44AM.
Camera footage for 5/28/23:
Hall 1 observation checks completed 2:20AM, 2:32AM and 2:42AM.
Hall 2 observation checks completed 2:43AM, 2:52AM and 3:13AM.
Hall 6 observation checks completed 1:30AM, 1:56AM and 2:17AM.
Camera footage for 5/30/23:
Hall 1 observation checks completed 2:32AM, 2:45AM and 3:01AM.
Hall 2 observation checks completed 2:00AM, 2:16AM and 2:31AM.
Hall 6 observation checks completed 3:17AM, 3:44AM and 3:59AM.
Provider Comments:
CCL Staff Signature : Date: 6/15/2023
Provider Signature : Date: 6/15/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: Licensing visited the facility to conduct a buildings and grounds review and review video for the early morning hours of 5/15/23 – 5/17/23. 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: Delta Family Health and Fitness for Children
Facility Number: 172
Licensee Address: 815 EAST SAINT LOUIS STREET
HAMBURG AR 71646
Licensing Specialist: Clayton DeBoer
Person In Charge: Dean Hill II
Record Visit Date: 5/18/2023
Home Visit Date: 5/18/2023
Purpose of Visit: Monitor Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Buildings & Grounds conducted from 8:30AM-10:30AM. Census: 19
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 3

Girls Hall 6 observed to be furnished and in good repair. Bathrooms for each room clean and sanitary. Girls'
shower area clean and sanitary with functioning showers.
Girls Hall 1 observed to be furnished and in good repair. Bathrooms for each room clean and sanitary. Girls'
shower area clean and sanitary with functioning showers.
Boys Hall 2 observed to be furnished and in good repair. Bathrooms for each room clean and sanitary. Girls'
shower area clean and sanitary with functioning showers.
Cafeteria observed, clients eating breakfast. Staff/client ratio: 2:7
Classroom observed. Staff/client ratio 2:10 + 1 teacher.
Outdoor area observed to be clean and free of safety hazards.
MAR checked for:
All initialed and up to date. AM meds had just been administered and were initialed.
Provider Comments:
CCL Staff Signature : Date: 6/15/2023
Provider Signature : Date: 6/15/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 3

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

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: Delta Family Health and Fitness for Children
Facility Number: 172
Licensee Address: 815 EAST SAINT LOUIS STREET
HAMBURG AR 71646
Licensing Specialist: Clayton DeBoer
Person In Charge: Dean Hill II
Record Visit Date: 5/18/2023
Home Visit Date: 5/18/2023
Purpose of Visit: Revisit Complaint
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Video reviewed of Halls 1, 2 and 6 for the early morning hours of 5/15/23, 5/16/23 and 5/17/23.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Hall 1 video reviewed for 5/15/23. Checks observed being conducted at 2:27AM, 2:46AM, 3:00AM.
Hall 6 video reviewed for 5/16/23. Checks observed being conducted at 1:02AM, 1:18AM, 1:35AM.
Hall 2 video reviewed for 5/17/23. Checks observed being conducted at 3:17AM, 3:38AM, 3:47AM.
All checks observed within licensing standards timeframe.
Provider Comments:
CCL Staff Signature : Date: 6/15/2023
Provider Signature : Date: 6/15/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: Licensing visited the facility to review video of the early morning hours of 4/28/23, 4/29/23, and 5/1/23. 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: Delta Family Health and Fitness for Children
Facility Number: 172
Licensee Address: 815 EAST SAINT LOUIS STREET
HAMBURG AR 71646
Licensing Specialist: Clayton DeBoer
Person In Charge: Dean Hill II
Record Visit Date: 5/2/2023
Home Visit Date: 5/2/2023
Purpose of Visit: Monitor Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Facility visited 5/2/23 from 3:30PM-4:30PM. Census:18
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Video reviewed from the early mornings of 4/28/23, 4/29/23 and 5/1/23.
4/28/23: Hall 1 checks seen conducted at 4:01AM, 4:03AM, 4:09AM and 4:16AM.
Hall 2 checks seen conducted at 4:00AM, 4:03AM, 4:17AM and 4:21AM.
Hall 6 checks seen conducted at 4:00AM, 4:10AM, 4:14AM and 4:16AM
4/29/23: Hall 1 checks seen conducted at 3:01AM, 3:15AM and 3:30AM.
Hall 2 checks seen conducted at 3:00AM, 3:16AM and 3:30AM.
Hall 6 checks seen conducted at 3:15AM, 3:40AM and 4:00AM.
5/1/23: Hall 1 checks conducted at 1:01AM, 1:16AM and 1:31AM.
Hall 2 checks conducted at 1:45AM, 2:01AM and 2:16AM.
Hall 6 checks conducted at 1:59AM, 2:22AM and 2:27AM.
No licensing violations seen during video reviewed this visit.
Provider Comments:
CCL Staff Signature : Date: 6/15/2023
Provider Signature : Date: 6/15/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: Licensing visited the facility to review video from the early morning hours of 4/14/23 – 4/16/23. The facility was cited 907.6 for issues identified during the review.

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: Delta Family Health and Fitness for Children
Facility Number: 172
Licensee Address: 815 EAST SAINT LOUIS STREET
HAMBURG AR 71646
Licensing Specialist: Clayton DeBoer
Person In Charge: Dean Hill II
Record Visit Date: 4/18/2023
Home Visit Date: 4/18/2023
Purpose of Visit: Monitor Visit
Regulations Out of Compliance:
Regulation Number: 9. 907. 6
Regulation Description: Supervision during sleeping hours shall include a visual check on each child at least
every thirty (30) minutes.
Findings Description: Two staff had a 40 and 44 minute gap between checks the early morning of 4/16/23.
Action Due Date:
Action Due Description:
Comply Date:
Sub Regulation Description:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 3

Regulations Not Correctable:
Narrative:
Facility visited 4/18/23 from 9:00AM-10:30AM. Census: 18
Video reviewed from the early morning hours of 4/14/23, 4/15/23 and 4/16/23. All staff seen awake (moving)
during video reviewed.
4/14/23: Hall 1 checks were seen conducted at 1:07AM, 1:21AM and 1:33AM.
Hall 2 checks seen conducted at 1:16AM, 1:19AM and 1:30AM
Hall 6 checks seen conducted at 1:06AM, 1:22AM and 1:36AM
4/15/23: Hall 1 checks conducted 2:10AM, 2:16AM and 2:30AM
Hall 2 checks conducted 2:18AM, 2:42AM and 3:04AM
Hall 6 checks conducted 2:00AM, 2:15AM and 2:30AM
4/16/23: Hall 1 checks conducted 4:26AM, 5:10AM and 5:27AM
Hall 2 checks conducted 4:00AM, 4:40AM, 4:48AM and 5:12AM
Hall 6 checks conducted 4:00AM, 4:15AM and 4:34AM
was staff on Hall 1 on 4/16/23 and had a gap between checks from 4:26AM-5:10AM.
was staff on Hall 2 on 4/16/23 and had a gap between checks from 4:00AM-4:40AM.
Delta has had a Proxiguard Patrol Management system installed which requires staff to wave a wand in front
of a sensor at the beginning and end of the hall. Dean Hill viewed the data from the Proxiguard system which
confirmed the gaps in hall checks.
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
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 3 of 3


summary: Licensing visited the facility to conduct training regarding the Minimum Licensing Standards: Section 900.

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: Delta Family Health and Fitness for Children
Facility Number: 172
Licensee Address: 815 EAST SAINT LOUIS STREET
HAMBURG AR 71646
Licensing Specialist: Chelsea Vardell
Person In Charge:
Record Visit Date: 4/6/2023
Home Visit Date: 4/6/2023
Purpose of Visit: Corrective Action Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
The program coordinator and licensing specialist visited the facility to conduct the intent training regarding
the Minimum Licensing Standards: Section 900. The intent training is part of the current Corrective Action
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Agreement with the facility and the PRLU. The facility staff participated very well and asked questions
throughout the presentation. The facility administrator will send the sign in sheet for all staff that participated
in the in-person training today. All remaining staff who were not able to attend, will be trained by
management using the slideshow provided to the facility.
Provider Comments:
CCL Staff Signature : Date: 4/6/2023
Provider Signature : Date: 4/6/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: Technical assistance was provided to the facility regarding the current law on mandated reporting. R102.3.h and R110.9.

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: Delta Family Health and Fitness for Children
Facility Number: 172
Licensee Address: 815 EAST SAINT LOUIS STREET
HAMBURG AR 71646
Licensing Specialist: Clayton DeBoer
Person In Charge:
Record Visit Date: 3/29/2023
Home Visit Date: 3/29/2023
Purpose of Visit: Technical Assistance Request Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Number: 1. 102. 3 .h
Regulation Description: The following policies of the agency shall be current and available to all employees of
the agency and the Licensing Specialist:
Findings Description:
Action Due Date:
Action Due Description:
Comply Date:
Sub Regulation Description:
Regulation Number: 1. 110. 9
Regulation Description: Any owner/operator, employee, foster parent, or volunteer in a child welfare agency
shall immediately notify the Child Abuse Hotline if he or she has reasonable cause to suspect that a child has
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

been subjected to child maltreatment, died as a result of child maltreatment or if they observe a child being
subjected to conditions or circumstances that would reasonably result in child maltreatment.
Findings Description:
Action Due Date:
Action Due Description:
Comply Date:
Sub Regulation Description:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
After review of your agency’s current mandated reporter policy, it has been determined that it does not
comply with the current law in the state of Arkansas nor the Minimum Licensing Standards.
Technical assistance was provided to the agency regarding the current law on mandated reporting. R102.3.h,
and R110.9.
Please ensure that your current mandated reporter policy is updated to comply with A.C.A. 12-18-402 and the
Minimum Licensing Standards by 4/12/2023 and provide a copy to the Licensing Unit for review. Once the
needed changes have been made, please ensure that all staff are retrained on the new policy within two weeks
of the new policy going into effect.
Provider Comments:
CCL Staff Signature : Date: 3/29/2023
Provider Signature : Date: 3/29/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: Licensing visited the facility to conduct a buildings and grounds walkthrough. The facility was cited 912.4, 911.6, 911.15.f, 907.2, and 907.6 for issues identified during the review.

raw_content:
ARKANSAS
DEPARTMENT OF

x

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: Delta Family Health and Fitness for Children

Facility Number: 172

Licensee Address: 815 EAST SAINT LOUIS STREET
HAMBURG AR 71646

Licensing Specialist: Clayton DeBoer
Person In Charge: Dean Hill II
Record Visit Date: 3/22/2023

Home Visit Date: 3/22/2023

Purpose of Visit: Monitor Visit

Regulations Out of Compliance:

Regulation Number: 9. 912. 4

Regulation Description: The bathroom shall be clean and sanitary.

Findings Description: Boys Hall 2 middle shower and toilet in room 23 were not clean.

Action Due Date:

Action Due Description:
Comply Date:

Sub Regulation Description:
Regulation Number: 9. 911.6

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

Findings Description: Girls Hall 1 bathroom of room 5 had a partially removed light switch cover and broken
ceiling drop tile. Boys Hall 2 middle shower was not clean. Boys Hall room 23 had a ripped mattress and area
behind toilet seat was not clean. Boys Hall room 30 had a bed to floor bracket that was loose enough to be

removed by a client. The bracket could potentially be used for self- harm or harm of another.

Action Due Date:

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

Page 1 of 4

Action Due Description:
Comply Date:

Sub Regulation Description:
Regulation Number: 9. 911. 15 .f

Regulation Description: Areas used by children shall be designed, constructed, and furnished to reduce risk of
suicide and assault including, but not limited to:

Findings Description: Girls Hall 1 room 6 had a string sewn into the pants.
Action Due Date:

Action Due Description:

Comply Date:

Sub Regulation Description:

Regulation Number: 9. 907. 2

Regulation Description: Child caring staff shall be responsible for providing the level of supervision, care, and
treatment necessary to ensure the safety and well-being of each child at the facility, taking into account the child’s
age, individual differences and abilities, surrounding circumstances, hazards and risks.

Findings Description: Night staff observed not present on the hall nor doing appropriate checks.
Action Due Date:

Action Due Description:

Comply Date:

Sub Regulation Description:

Regulation Number: 9. 907.6

Regulation Description: Supervision during sleeping hours shall include a visual check on each child at least
every thirty (30) minutes.

Findings Description: Night staff observed not present on hallway nor doing appropriate checks.
Action Due Date:

Action Due Description:

Comply Date:

Sub Regulation Description:

Regulations Needing Technical Assistance:

Regulation Not Applicable:

Regulations Not Correctable:

www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 4

Narrative:

Buildings & Grounds conducted from 8:45AM-11:00AM. Census: 19

Girls Hall 1 and 6 and Boys Hall 2 observed. Girls Hall 1 bathroom of room 5 had a partially removed light
switch cover and broken ceiling drop tile. Girls Hall room 6 had a pair of sweatpants with a string in the
waste. Boys Hall 2 middle shower was not clean. Boys Hall room 23 had a ripped mattress and area behind
toilet seat was not clean. Boys Hall room 30 had a bed to floor bracket that was loose enough to be removed
by a client. The bracket could potentially be used for self- harm or harm of another.

Outdoor grounds observed to be safe and free of safety hazards.

2 classrooms observed. Staff/client ratios 2:9 and 2:10. When staff present in the classrooms were asked how
many kids were present, they stood up to count before replying.

Video reviewed from Sunday, 3/20/23. Hall 1 1:35AM-2:15AM staff was not on the hall nor doing proper
checks. Hall 6 2:25AM-3:35AM staff was not present on the hall in between checks.

MAR checked for:

All initialed and up to date.

Consultation had with Program Director Dean Hill today on needed building repairs and the importance of
staff being aware of the number of clients they are supervising. Sweatpants with string was immediately
removed and given to Dean Hill. Dean Hill indicated that before the conclusion of today's visit the bed to
floor bracket, light switch cover and broken drop tile had been fixed.

Program Coordinator discussed with Dean Hill the night time ratio with staff and residents on each units.
Dean Hill reported that the units occasionally have 9 residents assigned on them in which the nurse would
work in ratio with the direct care staff assigned to the unit that night. The Coordinator discussed that if the
nurse is to be counted in ratio then they will be needed to work in ratio on the unit with visual of the residents.
The Coordinator discussed how watching video at the nurses station of the units or not visualizing the
residents does not count as working in ratio for the supervision of the residents.

www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 3 of 4

Facility cited 907.2, 907.6, 911.6, 911.15f and 912.4. As to document sub-regulation f: Children's personal
items that contain cords, pull-ties, strings, or other parts that could be used to inflict self-injury shall not be
left in the child's room unless the dangerous component has been removed.

Provider Comments:

CCL Staff Signature : Date: 3/22/2023

Provider Signature : Date: 3/22/2023

www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 4 of 4


summary:
The following non-compliance areas have been cited during the past 6 months:
907.2 – Citations on 02/13/23 and 03/01/23 regarding staff being asleep and failing to supervise the residents.
907.5 – Citation on 02/13/23 regarding the overnight shift staff failing to remain awake and provide appropriate supervision of the residents.
907.6 – Citations on 02/13/23 and 03/01/23 regarding staff failing to conduct visual checks during sleeping hours on each child at least every 30 minutes.

raw_content:
ARKANSAS
DEPARTMENT OF

)- 7 HUMAN
=f SERVICES

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

Corrective Action Agreement

Date: March 22nd, 2023

To: Dean Hill Il

Owner Name: Delta Family Health and Fitness for Children, Inc
Facility Name: Delta Family Health and Fitness for Children
License #: 172

Mr. Hill,

This document constitutes a formal Corrective Action Agreement (CAA) agreed upon by Delta
Family Health and Fitness for Children and the Department of Human Services, Division of Child
Care and Early Childhood Education, Placement and Residential Licensing Unit. This CAA will be
in effect for a period of six months from the date of signing by both parties. This agreement
may be extended beyond six months should DHS determine any non-compliance with the CAA
during the stated corrective action period.

The purpose of this agreement is to gain and maintain a high degree of compliance with
licensing requirements. The following non-compliance areas have been cited during the past six

months:

Minimum Licensing Standards (Residential):

907.2 Child caring staff shall be responsible for providing the level of supervision, care, and
treatment necessary to ensure the safety and well-being of each child at the facility, taking
into account the child’s age, individual differences and abilities, surrounding circumstances,
hazards and risk.

e Delta Family Health and Fitness received citations on the following dates regarding
staff being asleep and failing to supervise the residents.

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

o 02/13/2023-Overnight staff can be seen on video footage asleep while clients
leave their bedrooms and sneak into other resident's bedrooms.
= Staff on the male and female hall can be seen on video asleep while a
client leaves one hall and sneaks into the bedroom of another client on
another hall.

o 03/01/2023- Review of video footage from the night/early morning of
02/27/2023 between the hours of 1:28 a.m. to 4 a.m. revealed that staff failed
to conduct visual checks on residents per the Minimum Licensing Standards
and Delta Family Health’s policy.

= Camera footage reviewed from Girls Hall 1 from 2/27/23, 1:28AM-2:01AM.
Staff seen checking two rooms at 1:28AM. Staff does not walk close enough
to check other two rooms which were occupied by clients.

«= Camera footage reviewed from Girls Hall 6 from 2/27/23, 1:58AM-2:2 1AM.
Staff is seen checking all rooms at 1:58AM and next at 2:21AM.

= Camera footage reviewed from Boys Hall 2 from 2/27/23, 2:22AM-3:06AM.
Staff is seen doing checks at 2:22AM, 2:31AM, and next check at 3:06AM, 35
minutes in between last check.

= Camera footage reviewed from Boys Hall 2 from 2/28/23, 3:09AM-4:06AM.
Staff is seen performing checks on all rooms at 3:09AM, 3:39AM, and 4:06AM.

907.5 All child caring shift-staff, counted in the staff child ratio shall remain awake at all
times.

e Delta Family Health and Fitness received a citation the following date regarding the
overnight shift staff failing to remain awake and provide appropriate supervision of
the residents.

o 02/13/2023-
= Staff on the male and female hall can be seen on video asleep
while a client leaves one hall and sneaks into the bedroom of
another client on another hall. The client was found in the other
client’s bedroom after being there for at least 3 hours.

907.6 Supervision during sleeping hours shall include a visual check on each child at least
every thirty (30) minutes.

o 02/13/2023-
= Staff were seen asleep on the video and not completing checks as
outlined in Minimum Licensing Standards. Delta Fitness has a
every 10 minutes room check policy; these checks were not
completed either. Staff documented that the checks were
completed every 10 minutes, but that was not accurate.

o 03/01/2023-

= Review of video footage from the night/eariy morning of 02/27/2023
between the hours of 1:28 a.m. to 4 a.m. revealed staff had failed to
conduct visual checks on all residents per the Minimum Licensing
Standards and Delta Family Health’s own policy.

« Camera footage reviewed from Girls Hall 1 from 2/27/23, 1:28AM-
2:01AM. Staff seen checking two rooms at 1:28AM. Staff does not
walk close enough to check other two rooms which were occupied by
clients.

» Camera footage reviewed fram Girls Hall 6 from 2/27/23, 1:58AM-
2:21AM. Staff is seen checking all rooms at 1:58AM and next at
2:21AM.

« Camera footage reviewed from Boys Hall 2 from 2/27/23, 2:22AM-
3:06AM. Staff is seen doing checks at 2:22AM, 2:31AM, and next
check at 3:06AM, 35 minutes in between last check.

= Camera footage reviewed from Boys Hall 2 from 2/28/23, 3:09AM-
4:06AM. Staff is seen performing checks on all rooms at 3:09AM,
3:39AM, and 4:06AM.

The agency is required to complete the following:

¢ The facility management shall continue to conduct a minimum of once per week
random camera footage review to determine all staff are following Minimum Licensing
Standards. These checks shall be documented and provided to the licensing unit
monthly.

© The facility shall ensure that all staff are trained in documentation and proper
supervision of clients on the overnight shift. Documentation of all training being
completed with staff will be provided to the licensing unit by 5/19/23.

e The Licensing Unit will provide intent training to the facility regarding the 900 section of
the Minimum Licensing Standards. All facitity staff shall be required to attend and a sign
in sheet will be provided to the Licensing Unit.

This document is intended to clarify any outstanding issues and to reduce the risk of
misunderstanding or miscommunication.

Please be advised that any serious non-compliance cited during this corrective action period
may result in a recommendation for adverse action on the license. Any serious violation of
this corrective action plan will result in recommendation for adverse action on the license.

Please do not hesitate to contact the Placement and Residential Licensing Unit if you have any
questions or concerns regarding ongoing compliance with this agreement or any other licensing
requirement.

The sig e of the licepsee constitutes full acceptance of the provisions of this agreement.

3/ FA 23

Owner/ Admipistrator/Agency Representative Date

821-53

Date

Licensing Supervisor Dat

doc_type: Corrective Action Agreement


summary: Licensing visited the facility to discuss the initiation of a formal Corrective Action Agreement between the facility and DHS.

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: Delta Family Health and Fitness for Children
Facility Number: 172
Licensee Address: 815 EAST SAINT LOUIS STREET
HAMBURG AR 71646
Licensing Specialist: Chelsea Vardell
Person In Charge: Dean Hill II
Record Visit Date: 3/22/2023
Home Visit Date: 3/22/2023
Purpose of Visit: Corrective Action Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Census 19
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

The licensing specialist and program coordinator visited the facility to discuss the initiation of a formal
Corrective Action Agreement between the facility and DHS. The Program Coordinator presented the
Agreement to Dean Hill, Lachandra Williams, Becky Brooks, Lashundra Kesee, Dede Smith and Emily
Greene.
The facility reports that they have recently installed new sensors on the end of each of their resident units. The
staff have a wand that they must carry to the end of each hall and wave in front of the sensor so it can log that
staff were present on the unit. The information is then saved on the device and can be downloaded by staff the
following morning to ensure staff are completing their required visual checks of the residents during sleeping
hours. The facility has installed motion sensors on the end of the halls to alert staff when a resident has come
off a unit. The facility has also already completed two in service trainings for staff on the importance of
documentation and supervision of the residents on 2/16/23 and 3/1/23. Sign in sheets were provided to the
specialist.
Provider Comments:
CCL Staff Signature : Date: 3/22/2023
Provider Signature : Date: 3/22/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: Licensing completed a monitor visit during the early morning hours. No deficiencies cited.

raw_content:
ARKANSAS
) DEPARTMENT OF

\}v7 HUMAN
~a' SERVICES
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550

521 Visit Compliance Report

Licensee: Delta Family Health and Fitness for Children

Facility Number: 172

Licensee Address: 815 EAST SAINT LOUIS STREET
HAMBURG AR 71646

Licensing Specialist: Clayton DeBoer
Person In Charge: LaChandra Williams
Record Visit Date: 3/15/2023

Home Visit Date: 3/22/2023

Purpose of Visit: Monitor Visit

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

Regulations Not Correctable:

Narrative:

Program Manager Sharra Litzsey completed a monitor visit during the early morning hours on 3/15/23. Upon
arrival, a nurse was sitting at the nurse station. Staff members were walking on the boy's hall and 2 female

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

halls. New sensors have been installed at the entrance of each hall. Once the alarm is set, if anyone goes past
the sensor, the alarm will sound and a flashing light in the foyer area. Nightly logs were viewed on both
female logs and were current until 1 a.m.

Nurse counted into ratio Boys Hall 2:10, Girls Hall 1:4, Girls hall 1:5
MARS reviewed:

Provider Comments:

CCL Staff Signature : Date: 3/22/2023
Provider Signature : Date: 3/22/2023

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


summary: Licensing conducted a follow up visit to address night staff staying awake and doing bed checks per licensing standards. The facility was cited 907.2 and 907.6 for issues observed during the visit.

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: Delta Family Health and Fitness for Children
Facility Number: 172
Licensee Address: 815 EAST SAINT LOUIS STREET
HAMBURG AR 71646
Licensing Specialist: Clayton DeBoer
Person In Charge: Dean Hill II
Record Visit Date: 3/1/2023
Home Visit Date: 3/2/2023
Purpose of Visit: Special Visit
Regulations Out of Compliance:
Regulation Number: 9. 907. 2
Regulation Description: Child caring staff shall be responsible for providing the level of supervision, care, and
treatment necessary to ensure the safety and well-being of each child at the facility, taking into account the child’s
age, individual differences and abilities, surrounding circumstances, hazards and risks.
Findings Description: PM staff did not perform checks within 30 minutes. One PM staff seen not checking on all
clients she was supposed to be.
Action Due Date:
Action Due Description:
Comply Date:
Sub Regulation Description:
Regulation Number: 9. 907. 6
Regulation Description: Supervision during sleeping hours shall include a visual check on each child at least
every thirty (30) minutes.
Findings Description: PM staff did not check on all clients within a 30 minute timeframe.
Action Due Date:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 3

Action Due Description:
Comply Date:
Sub Regulation Description:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Follow up visit to address PM staff staying awake and doing bed checks per licensing standards.
Camera footage reviewed from Girls Hall 1 from 2/27/23, 1:28AM-2:01AM. Staff unknown because staff
never walk close enough to the camera to identify. Staff seen checking two rooms at 1:28AM. Staff does not
walk close enough to check other two rooms which were occupied by clients.
Camera footage reviewed from Girls Hall 6 from 2/27/23, 1:58AM-2:21AM. Staff Donna Pace is seen
checking all rooms at 1:58AM and next at 2:21AM.
Camera footage reviewed from Boys Hall 2 from 2/27/23, 2:22AM-3:06AM. Staff Willl Caldwell is seen
doing checks at 2:22AM, 2:31AM, and next check at 3:06AM, 35 minutes in between last check.
Camera footage reviewed from Boys Hall 2 from 2/28/23, 3:09AM-4:06AM. Staff Tina Bankston is seen
performing checks on all rooms at 3:09AM, 3:39AM, and 4:06AM.
Unknown staff did not check 2 of the 4 rooms she was supposed to be checking. Staff Will Caldwell was
observed doing checks 35 minutes apart. It should be noted that facility policy is that staff perform checks
every 10 minutes. Facility cited 907.2 and 907.6.
Provider Comments:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 3

CCL Staff Signature : Date: 3/2/2023
Provider Signature : Date: 3/2/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 3 of 3


summary: Licensing completed an afterhours visit. 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: Delta Family Health and Fitness for Children
Facility Number: 172
Licensee Address: 815 EAST SAINT LOUIS STREET
HAMBURG AR 71646
Licensing Specialist: Sharra Singleton-Litzsey
Person In Charge:
Record Visit Date: 2/19/2023
Home Visit Date: 2/20/2023
Purpose of Visit: Self Report Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Program Manager Sharra Litzsey completed an afterhours visit beginning at 11:45 pm until 12:30 a.m. During
the visit, community showers were observed to be clean and in good repair. Hall 6 1:5, Hall 2 2:9, Hall 1:4.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Each bedroom has an alarm, if clients are moving around in the bedroom while the alarms are set, a chime is
heard, and the alarm has to be dis-alarmed and reset.
Provider Comments:
CCL Staff Signature : Date: 2/20/2023
Provider Signature : Date: 2/20/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: Two residents reported they had consensual sexual intercourse after one resident snuck into the other’s room. During the video review, two staff members were observed sleeping when the resident snuck into the peer’s room. The facility was cited 907.2, 907.5, and 907.6 as a result of this incident.

raw_content:
AR KAN S A S&S
DEPARTMENT OF

4 HUMAN
<a\ SERVICES

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

Notice of Serious Incident

Date of Incident: 2/13/2023

Date Received by DCCECE: 2/13/2023

Facility Name: Delta Family Health and Fitness for Children
Facility Number: 172
Facility Type: Residential

Incident Type: Licensing

Report Description: Parental-{E (mom) Approx at 3:18 am
HE (age: 13) snuck off of Hall Six and went over to the Hall 2 which houses 9
boys il proceeded to look into several of the boys rooms until she entered
room. | | was found in is room at 7:10 am by the male staff.
After talking with both parties each agreed they did have sexual intercourse and it was

consensual by both. Ref number: 7 HE DC rs-Samantha Jones
(Caseworker) Fe Approx at 3:18 am ee suck off of Hall Six and
went over to the Hall 2 which houses 9 boys. JJ proceeded to look into several of the
boys rooms until she entered room. Sg was found ni
room at 7:10 am by the male staff. After talking with both parties each agreed they did have
sexual intercourse and it was consensual by both. Ref number: Per ASP:
a: Referral Number Child ii The referral was not accepted for
GE 200 was documented only due to; Does not meet criteria set forth in

Cs fo: A MEE. Client Statements 2/15/23
EE ) 9:30-10:00am Jo stated II wasn?t on the hall at one point,

she was there and she wasn?t. (Nurse was not present) was at the
nurses? station and she didn?t see her sneak off the hall, she went around the nurses?
station, but saw and returned back to her room. On the second attempt

stated fF was snoring, she check all the rooms i) they
were all sleep, until she found because his feet were ashy explained
was sleep and she woke him up. He went to the bathroom, they were talking and then they

had sex. shared she talked with another male peer across the hall, Jj and
HB was still asleep. ?1 think I fell asleep, waiting for daylight and caught me on
top him talking to him?. MHP asked the client if they had sexual intercourse in which

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

| | placed his penis inside of her, ?He was soft most of the time, he had to pull it out to
get hard again, we tried different positions, we did it one more time at daylight?. MHP
asked if| 7 checked the rooms and she stated, ?One time?.

HE 10:12-10:19 am ?Got wicked? stated when MHP asked the client what
happened during the early morning hours in his room. The client stated, ?I was sleep, doing
my thang, I heard someone say my name, | was there, I said you need to get back over
there and she said, not without a prize?. MHP asked what was the prize, ?I said you can
have my stress ball? and he reported tsated that?s not what she wanted, ?she said she
wanted me to fuck her?. MHP asked the client in their words if he ?fucked her? and he
stated not really. The client shared he did not like the terminology MHP was being used
and MHP informed him it was the terminology he used but MHP asked the client did he
insert his penis into HE vagina, he was still uncomfortable with the terminology but he
answered, ?only for a few minutes, then I tried to get her to leave but she kept wanting to do
it, I was stalling?. MHP asked the client what he was doing to stall, ?I was talking and
joking like I usually do?. The client did share he talked to [fin the room across from
him and reported ii was watching them while masturbating. MHP asked the client
where was staff, pF was on the hall sleep?. MHP asked if fF did room checks,
Phe would walk down the hall, he did that a lot?. MHP asked the client why he went to the
nurses? station after he stated there was nothing, ?to get >. He stated, FO was
in the bathroom, he fell asleep, she was on top of me trying to wake me up, we got caught?.
Ee 10:36-10:47 21 woke up early, Iwas up early and we talked I
went back to my corner and we went back to sleep? stated the client when MHP asked what
happened in the early hours of the morning. MHP asked the client if he was sure that was
his response and shared 2 others indicated they had talked to him. Jj I don?t know
when she got there, I stayed up and watched them? stated . ?I knew it wasn?t a nurse
because a nurse doesn?t have pajamas on? reported i. stated came out of
the bathroom, | | was laying down with the covers on, ?when the girl came out she
didn?t have any pants on?. The client stated, ?after me and i got done talking I went to
my corner of the bed, read my book and went to bed. MHP asked the client where was
HM 2he was at the dayroom sleep for a period of time?. MHP asked the client if he was
masturbating during this time and he denied it. MHP asked the client why he didn?t tell
staff, ?It wasn?t my business?

Interim Action Narrative: Staff were sent home on leave pending investigation.

Maltreatment Narrative:

Licensing Narrative: On 2/13/23 at approx at 3:18 am client snuck off of Hall
Six and went over to the Hall 2 which houses 9 boys. | proceeded to look into several of the
boys rooms until she entered [Is toom JJ was found in [Ps room at 7:10 am
by the male staff. After talking with both parties each agreed they did have sexual
intercourse and it was consensual by both. The was called,
i. It was not accepted. Facility visited 2/13/23 from 11:30AM to 1:00PM. Video
reviewed. The hallways were visible in the video. Client JJJJcan be seen leaving her bedroom
around 3:05 AM and walking past staff Po who was responsible for
monitoring Hall Six (Girls? Hall). J was seen asleep in a chair, seemingly
unaware that clien{j had exited her room. | then seems to wait for nurses? station staff
(who are seen moving) to not be looking §j is seen entering Hall Two (Boys? Hall) around
3:16AM. Staff a. who is responsible for monitoring Hall Two (Boys? Hall) is
seen sleeping in a chair, seemingly unaware of a entering the hallway. His seen entering
client JJJ?s room. At around 4AM staff [J awakens and appears to do periodic
rounds. At this time, JJ continues to remain in [Ps room. At 7:11AM staff J appears
to discover J in Ps room and escorts her back to her room. Ten-minute check charts for
both clients reviewed for this time period. Some are initialed, some have a line drawn
through as to indicate the same checks are being conducted. Staff are clearly seen asleep in
the video viewed today, not conducting ten-minute checks on the clients involved in this
incident. The names of the other staff working during this incident and their hours are as

follows: A sPM-34M. RRR AM-1M. SR 4AM-7AM.

Facility cited 907.2, 907.5 and 907.6. lnit]_ ii i call reported by facility was
screened out. This Licensing Specialist called the I regarding this
incident as well, ref#f§j5. This report was screened out as well. Email sent to facility to
inquire about Medical follow up for 2/ 14/23. Email received from facility 2/14/22: Our
Female client has been seen at our local clinic by a female nurse practioner and Dr. Vora
has been notified and medications changed to hold Abilify until three negative blood and
urine pregnancy test at Hamburg Health Clinic. Also she is scheduled at the Women's
Clinic in Crossett for an appointment and an appointment March 14 to receive i)
t to provide effective birth control. Email sent 2/17/23 as to inquire
about medical attention for the male involved in this incident. Email received from facility
2/17/23: The doctor did not order the male client to receive any medical attention. The
doctor's plan includes: "I suggest we educate clients about contraceptives - pregnancy etc.

and recommend girls on contraceptives, Separate gender Group education, Health unit
consultation (For the female client), Provide reading materials per health units and Then, it
is up to them and guardians and parents".

AR KOA NOB &
gta OF

4 _ 47 HUMAN
tat SERVICES
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot $140, Little Rock, AR 72203-1437

P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550

521 Visit Compliance Report

Licensee: Delta Family Health and Fitness for Children

Facility Number: 172

Licensee Address: 815 EAST SAINT LOUIS STREET
HAMBURG AR 71646

Licensing Specialist: Clayton DeBoer
Person In Charge: Dean Hill I!
Record Visit Date: 2/13/2023

Home Visit Date: 2/13/2023

Purpose of Visit: Self Report Visit

Regulations Out of Compliance:

Regulation Description: Child caring staff shall be responsible for providing the level of supervision, care, and
treatment necessary to ensure the safety and well-being of each child at the facility, taking into account the child’s
age, individual differences and abilities, surrounding circumstances, hazards and risks. n

Sub Regulation Description: .
Regulation Number: 9.907.2
Regulation Description: All child caring shift-staff, counted in the staff child ratio shall remain awake at all times.
Sub Regulation Description:

Regulation Number: 9.907.5

Regulation Description: Supervision during sleeping hours shall include a visual check on each child at least
every thirty (30) minutes.

Sub Regulation Description:
Regulation Number: 9.907.6

Regulations Needing Technical Assistance:

www.arkansas.gov/dhs . — PE EEE eo ne De SS
Serving more than one million ‘Arkansané: ghey year. OOS I ee Paget of 2

Regulation Not Applicable:
Regulations Not Correctable:

Narrative:

On 2/13/23 at approximately 3:18AM Hisnuck off of Hall Six (Girls’ Hall) and went over to Hall Two (Boys’ Hall). proceeded to look into
several of the boys’ rooms until she entered fs room. Jj was found in Js room at 7:10AM by staff responsible for monitoring Hall Two
(Boys’ Hall). After talking with both parties each agreed they did have sexual intercourse and it was consensual by both. Th iii
was called 2/13/23, Ref

Facility visited 2/13/23 from 11:30AM to 1:00PM. Video reviewed. The hallways were visible in the video. Client [can be seen leaving her
bedroom around 3:05 AM and walking past staff [EE who was responsible for monitoring Hall Six (Girls’ Hall). was
seen asleep in a chair, seemingly unaware that clientJhad exited her room. Bipben seems to wait for nurses’ station staff (who are seen moving)
to not be looking. [jis seen entering Hall Two (Boys’ Hall) around 3:16AM. Staff JE who is responsible for monitoring Hall Two
(Boys’ Hall) is seen sleeping in a chair, seemingly unaware of Bi tcring the hallway. Is scen entering client [fs room. At around 4AM staff
GE awakens and appears to do periodic rounds. At this time, Mlcontinues to remain in [ls room. At 7:11AM staff HEE 2ppears to
discover in | § room and escorts her back to her room. Ten-minute check charts for both clients reviewed for this time period. Some are
initialed, some have a line drawn through as to indicate the same checks are being conducted. Staff are clearly seen asleep in the video viewed
today, not conducting ten-minute checks on the clients involved in this incident. Facility cited 907.2 and 907.5.

a" hed Fe

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

_ ARK ANSA S
) DEPARTMENT OF

)\-7 HUMAN
» ©! SERVICES

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

521 Visit Compliance Report

Licensee: Delta Family Health and Fitness for Children

Facility Number: 172

Licensee Address: 815 EAST SAINT LOUIS STREET
HAMBURG AR 71646

Licensing Specialist: Clayton DeBoer
Person In Charge:

Record Visit Date: 2/23/2023

Home Visit Date: 2/23/2023

Purpose of Visit: Revisit Complaint

Regulations Out of Compliance:

Regulations Needing Technical Assistance:

Regulation Not Applicable:

Regulations Not Correctable:

Narrative:

Follow up visit conducted today from an incident that occurred on 2/13/23 in which client Bb snuck
undetected into client oom. Clients reported having intercourse. Previous visit 2/13/23 for this incident,

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

staff eS «ose! via camera footage sleeping during their shift. This

enabled client fo sneak into client Boom undetected.

Visit 2/23/23: Program Director Dean Hill was unavailable today. Staff Becky Brooks assisted licensing
during today's visit. Video footage unable to be viewed today as no staff present had access to camera.
Nightly check logs for staff and produced for licensing. Preventative
measures for night staff sleeping during shifts discussed. Medical follow up visits for female client
discussed.

Provider Comments:

CCL Staff Signature : Date: 2/23/2023
Provider Signature : Date: 2/23/2023

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


summary: Licensing visited the facility to conduct a buildings and grounds walkthrough. The facility was cited 911.6 for issues observed during the review.

raw_content:
521 Visit Compliance Report

Licensee: Delta Family Health and Fitness for Children

Facility Number: 172

Licensee Address: 815 EAST SAINT LOUIS STREET
HAMBURG AR 71646

Licensing Specialist: Clayton DeBoer
Person In Charge: Dean Hill I!
Record Visit Date: 2/7/2023

Home Visit Date: 2/8/2023

Purpose of Visit: Monitor Visit

Regulations Out of Compliance:

ARKANSAS
) DEPARTMENT OF

iy HUMAN
» “at SERVICES

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

y

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

Sub Regulation Description:

Regulation Number: 9.911.6

Regulations Needing Technical Assistance:

Regulation Not Applicable:

Regulations Not Correctable:

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

Page 1 of 2

Narrative:
Buildings & Grounds conducted from 5:30PM-6:30PM. Census: 17.

Cafeteria observed. Staff/client ratio: 3:5.

Boys Hall observed to be furnished, clean and in good repair. Staff/client ratio: 2:8. Shower area was in use.
One staff sitting outside of shower area. Girls Hall staff/client ratio 1:4. Girls Hall observed to be furnished,
clean and in good repair except for room 66. Room 66 wall A/C unit had no cover over vent. This did not
appear to be a safety hazard. Shower area was in use. One staff sitting outside of shower area.

MAR checked at around 5:45PM. Noon meds were initialed and up to date. PM meds had not been distributed
at this ttme. PM meds had not been initialed. MAR checked for:

Facility cited 911.6 for missing A/C vent in room 66. This will need to be fixed by 2/15/23.

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


summary: Licensing visited the facility to review children’s records. All files reviewed complied with minimum licensing standards.

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: Delta Family Health and Fitness for Children
Facility Number: 172
Licensee Address: 815 EAST SAINT LOUIS STREET
HAMBURG AR 71646
Licensing Specialist: Clayton DeBoer
Person In Charge: Dean Hill II
Record Visit Date: 1/18/2023
Home Visit Date: 1/18/2023
Purpose of Visit: Children’s Records
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulations Not Correctable:
Narrative:
Client Records Review for clients:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year
Page 1 of 2

All items per Minimum Licensing Standards accounted for.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year
Page 2 of 2


facility_name: Little Creek Behavioral Health

summary: Officers were contacted by Dell Children’s Hospital in Austin, TX where a juvenile was being treated. The juvenile disclosed that she was sexually assaulted or possibly raped sometime within the last year by a staff member while she was at Little Creek.

raw_content:
FAULKNER COUNTY SHERIFFS OFFICE ** Juvenile Involved **

Incident Report Report Status: FILED IN RECORDS
Case Number: 25-0902106 Case Status: ACTIVE
Page 1 of 2
Case#: 25-0902106 Report Date: 09/08/2025 15:33
Report By: Deputy. Austin Reeder - (F30) Arrival Time:
Case Type: SEX CRIME UNDER 18 Reporting Zone: D
Business: LITTLE CREEK BEHAVIOR Occurred From: 09/08/2025 15:33
Address: 161 SKUNK HOLLOW RD Occurred Through: 09/08/2025 15:33
Intersection: Reportable IBRS: No
City/State/Zip: CONWAY, AR 72032 School:
Lat/Long: Lat: 35.0682283 / Long: -92.3841968 Case Status: ACTIVE
Case Type: SEX CRIME UNDER 18 File / Cad ID:
Assigned To: __ Investigator. Caleb Reed - (Cd8) Assigned Date: 09/11/2025
Cleared By: Cleared Date:
How Cleared:
IBR Clear Code: Clery Related: NO
UCR / Offenses
UCR: All Other Offenses - [90Z] Status: Completed
Charge: GENERAL INFORMATION REPORTS
Statute: Charge Code: GEN INFO
Victims
Victim Type: Individual
Name: Po DOB: Race/Sex: J
Address: Po Current Age: 17 Height:
City/State: [x Age: 17 Weight:
Email: Hair Color: Eyes:
Home Phone: Work: Cell: DL#:
Resident: NON-RESIDENT Ethnicity:
Occupation: Military:
Email: Narcan Dose: 0 SSN:
Employer:
Offender / Suspect
Name UNKNOWN, UNKNOWN DOB: Race/Sex: U/U
Address: Current Age: Height:
City/State: Age: 0 Weight:

Resident: UNKNOWN Hair Color: Eyes:

FAULKNER COUNTY SHERIFFS OFFICE ** Juvenile Involved **

Incident Report Report Status: FILED INRECORDS
Case Number: 25-0902106 Case Status: ACTIVE
Page 2 of 2

Complainant
Nene: 00: Race/Sex: il
Address: Po Current Age: fj Height: P|
CityState: Age: a Weight:
Email: Hair Color: [x Eyes: | |
Home: PY Cell Phone: DL#: PY
Occupation: Work Phone:
Employer:
Narrative

On Monday September 8, 2025, | was dispatched to a call for service and made contact complainant

HE via phone.

stated she works at Dell Children's Hospital in Austin Texas and stated she has a patient who used to
live at little creek behavioral. EE stated while being treated, JV1 (Victim) disclosed information to her and a
social worker that she was sexually assaulted or possibly raped sometime within the last year while she was at Little
Creek by a staff member. J stated she called to see if it was reported and I was unable to find any

information. EJ stated since she is a mandated reporter, she would like to make a report, but stated she has
very little information.

was able to provide me with JV1's information, but stated JV1 has not said much about the incident
therefore she does not have any other information. EE stated if or when they get more information about the
incident, they will call back to add to the report. At this time, this is all the information we have.

REEDER, AUSTIN 9/8/2025, 3:48:47 PM

ee

Reporting Officer Approved By Officer
Deputy. Austin Reeder - (F30) Sergeant. Zachary Cooley - (F6)
Reported On: 09/08/2025 15:33 Approved On: 09/14/2025 15:48
FILED INRECORDS
Case Status: ACTIVE Administrative Use Only - IBRS Date

151616


summary: A resident was transported to the hospital for assessment after slipping in the shower and striking her head on the wall.

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: 032430
Date of Incident: 08/25/2025
Date Received: 08/26/2025
Facility Name: Little Creek Behavioral Health
Incident Type: DPSQA - Incident & Accident - OLTC
Case Status: Under Review
DPSQA - Incident & Accident - OLTC
Report Description: reported slipping and falling while taking a shower, striking the
back of her head on the wall. Assessment was initiated immediately, and the resident was
alert and oriented to person, place, time, and situation. denied loss of consciousness,
dizziness, nausea, or visual disturbance.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was transported to the Emergency Room after accidently hitting his head on the corner of the TV while standing up.

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: 032142
Date of Incident: 08/14/2025
Date Received: 08/15/2025
Facility Name: Little Creek Behavioral Health
Incident Type: DPSQA - Incident & Accident - OLTC
Case Status: Complete
DPSQA - Incident & Accident - OLTC
Report Description: At 1834 nurses called to unit regarding resident .
Resident stated he was bent down under the TV and stood up, hitting his head on the
corner of the TV. Upon assessment resident is calm and cooperative. There is an
approximately 1" laceration noted to the top of his head with small amount of blood present.
Wound cleaned and , APRN notified. Order given by provider to send resident
to for further assessment. Resident returned to Little Creek at
9:35 with
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Call for service states that CPS from Texas called to speak to an officer about a resident from the facility.

raw_content:
Call Details Report For CFS # 25-0801929

CFS Number
25-0801929

Inciden
ATTEMPT TO CONTACT

Caller Name
OSBORNE, ASHLEY

Location
161 SKUNK HOLLOW RD, FAULKNER COUNTY

Initial Statement

CPS FROM TX - WOULD LIKE TO SPEAK TO F26 ABOUT [in

Notes
8/8/2025 11:19:19 AM by: palarcon
NO REPORT - ALL QUESTIONS ANSWERED

Unit Call Times

Unit ID Date/Time
F26 8/8/2025 11:04:10 AM
F26 8/8/2025 11:19:19 AM

Dispositions Assigned to This Call
Di iti wt Assi
NO REPORT 8/8/2025 11:19:19 AM

D Tim
8/8/2025 10:55 AM

Primary Unit
F26

Caller Phone
2542897407

Status
DISPATCHED

CLEARED

Assigned By

palarcon

8/21/2025 11:18:12 AM