summary: Upon officers’ arrival, staff advised juvenile arrived at facility around 1630 hours and was immediately aggressive and hostile with staff. Juvenile began tearing up property in the lobby during medical assessment and slapped a staff member after she informed another staff to call the police. Juvenile was taken to hospital via MEMS for assessment and replacement.

raw_content:
LITTLE ROCK POLICE DEPARTMENT INCIDENT REPORT

. INCIDENT. Reportgenerated: 4/13/2023 10:34 PM
MODO ) ¢ LARA U

INCIDENT NUMBER

2023-041 260

LLY &

INCIDENT DATE LOCATION OF INCIDENT (ADDRESS / BUSINESS NAME) DISTRICT
2002 S FILLMORE ST

4/13/2023 5:46:23 PM 54

METHODIST CHILDRENS HOME

OFFENSE

OFFENSE STATUS

Attempted | |
Completed —' [7] . - :
Attempted

TYPE OF CRIMINAL ACTIVITY: GANG RELATED INFO:

INCIDENT OFFENSE TYPE

, ASSAULT 3RD DEGREE

SUSPECTS USED;

Oa) Alcohol mt) Drugs Oe) Buying / Receiving Oe) Cultivate / Manufacture / Publish me) Juvenile Gang
ow Computer Equip wm” Not Applicable / Ce) Exploiting Children C0) Operating / Promoting / Assisting Oe) Other Gang
Unknown

(A(T) Transport / Transmit / Import [7](U) Using / Consuming [VJ(N) None / Unknown
[_](D) Distributing / Selling

Ole) Possessing / Concealing

LOCATION CODE: (116) Lake / Waterway [(](44) Daycare Facility (G1) Rest Area

(1001) Air / Bus / Train Terminal (117) Liquor Store (145) Dock / Wharf / Freight Terminal [_](52) School - College / University
[)(02) Bank / Savings & Loan (118) Parking Lot / Garage (146) Farm Facility [1(53) School - Elementary / Secondary
[[](03) Bar / Night Club [1(19) Rental / Storage Facility (1147) Gambling / Casino / Racetrack — [7] (54) Shelter - Mission / Homeless
(04) Church / Synagogue / Temple W]20) Residence / House Cas) Industrial Site C055) Shopping Mall

(105) Commercial / Office Building Ole 1) Restaurant Ol) Military Installation Cts) Tribal Lands

[£1 (06) Construction Site (122) School / College (21(50) Park / Playground (167) Community Center

(107) Convenience Store (1(23) Service / Gas Station

(21 (08) Department / Discount Store [1(24) Specialty Store (TV, Fur, Ete)
C09) Drug Store / DR Office / Hospital es) Other / Unknown WEAPON FORCE: (on I-15, an "A" denotes Automatic or Semi-Automatic)

(10) Field / Woods (137) Abandoned/Condemned Structure (101) Firearm (Unknown) [](50) Poison

Oa 1) Government / Public Building Oes) Amusement Park ~ a2) Handgun C60) Explosives

[J(12) Grocery / Supermarket (139) Arena / Stadium / Fairgrounds ~~ (113) Rifle (1(65) Fire / Incendiary Device
[([J3) Highway / Road / Alley (140) ATM Separate from Bank _ (4) Shotgun om Narcotics / Drugs /
(14) Hotel / Motel / Ete (141) Auto Dealership New / Used (115) Other Firearm Sleeping Pills

Cc) (15) Jail / Penitentiary C2) Camp / Campground eo) Knife / Cutting Instr (Axe, ete) Ces) Asphyxiation

(1030) Blunt Object (Club, ete) (190) Other

(FOR BURGLARY ONLY) METHOD OF ENTRY: (135) Motor Vehicle (as weapon) (195) Unknown

NUMBER OF PREMISES ENTERED Ce) Forcible [Ny No Force [Z](40) Personal Weapons (hands, etc) (1199) None

NARCAN USED; Des Ono (Jother

ENTRY DATE REPORTING OFFICER ORIGINAL APPROVING SUPERVISOR '
MIMVR in use

04/14/2023 03:11:20 | BAYLEY YOUNG 7 CHAD STANGE

LRPD Form 5501-01 Rev, RMS-2019-01-23 Page | of 6

INCIDENT NUMBER 2023-041260

VICTIM
VICTIM # NAME (Last, First, Middle) or BUSINESS
1 MCCRAW,STEPHANIE

ADDRESS:
2002 S FILLMORE ST LITTLE ROCK AR 72205

HOME PHONE: WORK PHONE: MOBILE PHONE: OTHER PHONE:
5017736188

sex: [[](M) Male ETHNICITY; [_](H)Hispanic RACE: [VZ](W) White [[](B) Black [_](1) American Indian | DATE OF BIRTH
[(](F) Female = [[](U) Unk. | [ZJ(N) Non-Hispanic [[](U) Unk. (cA) Asian / Pacific Islander [F](U) Unknown 06/18/1987

RES. STATUS: — [¥J(R) Resident | MENTALLY AFFLICTED? OCCUPATION / EMPLOYER:
(JcN) Nonresident [[](U) Unknown | [](¥) Yes [ZJ(N)No [](U) Unk.

AGE: . RELATIONSHIP OF THIS VICTIM TO SUSPECTS
Exact Age: 35 SUSPECT(S) VICTIM WAS: (by Suspect Number)
Range: - Cices) 7-364 Days Old (SE) Spouse (AQ) Acquaintance

Cann) Under 24 Hrs. Old ~— [](99) Over 98 Years Old DL. /ID No. (STATE) on (FR) Friend
[Jns) 1-6 Days Old (100) Unknown (PA) Parent (NE) Neighbor

(SB) Sibling (BE) Babysitter (baby)
THIS VICTIM RELATED TO WHICH OFFENSES? (CH) Child (BG) Boy/Girl Friend

Mi C2 03 C4 Os O6 7 Os (GP) Grandparents (CF) Child of BF / GF

(GC) Grandchild eee HR) Homosexual Rel.
(IL) Inlaw (XS) Ex-Spouse

(SP) Stepparent (EE) Employee
VICTIM INJURY: (SC) Stepchild (ER) Employer

[ZJ(N) None (1M) Apparent Minor Injury (](B) Apparent Broken Bones (SS) Stepsibling re Aire arene
(1) Possible Internal Injury LACT) Loss of Teeth (J(L) Severe Laceration (OF) Other Family aa Relalonatip Uelinovin
[J(0) Other Major Injury (1(v) Unconsciousness OT

VICTIM TYPE: [VJ (1) Individual (1(B) Business [[](F) Financial Inst. [[](U) Unknown
((G) Government [[](R) Religious [[](S) Society / Publie [[](O) Other

(ST) Stranger (VO) Victim Was Suspect

AGGRAVATED ASSAULT / HOMICIDE: Oo Argument a) Assault on Law Enf Officer (J03) Drug Deal

(104) Gangland Js) Juvenile Gang (106) Lover's Quarrel (]07) Mercy Killings

(J 08) Other Felony Involved Cos) Other Circumstances mi 10) Unknown Circumstances (]20) Criminal Killed by Private Citizen
(121) Criminal Killed by Police Officer [[](30) Child Playing w/ Weapon (101) Gun-Cleaning Accident [-1(32) Hunting Accident

(4033) Other Negligent Weapon Handling (1034) Other Negligent Killings

CLOTHING DESCRIPTION

HAT SHIRT
COAT. PANTS/DRESS

Page 2 of 6

INCIDENT NUMBER 2023-041260

SUSPECT #
1
ARRESTEE #
HOME PHONE: WORK PHONE:

SEX; [Z](M) Male ETHNICITY: [_](H)Hispanic
Ce) Female Cw) Unk. Mn) Non-Hispanic Ow) Unk

NAME (Last, First, Middle)

RES, STATUS: [ICR) Resident
(JN) Nonresident [[](U) Unknown

SUSPECTS ACTIONS RELATED TO
vl v2 V3 V4
L_|vs v6 v7 v8
DISPOSITION OF JUVENILE:

(H) Handled within Department
(R) Referred outside Department

AGE:

Exact Age

Range: -
(1099) Over 98 Years Old
[[](00) Unknown

13

THIS SUSPECT RELATES TO WHICH OFFENSES?
Mi C2 03 C4 Os Ose 7

ARREST LOCATION:

Cs

CHARGE: §-13-207

ARRESTING OFFICERS
OFFICER 1:
OFFICER 2:
OFFICER 3:
OFFICER 4;

MENTALLY AFFLICTED?
Cy) Yes (J(N)No [](U) Unk

ARREST TYPE:
[1(S) Summons / Cited

ATOLMATION Report generated: 4/13/2023 10:34 PM

SUSPECT #1

MOBILE PHONE: OTHER PHONE:

RACE: [[](W) White [7](B) Black [[](1) American Indian
Ca) Asian / Pacific Islander Ow) Unknown

OCCUPATION / EMPLOYER:

WEAPONS AT ARREST;
(001) Unarmed
Ola 1) Firearm (Unk)

~~ Oa2) Handgun

~~ [J13) Rifle

~ (04) Shotgun

~~ (105) Other Firearm

HEIGHT:
Ft

In

D.L. / ID No. (STATE) WEIGHT:

Lbs

(onewone --\y)

OC) On View Arrest
Cir) Taken Into Custody
Ca6) Iegal Cutting Instrument

Sees Ci 17) Club/Blackjack/Brass

OFFICER 5
OFFICER 6:
OFFICER 7:
OFFICER 8:

Suspect information continued on next page.

Page 3 of 6

INCIDENT NUMBER 2023-041260

SUSPECT #1
SUSPECT # NAME (Last, First, Middle)
1
COMPLEXION: HAIR STYLE: HAIR COLOR: FACIAL HAIR: DEMEANOR: SCAR / MARK:
(1) Light |] (1) Black |\/](01) Clean Shaven (O01) Angry (01) Head
| |(2) Medium | _|(2) Blonde | _](02) Unshaven | _|(02) Apologetic (02) Neck
| _](3) Dark |_}(3) Brown (03) Full Beard | (03) Calm (03) Hand (rt)
(4) Acne (4) Grey (04) Must. (hvy) (04) Irrational (04) Hand (Ift)
(5) Freckled i (5) Red (05) Must. (thin) (05) Nervous (05) Arm (rt)
(6) Ruddy (6) Sandy (06) Brows (hvy) (06) Polite (06) Arm (If)
(7) Other (7) Other (07) Brows (thin) (07) Professional (07) Body
(8) Unknown (8) Unknown (08) Side Burns (08) Stupor Flos) Leg (rt) 4
i (09) Goatee (09) Violent (09) Leg (1ft) (9) Unknown
HAIR LENGTH: (10) Other EYE COLOR: (10) Other (10) Drunk /High — [-](10) Other
[](1) Long (11) Unknown [](1) Blue (11) Unknown (11) Other (11) None TATTOO LOC:
(2) Medium BUILD: |\/|(2) Brown (12) Unknown |_}(12) Unknown ()(01) Am (ift)
(3) Short : (3) Grey (02) Arm (rt)
(4) Bald(ing) (4) Green CLOTHING DESCRIPTION: (03) Leg (If)
(5) Other (5) Hazel (04) Leg (rt)
(6) Unknown (6) Other HAT _—$—_ $$ | F005) Hana ct
(4) Muscular (J?) Unknown | COAT (06) Hand (rt)
| _|(5) Unknown SHIRT (07) Face
PANTS/DRESS (08) Neck
SHOES (09) Finger(s)
Sa ae (10) Chest
(11) Back
ADDED DESCRIPTION:
na

Page 4 of 6

INCIDENT NUMBER 2023-041260

NARRATIVE

OFFICERS RESPONDED TO THIS LOCATION (METHODIST CHILDREN'S HOME) IN REFERENCE TO A DISTURBANCE
IN PROGRESS. STAFF ADVISED THERE WAS A JUVENILE MALE ON SCENE DESTROYING PROPERTY AND MAKING
THREATS TOWARDS STAFF MEMBERS. UPON ARRIVAL, OFFICERS MADE CONTACT WITH EMPLOYEE STEPHANIE
MCCRAW. MS. MCCRAW STATED JUVENILE 1 (SUSPECT) ARRIVED AT THE FACILITY AROUND 1630 HOURS AND WAS
IMMEDIATELY AGGRESSIVE AND HOSTILE WITH STAFF MEMBERS. MS. MCCRAW STATED WHEN THEY BEGAN THEIR
MEDICAL ASSESSMENT ON JUV. 1, HE BEGAN TEARING UP PROPERTY IN THE LOBBY. MS, MCCRAW STATED SHE
ADVISED ANOTHER STAFF MEMBER TO CALL THE POLICE, AND JUV. 1 THEN SLAPPED HER ACROSS THE FACE.
OFFICERS DID NOT OBSERVE ANY MARKS TO MS. MCCRAW'S FACE WHILE ON SCENE. OFFICERS MADE CONTACT
WITH JUV. 1 WHO CONTINUED TO BE HOSTILE TOWARDS OFFICERS AND MEMS. MS. MCCRAW REQUESTED JUV. 1
BE TAKEN TO CHILDREN'S HOSPITAL FOR ASSESSMENT AND REPLACEMENT. JUV. 1 WAS RESTRAINED BY MEMS
STAFF DUE TO HIM ATTEMPTING TO KICK THE PARAMEDICS ON SCENE. HE WAS TAKEN TO CHILDREN'S HOSPITAL
VIA MEMS WITHOUT INCIDENT WHERE HE RECIEVED MEDICAL ATTENTION. MS. MCCRAW WAS GIVEN AN INCIDENT
NUMBER ON SCENE. MS, MCCRAW ADVISED THE FACILITY POSSIBLY HAD CAMERAS THAT CAPTURED THE
INCIDENT AND OFFICERS ADVISED HER ON THE PROCESS OF SEEKING WARRANTS. MVR AND BWC IN USE.

Page 5 of 6

INCIDENT NUMBER 2023-041260 L@gNTFOFMALION — Report generated: 4/13/2023 10:34 PM

ADDITIONAL HOMICIDE CIRCUMSTANCES ma) Criminal attacked a civilian Ow) Criminal resisted arrest

Ow) Criminal attacked police officer, that officer killed criminal Cw) Criminal attempted flight from a crime O° Unable to determine /
([](8) Criminal attacked police officer, criminal killed by other officer (J(E) Criminal killed in commission of a crime not cnough information

RELATED CASE NUMBER(S)
CAR JACKING? [YES [ZNO DRIVE-BY? [YES [ZNO GANG RELATED? [YES [¥]No

HATE/BIAS RELATIONSHIP: —[¥](88) None [J YES, SEE BELOW
RACIAL (Anti-) RELIGIOUS (Anti-) ETHNICITY / NATIONAL ORIGIN (Anti-)_ SEXUAL (Anti)

CJq1) white [](21) Jewish (132) Hispanic (141) Male Homosexual (Gay)
[_](12) Black [_](22) Catholic (](33) Other Ethnicity (J (42) Female Homosexual (Lesbian)
(13) American Indian / [_](23) Protestant . [](43) Homosexual (Gay and Lesbian)
CU Aiaskan Native [](24) Islamic (Muslim) PIRARILTEY (ee) 144) Heterosexual
(](14) Asian / Pacific Islander [_](25) Other Religion (161) Physical Disability (1(45) Bisexual
[_J(15) Multi-Racial Group (1(26) Multi-Religious Group {_](52) Mental Disability
(27) Atheist/Agnostic

Page 6 of 6


state: AR

facility_name: United Methodist Children's Home - Little Rock

summary: Officers were advised that 4 van windows were broken out by one of the residents.

raw_content:
LITTLE ROCK POLICE DEPARTMENT INCIDENT REPORT

(JUVENILE INFORMATION .
ACPO 8 ¢

(INCIDENT NUMBER

2023-037587

[INCIDENT DATE

4/4/2023 4:14:27 PM

INCIDENT .

LOCATION OF INCIDENT (ADDRESS / BUSINESS NAME)

Report.generated: 4/5/2023 6:42 AM
YPE OF CALL

CRMISC

DISTRICT

2002 S FILLMORE ST
54

OFFENSE

INCIDENT OFFENSE TYPE

|, CRIMINAL MISCHIEF 1ST CEGREE MISO

SUSPECTS USED;

(J(A) Alcohol (J(D) Drugs

(-](C) Computer Equip ZN) Now Applicable /
nknown

(1.8) Buying / Receiving
ACE) Exploiting Children

L1(P) Distributing / Selling

LOCATION CODE:
(001) Air/ Bus / Train Terminal
([)(02) Bank / Savings & Loan
([)(03) Bar / Night Club

(2104) Chureh / Synagogue / Temple
[1(05) Commercial / Office Building
[J(06) Construction Site

(J(07) Convenience Store

C08) Department / Discount Store
[](09) Drug Store / DR Office / Hospital
(J(10) Field / Woods

(-J(11) Government / Public Building
Ci 12) Grocery / Supermarket
(13) Highway / Road / Alley
(14) Hotel / Motel / Ete

(5) Jail / Penitentiary

(16) Lake / Waterway

(107) Liquor Store

[Z](18) Parking Lot / Garage

(119) Rental / Storage Facility
(2120) Residence / House

C121) Restaurant

(122) School / College

(1023) Service / Gas Station

De) Specialty Store (TV, Fur, Etc)
(105) Other / Unknown

O67) Abandoned/Condemned Structure
(168) Amusement Park

C169) Arena / Stadium / Fairgrounds
Ceo) ATM Separate from Bank
(]41) Auto Dealership New / Used
a2) Camp / Campground

(FOR BURGLARY ONLY) METHOD OF ENTRY:

NUMBER OF PREMISES ENTERED Oe) Forcible Ow) No Force

(no [other

NARCAN USED: []Yes

ENTRY DATE REPORTING OFFICER
04/04/2023 23:27:56 | DREW TALBERT |

TYPE OF CRIMINAL ACTIVITY:

On Transport / Transmit / Import Cw) Using / Consuming

OFFENSE STATUS

‘AA -8-H
HHH 'H
GANG RELATED INFO:
Ow Juvenile Gang
CG) Other Gang
(JQ) None / Unknown

Attempted
Completed

Attempted
Completed

oO (C) Cultivate / Manufacture / Publish
Oo) Operating / Promoting / Assisting

(1() Possessing / Concealing

[J (44) Daycare Facility ([](51) Rest Area

(1145) Dock / Wharf/ Freight Terminal [[](52) School - College / University
Os) Farm Facility 163) School - Elementary / Secondary
Oa Gambling / Casino / Racetrack C4) Shelter - Mission / Homeless
Os) Industrial Site (16s) Shopping Mall

(1149) Military Installation (166) Tribal Lands

(150) Park / Playground O67) Community Center

(on 11-15, an “A" denotes Automatic or Semi-Automatic)

(150) Poison

[J (60) Explosives

[1] (65) Fire / Incendiary Device

oO Narcotics / Drugs /
Sleeping Pills

WEAPON FORCE:
Ola 1) Firearm (Unknown)

~ (12) Handgun
~~ [13 Rifle
~~ 14) shotgun
— (C5) Other Firearm
Deo) Knife / Cutting Instr (Axe, etc)
(1030) Blunt Object (Club, etc)
(16s) Motor Vehicle (as weapon)
[¥](40) Personal Weapons (hands, etc)

[1(85) Asphyxiation
[](90) Other

4 (95) Unknown
oO (99) None

ORIGINAL APPROVING SUPERVISOR

MICHAEL WILBANKS - MIMVR in use

LRPD Form 5501-01 Rev. RMS-2019-01-23 Page | of 9

INCIDENT NUMBER 2023-037587

VICTIM
VICTIM # NAME (Last, First, Middle) or BUSINESS
1 METHODIST FAMILY

ADDRESS:
2002 S FILLMORE ST LITTLE ROCK AR 72204

HOME PHONE: WORK PHONE: MOBILE PHONE: OTHER PHONE:
5012989155

SEX: [[](M) Male ETHNICITY: [_](H)Hispanic RACE: [[](W) White [[](B) Black [[](1) American Indian | DATE OF BIRTH
(UF) Female (Z](U) Unk. | [F](N) Non-Hispanic [7](U) Unk, (tA) Asian / Pacific Islander [7](U) Unknown 01/01/2011

RES. STATUS: [Z](R) Resident | MENTALLY AFFLICTED? OCCUPATION / EMPLOYER:
CW) Nonresident [](U) Unknown | [](Y) Yes [¥J(N)No [](U) Unk.

AGE: : RELATIONSHIP OF THIS VICTIM TO SUSPECTS
Exact Age: 12 SUSPECT(S) VICTIM WAS: (by Suspect Number)
Range: > (BB) 7-364 Days Old (SE) Spouse (AQ) Acquaintance

Cnn) Under 24 Hrs. Old [£](99) Over 98 Years Old D.L. /1D No. (STATE) Set gi (FR) Friend
CNB) 1-6 Days Old (00) Unknown (PA) Parent (NE) Neighbor

(SB) Sibling (BE) Babysitter (baby)
THIS VICTIM RELATED TO WHICH OFFENSES? (CH) Child (BG) Boy/Girl Friend

Mi Ce 03 O4 Os Oe 7 Os (GP) Grandparents (CF) Child of BE / GF

(GC) Grandchild (HR) Homosexual Rel,
(IL) Inlaw (XS) Ex-Spouse

VICTIM TYPE: [[](1) Individual — [](B) Business [[](F) Financial Inst. [[](U) Unknown

(1G) Government [](R) Religious [7](S) Society / Public [[](O) Other
(SP) Stepparent (EE) Employee

(SC) Stepchild (ER) Employer

(SS) Stepsibling (OK) Otherwise Known
(OF) Other Family (RU) Relationship Unknown
(ST) Stranger (VO) Victim Was Suspect

VICTIM INJURY:

Mw) None Cm) Apparent Minor Injury C1) Apparent Broken Bones
[1() Possible Internal Injury [[](T) Loss of Teeth [J(L) Severe Laceration
Oo) Other Major Injury Ci U) Unconsciousness

AGGRAVATED ASSAULT / HOMICIDE: [[](01) Argument ()(02) Assault on Law Enf Officer — [[](03) Drug Deal

[_] (04) Gangland [[1(05) Juvenile Gang [_](06) Lover's Quarrel (107) Mercy Killings

[J (08) Other Felony Involved C09) Other Circumstances Ci 10) Unknown Circumstances Oe) Criminal Killed by Private Citizen
[J(21) Criminal Killed by Police Officer — [-](30) Child Playing w/ Weapon (](31) Gun-Cleaning Accident (21032) Hunting Accident

103) Other Negligent Weapon Handling (034) Other Negligent Killings

CLOTHING DESCRIPTION

HAT SHIRT SHOES
COAT. PANTS/DRESS

Page 2 of 9

INCIDENT NUMBER 2023-037587 TTOFMATION — Report generated: 4/5/2023 6:42 AM

SUSPECT #1
SUSPECT # NAME (Last, First, Middle)
1

ARRESTEE #

HOME PHONE WORK PHONE: MOBILE PHONE: OTHER PHONE:

SEX: [Z](M) Male ETHNICITY; [[](H)Hispanic RACE; [¥](W) White [[](B) Black [[](1) American Indian | DATE OF BIRTH
(U(&) Female =[[](U) Unk. | (CN) Non-Hispanic [F](U) Unk. (tA) Asian / Pacific Islander [7](U) Unknown

RES. STATUS [ZJ(R) Resident | MENTALLY AFFLICTED? OCCUPATION / EMPLOYER:
(J) Nonresident [](U) Unknown | (](¥) Yes [7](N)No [](v) Unk

AGE: SUSPECTS ACTIONS RELATED TO : HEIGHT; WEAPONS AT ARREST:

Exact Age: 14 Hy: Hy. Hy; Hy: re ([)(01) Unarmed
1
Range * L_]vs V6 v7 V8 Z Ola 1) Firearm (Unk)

Cc (99) Over 98 Years Old DISPOSITION OF JUVENILE: D.L, /ID No, (STATE) WEIGHT: Oa2) Handgun
C00) Unknown (H) Handled within Department Lb — 7
(R) Referred outside Department a8 (1(13) Rifle
C4) Shotgun
THIS SUSPECT RELATES TO WHICH OFFENSES? ARREST TYPE Ow) On View Arrest —

(J(15) Other Firearm
WM O2 O3 O4 Os Ce G7 [Cs | Lis) Summons / cited (A(t) Taken Into Custody a

(9 yauone --y)

C]«16) Illegal Cutting Instrument

ARREST LOCATION: ARREST DATE (117) Club/Blackjack/Brass

CHARGE; §-38-203M

ARRESTING OFFICERS

OFFICER 1! OFFICER 5;
OFFICER 2: OFFICER 6:
OFFICER 3: OFFICER 7;
OFFICER 4; OFFICER 8;

Suspect information continued on next page.

Page 3 of 9

INCIDENT NUMBER 2023-037587

SUSPECT #
1

NAME (Last, First, Middle)

COMPLEXION: HAIR STYLE;

(01) Afro
(02) Wavy
(03) Straight
(04) Curly (4) Grey
(05) Braided (5) Red

(06) Ponytail | _|(6) Sandy
(07) Military | |(7) Other
Iv]

HAIR COLOR:
(1) Black
(2) Blonde
(3) Brown

| _|(2) Medium

| _|(5) Freckled

| |(6) Ruddy

(8) Unknown (08) Processed /](8) Unknown
(09) Wig/Toupee

| _](10) Other

(11) Unknown

BUILD;

HAIR LENGTH:

(1) Long
(2) Medium

EYE COLOR

(1) Blue
(2) Brown

|_](2) Medium
|_|(3) Heavy
|_|(4) Muscular
(5) Unknown

(7) Unknown

ADDED DESCRIPTION:

nla

SUSPECT #1

FACIAL HAIR;
(01) Clean Shaven
(02) Unshaven
(03) Full Beard
(04) Must. (hvy)
(05) Must. (thin)
(06) Brows (hvy)
(07) Brows (thin)
(08) Side Burns
(09) Goatee

[_](10) Other

[¥](11) Unknown

DEMEANOR:
(01) Angry
(02) Apologetic
(03) Calm
(04) Irrational
(0S) Nervous
(06) Polite
(07) Professional
(08) Stupor
(09) Violent
| |(10) Drunk / High
[_](1t) Other
(12) Unknown

SCAR/ MARK:
(OL) Head
(02) Neck
(03) Hand (rt)
(04) Hand (ft)
(05) Arm (rt)
(06) Arm (Ift)
(07) Body
(08) Leg (rt)
(09) Leg (Ift)

| |(10) Other

| |(11) None

(12) Unknown

CLOTHING DESCRIPTION:
HAT

COAT

SHIRT

PANTS/DRESS

SHOES

TATTOO;

(1) Designs
(2) Initials
(3) Names

| _|(4) Pictures
|_](5) Words

| _](6) Numbers
| }¢7) Insignia

TATTOO LOC:

[](01) Arm (if)
(02) Arm (rt)
(03) Leg (\ft)
(04) Leg (rt)
(05) Hand (If)
(06) Hand (rt)
(07) Face
(08) Neck
(09) Finger(s)
(10) Chest
(11) Back

Page 4 of 9

ATOFMALION — Report generated: 4/5/2023 6:42 AM

INCIDENT NUMBER 2023-037587

OTHER PERSONS - PERSON REPORTING
OTHER PERSON # | NAME (Last, First, Middle)
1 RUCKER,NICK

ADDRESS:
2002 S FILLMORE ST LITTLE ROCK AR 72204

MOBILE PHONE; OTHER PHONE:

HOME PHONE:
5012989155

WORK PHONE:

DATE OF BIRTH
01/15/1981

RACE: [[](W) White [¥](B) Black [7](1) American Indian
(0A) Asian / Pacific Islander Cv) Unknown

SEX: [V](M) Male
(1) Female [](U) Unk.

ETHNICITY: [_](H)Hispanic
[Z](N) Non-Hispanic [[](U) Unk.

RES. STATUS: [Z](R) Resident OCCUPATION / EMPLOYER:

(AN) Nonresident [[](U) Unknown

MENTALLY AFFLICTED?
Cy) Yes (CN) No [](U) Unk.

AGE: HEIGHT:
Exact Age: 42 Ft

Range: —-_____  [(eb) 7-364 Days Old
Own) Under 24 Hrs, Old O09) Over 98 Years Old
(ns) 1-6 Days Old []00) Unknown

D.L. / ID No, (STATE) WEIGHT:

COMPLEXION;
(1) Light
(2) Medium
(3) Dark
Hc Acne
[_](5) Freckled

(6) Ruddy
(7) Other
(8) Unknown

HAIR LENGTH:

[](1) Long
(2) Medium
(3) Short
(4) Bald(ing)
(5) Other
(6) Unknown

HAIR STYLE:

(01) Afro
(02) Wavy
(03) Straight
(04) Curly
(05) Braided
(06) Ponytail

[_](07) Military
(08) Processed
(09) Wig/Toupee
(10) Other
(11) Unknown

BUILD:
(1) Light
(2) Medium
(J(3) Heavy
(4) Muscular
(3) Unknown

HAIR COLOR:

(1) Black
[_](2) Blonde
(3) Brown
(4) Grey
(5) Red
(6) Sandy
(7) Other
(8) Unknown

EYE COLOR:

(Jc) Blue
(2) Brown
(3) Grey
(4) Green
(5) Hazel
(6) Other
(7) Unknown

FACAIL HAIR:

O01) Clean Shaven
(02) Unshaven
(03) Full Beard
(04) Must. (hvy)
(05) Must. (thin)
(06) Brows (hvy)
(07) Brows (thin)
(08) Side Burns
(09) Goatee
(10) Other
(11) Unknown

DEMEANOR;

(01) Angry

(02) Apologetic
(03) Calm

(04) Irrational
(05) Nervous
(06) Polite

(07) Professional
(08) Stupor

(09) Violent
(10) Drunk / High
(11) Other

[_](12) Unknown

CLOTHING DESCRIPTION

HAT

COAT

SHIRT
PANTS/DRESS
SHOES

SCAR/ MARK:

[J(01) Head
(02) Neck
(03) Hand (rt)
(04) Hand (Ift)
(05) Arm (rt)
(06) Arm (Ift)
(07) Body

(08) Leg (rt)
(09) Leg (Ift)

(10) Other
(11) None
(12) Unknown

TATTOO:

(1) Designs
(2) Initials
(3) Names
(4) Pictures
(5) Words
(6) Numbers
(7) Insignia
(8) None
(9) Unknown

TATTOO LOC:

(01) Arm (Ift)
(02) Arm (rt)
(03) Leg (Ift)
[](04) Leg (rt)
(05) Hand (Ift)
(06) Hand (rt)
(07) Face
(08) Neck
(09) Finger(s)
(10) Chest
(11) Back

Page 5 of 9

[INCIDENT NUMBER 2023-037587

VEHICLE #1

STATUS: SUBJECT HOLD AUTHORITY

YEAR: MAKE MODEL STYLE a LICENSE NO, (TYPE): LIC YEAR
2002 FORD 907XGS PC 2023
OWNER'S NAME (Last. First): =

COLOR DISPOSITION OF RECOVERY : INSURANCE POLICY #
WHI (J(1) Impounded [[](R) Release to Owner

Page 6 of 9

INCIDENT NUMBER 2023-037587

PROPERTY DRUG INFORMATION

P.LOSS | P.DES | QTY Description (ser#, color, make, model) PROP TAG | VALUE TYPE | QUANTITY | MEASURE

4 03 4.00 | UNKUNK+ 0 800 0.00
UN VAN WINDOWS

TYPE PROPERTY LOSS: (0) Stored (1) None (2) Burned (3) Counterfeited/Forged (4) Damaged/Destroyed/Vandalized (5) Recovered (6) Seized (7) Stolen, ete (8) Unknown

PROPERTY DESCRIPTION: (10) Drugs/Narcoties (21) Negotiable Instruments (32) Structures-Industrial/Manufacture
; (11) Drug/Narcotic Equipment (22) Nonnegotiable Instruments (33) Structures-Public/Community
(01) Aircraft (12) Farm Equipment (23) Office-Type Equipment (34) Structures-Storage
(02) Alcohol (13) Firearms (24) Other Motor Vehicles (35) Structures-Other
(03) Automobiles (14) Gambling Equipment (25) Purses/Handbags/Wallets (36) Tools-Power/Hand/Lawnmower
(04) Bicycles (15) Heavy Equipment Construction/ (26) Radios/TVs/VCR (37) Trucks
(05) Buses Industry (27) Recordings-Audio/Visual (38) Vehicle Parts/Accessories
(06) Clothes/Furs (16) Household Good (28) Recreational Vehicles (39) Watercraft
(07) Computer Hardware/ (17) Jewelry/Precious Metal (29) Structures-Single Occupancy (77) Other
Software (18) Livestock (30) Structures-Other Dwellings (88) Pending Inventory (of Property)

(08) Consumable Goods (19) Merchandise (31) Structures-Commercial/Business
(09) Credit Cards/Debit Cards (20) Money

TYPE DRUG MEASUREMENT;
DRUG TYPE: (D) Heroin (H) Other Narcotics — (L) Amphetamines/ (O) Other Depressants Units Weight
(A) Crack Cocaine (E) Marijuana (1) LSD Methamphetamines (P) Other Drugs Deve wal GM Oz
(B) Cocaine (F) Morphine () PCP (M) Other Stimulants (U) Unknown Type — | U)pinntee On Seo; etepaii {Ca Peon
(C) Hashish (G) Opium (K) Other Hallucino, (N) Barbituates (NP) Number of Plants

; 2 Capacity
FOR BURGLARIES: Point of Entry: (ML) Milliliter (GL) Gallon

(LT) Liter (FO) Fluid Ounce
Tools Apparently Used:

Page 7 of 9

INCIDENT NUMBER 2023-037587

NARRATIVE
NICK RUCKER SAID THAT ONE OF THE KIDS THERE BROKE OUT 4 WINDOWS FROM TWO OF THEIR VANS. THE

SUSPECT TOLD ME THAT HE WAS MAD BECAUSE HE GOT BEAT UP THE OTHER DAY AND DECIDED TO GET HIS
ANGER OUT BY BREAKING THE WINDOWS. | ADVISED MR. RUCKER THAT THEY COULD SEEK WARRANTS FOR THE
DAMAGE.

Page 8 of 9

INCIDENT NUMBER 2023-037587 ATOFMALION — Report generated: 4/5/2023 6:42 AM

ADDITIONAL HOMICIDE CIRCUMSTANCES [A(C) Criminal attacked a civilian (€) Criminal resisted arrest

Ca) Criminal attacked police officer, that officer killed criminal ml) Criminal attempted flight from a crime o® Unable to determine /
mG) Criminal attacked police officer, criminal killed by other officer Ce) Criminal killed in commission of a crime not enough information

RELATED CASE NUMBER(S)
CAR JACKING? [[JYES [¥]NO DRIVE-BY? [[]YES [ZJNO GANG RELATED? [_]YES [¥]NO

HATE/BIAS RELATIONSHIP: — [4](88) None (YES, SEE BELOW
RACIAL (Anti-) RELIGIOUS (Anti-) ETHNICITY / NATIONAL ORIGIN (Anti-) SEXUAL (Anti-)

(J(11) White (](21) Jewish (1032) Hispanic (1(41) Male Homosexual (Gay)
(_J(2) Black [_](22) Catholic (J(33) Other Ethnicity [_](42) Female Homosexual (Lesbian)
(13) American Indian / (23) Protestant . (43) Homosexual (Gay and Lesbian)
CU piaskan Native Hie Islamic (Muslim) anaes an; ice Heterosexual
(](14) Asian / Pacific Islander (] (25) Other Religion (21(51) Physical Disability [J(45) Bisexual
(_](15) Multi-Racial Group [_](26) Multi-Religious Group [_](52) Mental Disability
[](27) Atheist/Agnostic

Page 9 of 9

doc_type: Police Report


summary: Officers made contact with the caller who advised the juvenile had returned prior to the officers’ arrival.

raw_content:
LITTLE ROCK POLICE DEPARTMENT ABBREVIATED INCIDENT REPORT

[JUVENILE INFORMATION INCIDENT Report generated: 4/3/2023 11:27 PM

INCIDENT NUMBER UNIT ASSIGNED | CALL DATE CALL TIME TYPE OF CALL
2023-037 264 2X55 04/03/2023 22:39:00 MISPER

INCIDENT DATE LOCATION OF INCIDENT (ADDRESS / BUSINESS NAME) DISTRICT
2002 S FILLMORE ST

4/3/2023 10:39:38 PM 54

OFFENSE

NON POLICE INCIDENT

OFFICERS MADE CONTACT WITH THE CALLER WHO ADVISED THE JUVENILE HAD RETURNED PRIOR TO OFFICERS
ARRIVAL.

MVR/BWC IN USE.

ENTRY DATE REPORTING OFFICER ORIGINAL APPROVING SUPERVISOR i
04/04/2023 04:23:00 | BREONNA JOHNSON f | BREONNA JOHNSON P| VIMVR in use

LRPD Form 5501-01 Rev, RMS-2019-01-23 Page | of 1


summary: Officers secured the scene for MEMS.

raw_content:
LITTLE ROCK POLICE DEPARTMENT ABBREVIATED INCIDENT REPORT
INCIDENT

Report generated: 4/4/2023 7:13 PM

INCIDENT NUMBER UNIT ASSIGNED | CALL DATE CALL TIME TYPE OF CALL
2023-037212 2X52 04/03/2023 20:52:00 ASTMED

INCIDENT DATE LOCATION OF INCIDENT (ADDRESS / BUSINESS NAME)

4/3/2023 8:52:52 PM 2002 S FILLMORE ST

DISTRICT

54

OFFENSE

NON POLICE INCIDENT

OFFICERS SECURED THE SCENE FOR MEMS WITHOUT INCIDENT. MVR AND BWC IN USE.

ENTRY DATE REPORTING OFFICER ORIGINAL APPROVING SUPERVISOR MVR j
04/05/2023 00:06:48 | JORDAN RUFF , | JORDAN RUFF | | In use
LRPD Form 5501-01 Rev. RMS-2019-01-23 Page | of |


summary: A staff member hit a resident in the face with a clipboard after he “plucked her in the head”. The facility was cited 109.1.g for unprofessional conduct 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
Notice of Serious Incident
Date of Incident: 3/29/2023
Date Received by DCCECE: 3/29/2023
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Dual
Report Description: On 3/29/2023, at 701 a.m., , DHS
placement client, walked on the hallway where (staff) were sitting
on the hallway monitoring other clients. walked over to one side of chair
looking for her walkie talkie, then he went to the other side of and plucked her in
the head. stands up, stating to "boy leave me alone". reaches up
to pluck again and she reacted quickly by yelling stop and hitting in the
face with the clipboard. then continue to walk toward she extended her
arm to keep him away from her by using a little push. reported that she accidently
hit with the clipboard while trying to prevent him from plucking her. A
report was completed and the report was only documented and awaiting review from a
supervisor to determine if the report will be accepted or not. The referral number is
Corrective action plan: was suspended immediately due to
pending investigation.
Interim Action Narrative: was suspended immediately due to
pending investigation.
Maltreatment Narrative: We accepted a report involving a foster child ? The listed
?caregiver? is but quite possibly the reporter meant
Supv. Av is . He is currently in
DHS custody, and his PRFC is Out of home offender
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

is who is an employee of Methodist Family Children?s Home in
Little Rock, Ar. is currently residing at the facility and has been since January 6,
2023. Reportedly, was sitting in the hallway when came out of his room
looking for her walkie-talkie. He then asked her where it was and proceeded to ?pluck? her
in the head with his finger. It was disclosed that she told him to stop, and he attempted to
?pluck? her on the shoulder. However, reacted and swatted at him hitting him in the
face with her clipboard. It was not believed that ?s actions were intentional and
suggested that it seemed like she forgot the clipboard was in her hand. ?s nose did
bleed after being hit in the face, but he did not require outside care.
Licensing Narrative: Licensing received report from facility 3/29/23: On 3/29/2023, at 701
a.m., client walked on the hallway where (staff)
were sitting on the hallway monitoring other clients. walked over to one side of
chair looking for her walkie talkie, then he went to the other side of and plucked her
in the head. stands up, stating to "boy leave me alone". reaches up to
pluck again and she reacted quickly by yelling stop and hitting in the face with
the clipboard. then continue to walk toward she extended her arm to keep him
away from her by using a little push. reported that she accidently hit with the
clipboard while trying to prevent him from plucking her. A report was completed
and the report was only documented and awaiting review from a supervisor to determine if
the report will be accepted or not. The referral number is Corrective action
plan: was suspended immediately due to pending investigation.
3/30/23 email sent to inquire if report was accepted. The
report was accepted. Facility visited 3/30/23 and video of the incident reviewed.
Staff is sitting on the boy's hall, staff/client ratio in camera view 1:1.
6 clients reported to be on the hall at the time of the incident making staff/client ratio 1:6.
Client enters the hall and flicks staff in the head as she is sitting
down. Client attempts to flick staff in the head area again. Staff stands up and
tells client to leave her alone. Staff raises her left arm as to block from flicking
her. Staff had a clipboard in her hand when doing this. The clipboard struck client
in the face. Facility cited 109.1g. As to document sub-regulation: Engaging in behavior
that could be viewed as sexual, dangerous, exploitative, or physically harmful to children.
Staff member will be retrained in staff/client interaction in a way that is not physically
harmful to children. Received notification 6/6/23 that maltreatment complaint was
unfounded.

doc_type: Notice of Incident


summary: A resident placed a shirt around his neck, pulling it tightly and continued to choke himself until staff members removed the shirt from his neck. The facility was cited 907.2 and 907.3 for issues identified during a video review of the incident.

raw_content:
nurse reported by facility as not counted in staff/client ratio is seen observing client with
shirt around his neck. Nurse does not intervene but does stay close to client . Approx. 3
minutes after this staff are seen entering the foyer area and obtaining the shirt from client
. Client was not supervised by any staff counted in the staff/client ratio during a 6-
minute self-harm/suicidal gesture. Facility cited 907.2 and 907.3. Unit wide staff retraining
on supervision will be completed. Staff rosters for shifts 1,2 and 3 provided today for "Proper
Ratio & Supervision".


summary: Licensing visited the facility to review personnel records. The facility was cited 105.15.f, 105.15.g, 105.15.0h, and 107.4 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: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Licensee Address: 2002 SOUTH FILLMORE
LITTLE ROCK AR 72204
Licensing Specialist: Clayton DeBoer
Person In Charge:
Record Visit Date: 3/24/2023
Home Visit Date: 3/24/2023
Purpose of Visit: Personnel Records
Regulations Out of Compliance:
Regulation Number: 1. 105. 15 .f
Regulation Description: The agency shall maintain a personnel file for each employee, which shall include:
Findings Description: Item not present in file.
Action Due Date:
Action Due Description:
Comply Date:
Sub Regulation Description:
Regulation Number: 1. 105. 15 .g
Regulation Description: The agency shall maintain a personnel file for each employee, which shall include:
Findings Description: Item not present in file.
Action Due Date:
Action Due Description:
Comply Date:
Sub Regulation Description:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 3

Regulation Number: 1. 105. 15 .h
Regulation Description: The agency shall maintain a personnel file for each employee, which shall include:
Findings Description: Item not present in file.
Action Due Date:
Action Due Description:
Comply Date:
Sub Regulation Description:
Regulation Number: 1. 107. 4
Regulation Description: The agency shall document that all staff have been made aware of the need to protect
the confidentiality of children in the use of social media.
Findings Description: Item not present in file.
Action Due Date:
Action Due Description:
Comply Date:
Sub Regulation Description:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Personnel Records reviewed for:
Monica Y.
Lisa B.
Delores B.
Ladonna F.
Eva D.
Marquita J.
Danielle P.
Pamela W.
Shaniya Y.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 3

Derrick B.
Staff Derrick B.'s job title is Lead Maintenance. Staff did not have present in file: Resume or application,
documentation that employees are made aware of they are mandated reports of suspected child maltreatment
and have been given information on how to make a report, functional job description, 3 positive personal
references from non-relatives, and social media confidentiality. These items will need to be produced for this
staff member's file by 4/24/23.
Facility cited 105.15f, 105.15g, 105.15h and 107.4.
Provider Comments:
CCL Staff Signature : Date: 3/24/2023
Provider Signature : Date: 3/24/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 3 of 3

doc_type: Compliance Report


summary: Licensing provided technical assistance for 102.3.h, because it was determined that the facility’s current policy for “Reporting Instances of Abuse or Neglect” did not comply with Arkansas state law requirements on mandated reporting.

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: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Licensee Address: 2002 SOUTH FILLMORE
LITTLE ROCK AR 72204
Licensing Specialist: Clayton DeBoer
Person In Charge:
Record Visit Date: 3/24/2023
Home Visit Date: 3/24/2023
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: It was determined that the agency's current policy on mandated reporting requires staff to
"notify their supervisor immediately to determine need to report, reporting method and whom the report is to be
submitted, what immediate work needs to be done with the child, and what work needs to be done with the
perpetrator." This is not in compliance with current Arkansas state laws on reporting which state "An employer or
supervisor of an employee identified as a mandated reporter shall not require an employee or a volunteer to obtain
permission or notify any person, including an employee or a supervisor, before reporting child maltreatment to the
Child Abuse Hotline".
Action Due Date: 4/7/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 3

Action Due Description: Please ensure that your agency reviews your current mandated reporter policy and
update it to ensure that it complies with Arkansas state law on mandated reporting. Please ensure a copy of the
new policy is provided to the licensing unit by 4/7/2023 and all staff are retrained on the new policy by 4/21/2023.
Comply Date:
Sub Regulation Description:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
The Licensing Specialist received a copy of the current policy at the agency for "Reporting Instances of Abuse or Neglect". After review of the
policy, the agency is currently using, it was determined that it does not comply with Arkansas state law requirements on mandated reporting.
Technical assistance has been provided to the agency by the licensing unit.
As to document sub-regulation 102.3h: Child Maltreatment/Mandated Reporter Policy: According to
Arkansas Law, including procedures to ensure that alleged, suspected, or witnessed incidents of maltreatment
are reported to the Child Maltreatment Hotline and documented as required by these or applicable rule or laws
Provider Comments:
We plan on reviewing our policies and procedures to determine updates that are needed.
CCL Staff Signature : Date: 3/24/2023
Provider Signature : Date: 3/24/2023
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


summary: An x-ray was ordered after a resident jammed his finger while playing basketball.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 3/23/2023
Date Received by DCCECE: 3/24/2023
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Facility Type: Residential
Incident Type: Licensing
Report Description: On 3/23/23 , age DOB client, was
playing basketball in the gym with peers. jammed his finger. It swelled up a little
bit and an x-ray was ordered. Xray came out yesterday and there was no findings of fracture
and everything was normal.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: On client was playing basketball in the gym with
peers. jammed his finger. It swelled up a little bit and an x-ray was ordered. Xray came
out yesterday and there was no findings of fracture and everything was normal. Client
remains at facility. Continue to monitor.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Licensing visited the facility to conduct a buildings and grounds walkthrough. The facility was cited 908.8 for issues identified during the review.

raw_content:
ARKANSAS
DEPARTMENT OF

> HUMAN
=a! SERVICES

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

521 Visit Compliance Report

Licensee: United Methodist Children's Home Little Rock Campus

Facility Number: 115

Licensee Address: 2002 SOUTH FILLMORE
LITTLE ROCK AR 72204

Licensing Specialist: Clayton DeBoer
Person In Charge:

Record Visit Date: 3/15/2023

Home Visit Date: 3/15/2023

Purpose of Visit: Monitor Visit

Regulations Out of Compliance:

Regulation Number: 9. 908. 8

Regulation Description: The administering of all medications, including over-the-counter, shall be logged at the
time the medication is given, by the person administering the medication.

Findings Description: According to MAR, AM meds are to be distributed at 0800. At 0922 the AM meds were not
initialed. The nurse indicated that AM meds were distributed at 0800 but had not been initialed yet.

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:

Buildings & Grounds conducted from 9:00AM-10:00AM. Census: 28

4 classrooms observed. Staff/client ratios: 2:9, 2:7, 2:5 and 1:1. Foyer observed to have staff/client ratio 1:2.
Hallway observed to have staff/client ratio 1:2.

Sleeping quarters halls A and B observed to be furnished, clean, and in good repair. One bathroom out of
order and locked on this floor leaving 3 operational, clean and sanitary bathrooms for 18 clients. Outside
recreation area observed to be clean, safe and free of safety hazards. Cafeteria observed to be clean and
sanitary.

MAR checked for:

MAR was checked at 9:22AM. According to the MAR, AM meds are to be distributed at 0800 (8AM) but had
not been initialed at 9:22AM. Nurse consulted who stated that she had not yet initialed AM meds.
Conversation had with Compliance Director Shannon Rouse on the importance of initialing medications at the
time of distribution. Facility cited 908.8: Medication, including over the counter, shall be logged at the time
the medication is given, by the person administering the medication.

Provider Comments:

Facility will retrain and reiterate the importance of logging medications at the time of administration.

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

CCL Staff Signature :

www.arkansas.gov/dhs

Serving more than one million Arkansans each year

Date: 3/15/2023

Date: 3/15/2023

Page 3 of 3


summary: Complainant advised a juvenile ran from the facility but returned prior to officer’s arrival.

raw_content:
LITTLE ROCK POLICE DEPARTMENT ABBREVIATED INCIDENT REPORT

INCIDENT Report generated: 3/11/2023 6:54 PM

INCIDENT NUMBER UNIT ASSIGNED CALL DATE CALL TIME TYPE OF CALL
2023-027902 2X54 03/11/2023 | 17:37:00 MISPER
INCIDENT DATE LOCATION OF INCIDENT (ADDRESS / BUSINESS NAME) DISTRICT
3/11/2023 5:37:13 PM ne 54

OFFENSE

COMPLAINANT ADVISED A JUVENILE RAN FROM THE LOCATION, BUT RETURNED PRIOR TO OFFICER'S ARRIVAL.
OFFICERS MADE CONTACT WITH THE COMPLAINANT TO ENSURE EVERYTHING WAS OK. BWC IN USE.

ENTRY DATE REPORTING OFFICER ORIGINAL APPROVING SUPERVISOR MVRi
03/12/2023 00:52:43 | BRANDON LIKINS BRANDON LIKINS , om ee


summary: Two residents engaged in a verbal and physical altercation. The facility was provided technical assistance on regulation 907.2 as a result of this incident.

raw_content:
Corrective action that has taken place, clients are placed on 10ft, and placed on separate
sleeping halls. Phone call made to staff Justin King 3/14/23 who stated that the
was called because of the age difference between the clients, having just turned
and being was reported at the A/V and was reported as the A/O.
call was screened out. Facility visited 3/14/23 and video reviewed from
3/10/23. Client is seen in the Boy's foyer area with one staff, , and another
client, . Client is swinging as to hit staff . Staff is observed
holding out his arm as to prevent client from hitting him. This lasts for a few minutes.
Client is seen attacking client and hitting him. Staff immediately
intervenes to break up the fight. At this point additional staff assist. Client is eventually
deescalated and evaluated by the nurse. Facility provided Technical/Assistance on
regulation 907.2: Childcare 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. Staff will be retrained on asking for staff
assistance when needed.


summary: An x-ray was ordered after a resident’s hand was pinned between a door handle and the wall.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 3/8/2023
Date Received by DCCECE: 3/10/2023
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Facility Type: Residential
Incident Type: Licensing
Report Description: On March 8th 2023, age was in the gym
with his peers. Non DHS client. Empower provider. got out of line and put his left
hand behind the door handle. The door handle and the wall pinned his left hand slightly.
was assessed by the nurse and given an ice pack. The following day
complained of some pain. A x-ray was ordered and on 3/9/23 and results were sent back.
The results are no acute fracture or dislocation to his left hand.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative:On 3/8/23, client was in the gym with his peers.
got out of line and put his left hand behind the door handle. The door handle and the wall
pinned his left hand slightly. was assessed by the nurse and given an ice pack. The
following day complained of some pain. A x-ray was ordered and on 3/9/23 and
results were sent back. The results are no acute fracture or dislocation to his left hand.
Client remains at facility. Continue to monitor.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 3/8/2023
Date Received by DCCECE: 3/13/2023
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Facility Type: Residential
Incident Type: Licensing
Report Description: On 3.8.23 client age 13 DOB (non DHS) was
in the gym in line. got out of line and put his hand behind a door, and the door
closed his hand in between the door handle and wall. A x-ray was ordered and there were no
findings. A second x-ray was ordered by the APRN to x-ray clients wrist to make sure
everything was normal. Date of the exam was 3/11/2023 and x-ray on the left wrist. No
fracture line or cortical irregularity is evident. There is normal alignment. Joint spaces are
well maintained with no degenerative change.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative:Follow up X-ray. See Case#013181. On 3.8.23 client was
in the gym in line. got out of line and put his hand behind a door, and the door
closed his hand in between the door handle and wall. An x-ray was ordered and there were
no findings. A second x-ray was ordered by the APRN to x-ray client's wrist to make sure
everything was normal. Date of the exam was 3/11/2023 and x-ray on the left wrist. No
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

fracture line or cortical irregularity is evident. There is normal alignment. Joint spaces are
well maintained with no degenerative change. Client remains at facility. Continue to
monitor.


summary: Staff overheard a resident telling his mother that another resident touched him inappropriately and showed him his private parts. The facility was cited 907.2 and 907.3 and received technical assistance for 110.9.a as a result of this incident.

raw_content:
ARK ANS 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: 3/8/2023

Date Received by DCCECE: 3/13/2023

Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115

Facility Type: Residential

Incident Type: Licensing

Report Description: On 3.12.23 den 3 2 age DOB (non DHS
client) was talking to his mom on the phone. Staff overheard tate that another
client PF age a DOB a (non DHS client) touched him inappropriately
and showed bis private parts. told his mother that this happened on
Thursday. Consultant was notified during the phone call. Consultant came in on Monday
and spoke vi told consultant when and where this happened.
Consultant watched video footage on the incident of Wednesday morning and noticed that
both clients were in the hallway horse playing. pulled his pants down and exposed
himself to about 7:04am. At 7:09am you see enter I's room and
the door shuts, a couple seconds later you see the door re-open with hand
leaving private area. Both clients are dressed. ‘cee. 31323:
referral number is fF for documentation purposes. Action taken place is that the boys
are on separate hallways, 10 foot restriction, and Jj will be on SAO precautions.

Interim Action Narrative:

Maltreatment Narrative:

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

Licensing Narrative:On 3.12.23 cen 3 was talking to his mom on the
phone. Staff overheard state that another client touched him
inappropriately and showed [his private parts I told his mother that this
happened on Thursday. Consultant was notified during the phone call. Consultant came in
on Monday and spoke wil Ei i told consultant when and where this
happened. Consultant watched video footage on the incident of Wednesday morning and
noticed that both clients were in the hallway horse playing. J pulled his pants down
and exposed himself to P| about 7:04am. At 7:09am you see | enter

s room and the door shuts, a couple seconds later you see the door re-open with
PY hand leaving ivate area. Both clients are dressed. a
called on 3.13.23. referral number ‘ : documentation purposes. Action taken place
is that the boys are on separate hallways, 10 foot restriction, and will be on SAO
precautions. Facility visited 3/14/23 and video reviewed from 3/8/23. Clients i and ||
are observed horseplaying in the doorway and room of J. At one point JJ pulls the front
of his pants down in front of J. At one point Uf is seen grabbing at [JJ's groin area while
Bwas on his bed. No staff are present on the hallway for most of the video. Staff were

made aware of this incident by screening a phone call made with his mother on 3/12/23.
UMCH staff made the a | 13/23. Technical Assistance given on
regulation 110.9a: Any owner, operator, employee, foster parent, or volunteer in a child

welfare agency shall immediately notify the Child Abuse Hotline if they have reasonable
cause to suspect that a child has been subjected to child maltreatment. Facility cited 907.2

/14/23 ref#t

that no staff were observed supervising these clients a this incident in video viewed

and 907.3. Licensing made another report to the

3/14/23. Received correspondence 3/15/23 that as not accepted.

_ ARKANSAS
) DEPARTMENT OF

«| 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: United Methodist Children's Home Little Rock Campus

Facility Number: 115

Licensee Address: 2002 SOUTH FILLMORE
LITTLE ROCK AR 72204

Licensing Specialist: Clayton DeBoer
Person In Charge:

Record Visit Date: 3/14/2023

Home Visit Date: 3/14/2023

Purpose of Visit: Self Report 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: No staff were present on the hallway during this incident.

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: No staff were present on the hallway during this incident.

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:

On 3.12.23 clien J was talking to his mom on the phone. Staff overheard [JJ state that another client [JJ touched him
inappropriately and showed his private parts. || told his mother that this happened on Thursday. Consultant was notified
during the phone call. Consultant came in on Monday and spoke with a. Biltold consultant when and where this happened.
Consultant watched video footage on the incident of Wednesday morning and noticed that both clients were in the hallway
horse playing. Jpulled his pants down and exposed himself to JJ about 7:04am. At 7:09am you see [JJ enter J room
and the door shuts, a couple seconds later you see the door re-open with || hand leaving | | private area. Both clients are
dressed. Rie: 3.13.23. referral for documentation purposes and was not accepted. Action taken place is that
the boys are on separate hallways, 10 foot restriction, andy will be on SAO precautions.

Facility visited 3/14/23 and video reviewed from 3/8/23. Clients [JJ and [fare observed horseplaying in the doorway and
room off. At one point [J pulls the front of his pants down in front of J At one point [fis seen grabbing at J groin
area while || was on his bed. No staff are present on the hallway for most of the video. Staff were made aware of this
incident by screening a phone call | | made with his mother on 3/12/23. UMCH staff made the

3/13/23.

Technical Assistance given on regulation 110.9a: Any owner, operator, employee, foster parent, or volunteer in a child
welfare agency shall immediately notify the Child Abuse Hotline if they have reasonable cause to suspect that a child has
been subjected to child maltreatment.

Facility cited 907.2 and 907.3.

Facility will be conducting in service training to staff on supervision and ratio a will provide sign-in sheets for
this training to licensing when training is completed.

Provider Comments:

In response to the supervision, facility will perform an in-service and retraining of staff where they will review
footage and retrain on the 15-minute check policy and procedure. Staff will also retrain on monitoring position
when on the unit. In response to the hotline call, the term "immediately" is up for interpretation. The hotline was
called within 24 hours of knowledge of the incident.

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

CCL Staff Signature : Date: 3/14/2023

\

Provider Signature : Date: 3/14/2023

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


summary: Upon arrival to the facility, officers made contact with a staff member who reported that a juvenile was kicking the wall and causing damage to the building.

raw_content:
LITTLE ROCK POLICE DEPARTMENT INCIDENT REPORT
INCIDENT Report generated: 3/8/2023 10:51 PM

UNIT ASSIGNED CALL DATE CALL TIME TYPE OF CALL

(JUVENILE INFORMATION

INCIDENT NUMBER

2023-026754

INCIDENT DATE

2X40

03/08/2023 20:56:00 CRMISC

LOCATION OF INCIDENT (ADDRESS / BUSINESS NAME) DISTRICT

3/8/2023 8:56:32 PM

INCIDENT OFFENSE TYPE

1, CRIMINAL MISCHIEF 1ST DEGREE MISD

SUSPECTS USED:
(1A) Alcohol (1(P) Drugs

2002 S FILLMORE ST
54

OFFENSE

OFFENSE STATUS

Attempted | |

Completed WZ 2 3 4
Attempted

Completed sH ‘A "A ‘H

TYPE OF CRIMINAL ACTIVITY: GANG RELATED INFO:

Ce) Buying / Receiving

Oe Computer Equip wm™ Not Applicable / (J (£) Exploiting Children
Unieaw (J (1) Transport / Transmit /Import [[](U) Using / Consuming (JN) None / Unknown

wh

LOCATION CODE:
(-](01) Air / Bus / Train Terminal
(](02) Bank / Savings & Loan
[](03) Bar / Night Club

(J (04) Church / Synagogue / Temple
[_](05) Commercial / Office Building
[-] (06) Construction Site

(7) Convenience Store

ma) Department / Discount Store
{](09) Drug Store / DR Office / Hospital
([](10) Field / Woods

(J(1) Government / Public Building
Oo (12) Grocery / Supermarket
(13) Highway / Road / Alley
(144) Hotel / Motel / Ete

(15) Jail / Penitentiary

(FOR BURGLARY ONLY)
NUMBER OF PREMISES ENTERED

(J) Distributing / Selling

Cc (16) Lake / Waterway

([Ja7) Liquor Store

(J18) Parking Lot / Garage

Olas) Rental / Storage Facility

(20) Residence / House

(11) Restaurant

(J22) School / College

(123) Service / Gas Station

([] (24) Specialty Store (TV, Fur, Ete)
([] (25) Other / Unknown

(167) Abandoned/Condemned Structure
(J (38) Amusement Park

CO (39) Arena / Stadium / Fairgrounds
(140) ATM Separate from Bank
[[](41) Auto Dealership New / Used
O (42) Camp / Campground

METHOD OF ENTRY:

CA) Forcible [[]0N) No Force

NARCANUSED: [yes [[JNo [Other

ENTRY DATE REPORTING OFFICER
03/09/2023 03:41:15 | DESIDARIO PULLIE

[_](C) Cultivate / Manufacture / Publish (1) Juvenile Gang
Co) Operating / Promoting / Assisting | (G) Other Gang

Ole) Possessing / Concealing

[J(44) Daycare Facility CGI) Rest Area

(145) Dock / Wharf / Freight Terminal [7](52) School - College / University
[1 (46) Farm Facility (£1653) School - Elementary / Secondary
(147) Gambling / Casino / Racetrack — [_](54) Shelter - Mission / Homeless
(048) Industrial Site C15) Shopping Mall

(149) Military Installation ()(56) Tribal Lands

(160) Park / Playground (-](57) Community Center

WEAPON FORCE: (on I L-15, an "A" denotes Automatic or Semi-Automatic)

(Ja) Firearm (Unknown) [-]0) Poison

~~ Oi 12) Handgun (0) Explosives

__ (13) Rifle [_](65) Fire / Incendiary Device

— [J(14) Shotgun oO” Narcotics / Drugs /
(Jd5) Other Firearm Sleeping Pills

Deo) Knife / Cutting Instr (Axe, ete) (1@s) Asphyxiation

[_](30) Blunt Object (Club, ete) [J 90) Other

[-](35) Motor Vehicle (as weapon) (J 5) Unknown

[_]40) Personal Weapons (hands, etc) mic) None

ORIGINAL APPROVING SUPERVISOR

KALVIN SNOW VIMVR in use

INCIDENT NUMBER 2023-026754 (JUVENILE INFORMATION Report generated: 3/8/2023 10:51 PM

VICTIM
VICTIM # NAME (Last, First, Middle) or BUSINESS
1 SMITH, TAMICA

ADDRESS:
2002 S FILMOORE ST LITTLE ROCK AR 72204

HOME PHONE: WORK PHONE: MOBILE PHONE: OTHER PHONE:
5019064913

sEX: [_](M) Male ETHNICITY: [[](H)Hispanic RACE: [[](W) White [¥](B) Black [[](1) American Indian | DATE OF BIRTH
[V](F) Female [[](U) Unk. | [V](N) Non-Hispanic (Cw) unk. (A) Asian / Pacific Islander [](U) Unknown 07/14/1974

RES.STATUS: — [¥J(R) Resident | MENTALLY AFFLICTED? OCCUPATION / EMPLOYER:
(UN) Nonresident [[](U) Unknown | [](¥) Yes [¥](N)No [](U) Unk.

AGE: E RELATIONSHIP OF THIS VICTIM TO SUSPECTS

Exact Age: 48 SUSPECT(S) VICTIM WAS: (by Suspect Number)
Range: __ C)cs) 7-364 Days Old (SE) Spouse (AQ) Acquaintance
Conn) Under 24 Hrs, Old [[](99) Over 98 Years Old Dil 1D No, (STATED ene (FR) Friend

Spouse

(Uns) 1-6 Days Old (](00) Unknown (PA) Parent (NE) Neighbor

(SB) Sibling (BE) Babysitter (baby)
THIS VICTIM RELATED TO WHICH OFFENSES? (CH) Child (BG) Boy/Girl Friend

Mi C2 23 C4 Os Ob 7 Cs (GP) Grandparents (CF) Child of BF / GF

VICTIM TYPE: [¥](1) Individual © [[](B) Business [[](F) Financial Inst. [[](U) Unknown (SG) Grancehild! — _{s) Haomosesnal al

1G) Government [[](R) Religious [[](S) Society / Public [[](O) Other etd lay ES) Bese

(SP) Stepparent (EE) Employee
(SC) Stepchild (ER) Employer
(SS) Stepsibling (OK) Otherwise Known

VICTIM INJURY:
[Z](N) None (JM) Apparent Minor Injury [_](B) Apparent Broken Bones
[_] (1) Possible Internal Injury (_](T) Loss of Teeth (1) Severe Laceration

(OF) Other Family (RU) Relationship Unknown)
[](©) Other Major Injury [_](U) Unconsciousness

(ST) Stranger (VO) Victim Was Suspect

AGGRAVATED ASSAULT / HOMICIDE: [_](01) Argument []02) Assault on Law Enf Officer  [_](03) Drug Deal

[J 04) Gangland [](05) Juvenile Gang C (06) Lover's Quarrel O (07) Mercy Killings

(_](08) Other Felony Involved mG) Other Circumstances Cc 10) Unknown Circumstances ia (20) Criminal Killed by Private Citizen
Oe 1) Criminal Killed by Police Officer L160) Child Playing w/ Weapon C (31) Gun-Cleaning Accident C] (32) Hunting Accident

[](33) Other Negligent Weapon Handling [7] (34) Other Negligent Killings

CLOTHING DESCRIPTION

HAT SHIRT
COAT. PANTS/DRESS

Page 2 of 7

INCIDENT NUMBER 2023-026754 (JUVENILE INFORMATION Report generated; 3/8/2023 10:51 PM

SUSPECT # NAME (Last, First, Middle)
1
ARRESTEE # ADDRESS:
HOME PHONE: WORK PHONE: MOBILE PHONE: OTHER PHONE:

SEX: [Z](M) Male ETHNICITY: [_](H)Hispanic RACE: [¥](W) White [[](B) Black [[]() American Indian | DATE OF BIRTH
(_](F) Female (](U) Unk. | [Z](N) Non-Hispanic [[](U) Unk, [J(A) Asian / Pacific Islander [-](v) Unknown

RES. STATUS: [V](R) Resident MENTALLY AFFLICTED? OCCUPATION / EMPLOYER:

[@) Nonresident (Jv) Unknown (](v) Yes [V](N) No C]v) Unk,

AGE: SUSPECTS ACTIONS RELATED TO; ; HEIGHT: WEAPONS AT ARREST:

Exact Age: 16 Ay: Hye Hy; Hys mn ——— (]o1) Unarmed
anne eee: V5 V6 v8 I

Range: : LI WF : (11) Firearm (Unk)

[-](99) Over 98 Years Old} DISPOSITION OF JUVENILE: D.L./ ID No. (STATE) WEIGHT ~~ []a2) Handgun
[1] (00) Unknown (H) Handled within Department Lbs — :
(R) Referred outside Department _ (1:3) Rifle

SUSPECT #1

>
|
5
z
et.
2

(14) Shotgun
THIS SUSPECT RELATES TO WHICH OFFENSES? ARREST TYPE: [(1(©) On View Arrest ;

(Cas) Other Firearm
1 —2 23 4 Os De 7 [Cs | Ls) Summons / Cited (1(1) Taken Into Custody aaa

(-](16) Illegal Cutting Instrument
ARREST LOCATION: ARREST DATE: Olan Club/Blackjack/Brass

CHARGE: 5-38-203M

ARRESTING OFFICERS
OFFICER I: OFFICER 5:

OFFICER 2: OFFICER 6:
OFFICER 3: OFFICER 7:
OFFICER 4: OFFICER 8:

Suspect information continued on next page.

INCIDENT NUMBER 2023-026754

SUSPECT #
1

COMPLEXION:
(1) Light
| |(2) Medium
|_| (3) Dark
[J (4) Acne
(5) Freckled
(6) Ruddy
(7) Other
(8) Unknown

HAIR LENGTH:
(1) Long
[_](2) Medium
[V](3) Short

(4) Bald(ing)

(5S) Other

(6) Unknown

NAME (Last, First, Middle)

HAIR STYLE:

[ ](01) Afro

(02) Wavy

(03) Straight

| _|(04) Curly
(05) Braided
(06) Ponytail
(07) Military
(08) Processed
(09) Wig/Toupee
(10) Other
(11) Unknown

BUILD:
(2) Medium

(4) Muscular
|_|(5) Unknown

ADDED DESCRIPTION:

na

HAIR COLOR:

(2) Blonde
| _|(3) Brown

|_}(8) Unknown

EYE COLOR:

(1) Blue
(2) Brown

oO JUVENILE INFORMATION

SUSPECT #1

FACIAL HAIR:

(01) Clean Shaven
| |(02) Unshaven
| |(03) Full Beard
|_|(04) Must, (hvy)
| }(05) Must. (thin)
|_}|(06) Brows (hvy)
| _|(07) Brows (thin)
| _|(08) Side Burns
| | (09) Goatee

(10) Other

(11) Unknown

CLOTHING DESCRIPTION:

HAT

COAT

SHIRT
PANTS/DRESS
SHOES

DEMEANOR:

[_](01) Angry

|_|(02) Apologetic

(03) Calm

| _|(04) Irrational

| _](05) Nervous

|_|(06) Polite

|_](07) Professional

|_|(08) Stupor

| _](09) Violent
(10) Drunk / High
(11) Other

im 12) Unknown

Report generated; 3/8/2023 10:51 PM

SCAR / MARK:
(01) Head
(02) Neck
(03) Hand (rt)
(04) Hand (Ift)
(05) Arm (rt)
(06) Arm (Ift)
(07) Body
(08) Leg (rt)
(09) Leg (lft)

| |(10) Other
|_|(11) None
(12) Unknown

| _|(1) Designs
|_|(2) Initials

| |(3) Names

| |(4) Pictures
| |(5) Words
|_|(6) Numbers
| _|(7) Insignia

(9) Unknown

TATTOO LOC;

(1001) Arm cite
(02) Arm (rt)
(03) Leg (1ft)
(04) Leg (rt)
(05) Hand (Ift)
(06) Hand (rt)
(07) Face
(08) Neck
(09) Finger(s)
(10) Chest
(11) Back

INCIDENT NUMBER 2023-026754 [_]JUVENILE INFORMATION Report generated: 3/8/2023 10:51 PM

PROPERTY DRUG INFORMATION

P.LOSS | P.DES | QTY Description (ser#, color, make, model) PROP TAG QUANTITY | MEASURE

4 29 1.00 | UNK UNK BRN 0 150 0.00
UNK 2 HOLES IN DRY WALL
PROPERTY DESCRIPTION: (10) Drugs/Narcotics (21) Negotiable Instruments (32) Structures-Industrial/Manufacture
: (11) Drug/Narcotic Equipment (22) Nonnegotiable Instruments (33) Structures-Public/Community

(01) Aircraft (12) Farm Equipment (23) Office-Type Equipment (34) Structures-Storage
(02) Alcohol — (13) Firearms (24) Other Motor Vehicles (35) Structures-Other
(03) Automobiles (14) Gambling Equipment (25) Purses/Handbags/Wallets (36) Tools-Power/Hand/Lawnmower
(04) Bicycles (15) Heavy Equipment Construction/ (26) Radios/TVs/VCR (37) Trucks
(05) Buses Industry (27) Recordings-Audio/Visual (38) Vehicle Parts/Accessories
(06) Clothes/Furs (16) Household Good (28) Recreational Vehicles (39) Watercraft
(07) Computer Hardware/ (17) Jewelry/Precious Metal (29) Structures-Single Occupancy (77) Other

Software (18) Livestock (30) Structures-Other Dwellings (88) Pending Inventory (of Property)
(08) Consumable Goods (19) Merchandise (31) Structures-Commercial/Business
(09) Credit Cards/Debit Cards (20) Money

TYPE DRUG MEASUREMENT:

DRUG TYPE: (D) Heroin (H) Other Narcotics (L) Amphetamines/ (O) Other Depressants Units Weight

(A) Crack Cocaine (E) Marijuana (1) LSD Methamphetamines (P) Other Drugs DU) D F GM) G (02) 01
(B) Cocaine (F) Morphine (J) PCP (M) Other Stimulants} (U) Unknown Type ( on ol Kieeria Sa Perc
(C) Hashish (G) Opium (K) Other Hallucino, (N) Barbituates (NP) Number of Plants

Capacity
(ML) Milliliter (GL) Gallon
(LT) Liter (FO) Fluid Ounce

FOR BURGLARIES: Point of Entry:

Tools Apparently Used:

INCIDENT NUMBER 2023-026754 (JUVENILE INFORMATION Report generated: 3/8/2023 10:51 PM

NARRATIVE

UPON ARRIVAL, OFFICERS MADE CONTACT WITH SMITH. SMITH ADVISED JUV 1 WAS KICKING THE WALL AND
CAUSING DAMAGE TO THE BUILDING. SMITH ADVISED JUV 1 BECAME MAD DUE TO BELIEVING HIS PROPERTY WAS
TAKEN. SMITH ADVISED JUV 1 PROPERTY WAS NOT TAKEN, AND STATED HIS CASE WORKER WAS CONTACTED
REGARDING THIS SITUATION.

OFFICERS MADE CONTACT WITH JUV 1, JUV 1 ADVISED HIS PROPERTY HAS BEEN TAKEN, AND STATED HE IS NOT
ABLE TO LOCATE IT, JUV 1 ADVISED HE DID KICK THE WALL BUT ADVISED THAT IS THE ONLY THING THAT WAS
DAMAGED. JUV 1 ADVISED HE WILL GO BACK TO HIS ROOM AND SPEAK TO HIS CASE WORKER IN THE MORNING.
OFFICERS PROVIDED SMITH WITH INCIDENT NUMBER AND RELEASED BOTH PARTIES WITHOUT INCIDENT.

MVR 21C669 AND BODY CAM IN USE.

INCIDENT NUMBER 2023-026754 [_JJUVENILE INFORMATION Report generated: 3/8/2023 10:51 PM

ADDITIONAL HOMICIDE CIRCUMSTANCES Oe Criminal attacked a civilian Ol® Criminal resisted arrest

(1(A) Criminal attacked police officer, that officer killed criminal [_](D) Criminal attempted flight from a crime ge Unable to determine /
(_]@®) Criminal attacked police officer, criminal killed by other officer [J Criminal killed in commission of a crime not enough information

RELATED CASE NUMBER(S)
CAR JACKING? []YES [¥]NO DRIVE-BY? [_]YES [¥]NO GANG RELATED? [_]YES [V]NO

HATE/BIAS RELATIONSHIP: —[¥](88) None ~[) YES, SEE BELOW
RACIAL (Anti-) RELIGIOUS (Anti-) ETHNICITY / NATIONAL ORIGIN (Anti-) SEXUAL (Anti-)

Ld) White [](21) Jewish [J (32) Hispanic [](41) Male Homosexual (Gay)
[_]12) Black Flan Catholic (133) Other Ethnicity (_] (42) Female Homosexual (Lesbian)
(13) American Indian / (23) Protestant . (43) Homosexual (Gay and Lesbian)
CU Alaskan Native [](24) Islamic (Muslim) DRRAEES Pate) Hite Heterosexual
(114) Asian / Pacific Islander [_](25) Other Religion [](51) Physical Disability [_] (45) Bisexual
[_](15) Multi-Racial Group [_](26) Multi-Religious Group [_](52) Mental Disability
(e7) Atheist/Agnostic


summary: A resident was transported for acute care after tying socks together and wrapping them around her neck. During video review of the incident, a staff member is seen pulling the resident on the floor by her shirt, dragging her down the hallway, and placing her against the wall. The facility was cited 907.2, 907.3, and 109.1.g 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
Notice of Serious Incident
Date of Incident: 3/7/2023
Date Received by DCCECE: 3/8/2023
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Facility Type: Residential
Incident Type: Licensing
Report Description: On 3/7/23 at 7:50pm , age on
was trying to attempt to inflict self-harm. tied socks together and then
wrapped around his neck. Staff noticed what was happening, came into the room to remove
the socks from around neck, and take out of his room. was crying
and screaming I want to die. The doctor was notified and was sent to the acute
hospital.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative:On 3/7/23 at 7:50pm client was trying to attempt
to inflict self-harm. tied socks together and then wrapped around his neck. Staff
noticed what was happening, came into the room to remove the socks from around
neck, and take out of his room. was crying and screaming I want
to die. The doctor was notified and was sent to the acute hospital. Email sent to
facility 3/9/23 to save camera footage. Phone call made to facility 3/9/23 to determine that
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

client is AR Foster Care client and to confirm that camera footage of this incident is
available. Facility visited 3/9/23 and camera footage reviewed of Boys' Hall from the
evening of 3/7/23. At 7:50PM client is seen stepping half-way out of her (client
identifies as female) room and stating, "I'm killing myself right now". What appears to be a
sock is wrapped around her neck. No staff are seen in the hallway at the time says this.
Another client immediately goes to get staff who within less than a
minute enters the room. Another staff is seen assisting and standing in the hallway. Staff
is then seen pulling on the floor out of her room. Staff has ahold of
s shirt and drags down the hall and places against the wall. Additional staff and
nurse are then seen assisting seems to deescalate without further incident. Later in
the evening was taken to Methodist Acute Hospital. No staff were seen in Boys' Hall at
the time client made the suicidal comment. Dragging client by her shirt on the floor
was not a safe escort. Facility cited 907.2,907.3 and 101.9g. Licensing Specialist made report
to the for possible ref# The report was screened
out.


summary: Officers responded to the facility for a missing person call. While officers were asking questions for the report, the missing resident returned to the facility.

raw_content:
LITTLE ROCK POLICE DEPARTMENT ABBREVIATED INCIDENT REPORT
(JUVENILE INFORMATION INCIDENT

Report generated: 3/3/2023 8:32 PM
INCIDENT NUMBER

UNIT ASSIGNED | CALL DATE CALL TIME TYPE OF CALL
2023-024750 2X54 03/03/2023 17:41:00 MISPER

INCIDENT DATE LOCATION OF INCIDENT (ADDRESS / BUSINESS NAME)

3/3/2023 5:41:46 PM 2002 S FILLMORE ST

DISTRICT

54

OFFENSE

NON POLICE INCIDENT

OFFICERS RESPONDED TO THE LISTED LOCATION IN RELATION TO A MISSING PERSON CALL. WHILE OFFICERS

WERE ASKING QUESTIONS FOR THE REPORT THE MISSING SUBJECT RETURNED TO THE LISTED LOCATION. NO
REPORT WAS NEEDED. BWC/MVR IN USE.

ENTRY DATE REPORTING OFFICER ORIGINAL APPROVING SUPERVISOR MVRi
03/04/2023 02:27:32 | MELANIE WOOD MELANIE wooo [i in use


summary: An x-ray was ordered after a resident injured her finger during an altercation with a peer.

raw_content:
punch. and began to fight, staff immediately intervened by separating the clients.
HH was assessed by the nurse and her right pinky and ring finger was swollen. The
findings from the x-ray results were normal with no findings of any fractures. Facility visited
3/2/23. Video reviewed of incident in Girls' Hall A. Clients and seen in an
altercation. Four staff intervene to separate the clients. No unprofessional conduct by staff
heard or seen. Staff observed supervising clients to ensure their well-being. 's X-ray
results finding no fractures.


summary: An x-ray was ordered after a resident injured her hands during a physical altercation with a peer.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 2/25/2023
Date Received by DCCECE: 2/27/2023
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Facility Type: Residential
Incident Type: Licensing
Report Description: On 2/25/23 DOB female, nondhs client, was
in a physical altercation with another client. A x-ray was ordered. Right hand and left hand.
Left finger and a right finger were also x-rayed. There were "NO" findings of anything in all
of the x-rays. Normal visualized carpal bones in both hand.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative:On 2/25/23 was in a physical altercation with another
client. A x-ray was ordered. Right hand and left hand. Left finger and a right finger were
also x-rayed. There were "NO" findings of anything in all of the x-rays. Normal visualized
carpal bones in both hand. 2/27/23 phone call made to Justin King UMCH. Client remains
at facility. Continue to monitor. Facility visited 3/2/23. Camera footage reviewed of
incident. Client and two other clients are observed in a classroom setting with one
staff present. Clients and begin to fight. One staff immediately intervenes, followed
by another staff from outside the classroom almost immediately after. Client is escorted
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

to the hallway. Client comes from the dayroom area and begins to fight The two
staff already present are accompanied by two additional staff trying to separate clients
and . Clients fell to the ground with staff, client apparently having ahold of client
's hair. After less than a minute staff were able to separate clients without further physical
incident. No unprofessional conduct heard or observed by staff. Staff within ratio and
provided supervision as to ensure the safety and well-being of the clients.


summary: An x-ray was ordered after a resident complained of ankle pain from an injury received prior to her admission to the facility.

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: 2/23/2023
Date Received by DCCECE: 2/24/2023
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Facility Type: Residential
Incident Type: Licensing
Report Description: On 2/23/23 old, , non DHS client,
had to have an x-ray done on her ankle. stated that she hurt her ankle prior to being
admitted to the RTC. She was complaining of pain. X-ray was ordered and completed. The
results and findings are, ankle:
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative:On 2/23/23 client had to have an x-ray done on her
ankle. stated that she hurt her ankle prior to being admitted to the RTC. She was
complaining of pain. X-ray was ordered and completed. The results and findings are, ankle:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

p . Client remains at
facility. Continue to monitor.


summary: Two residents were in a physical altercation. An x-ray was ordered for Resident 1 due to swelling of the resident’s hand. Resident 2 received x-rays for his femur, tib/fib and knee.

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: 2/23/2023
Date Received by DCCECE: 2/27/2023
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Facility Type: Residential
Incident Type: Licensing
Report Description: On 2/23/23 DOB , nondhs client, was in
a physical altercation with another client. He was assessed and later noticed some swelling
so an x-ray was ordered. x-ray was done on 2/25/23 on his left hand. There is no acute
fracture or dislocation. Mineralization is normal, joint spaces are normal with no suspicious
erosions. No radiopaque foreign body. No acute hand fracture or dislocation.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative:On 2/23/23 was in a physical altercation with
another client. He was assessed and later noticed some swelling so an x-ray was ordered. x-
ray was done on 2/25/23 on his left hand. There is no acute fracture or dislocation.
Mineralization is normal, joint spaces are normal with no suspicious erosions. No
radiopaque foreign body. No acute hand fracture or dislocation. 2/27/23 phone call made to
Justin King UMCH who confirmed that X-ray was completed on 2/25/23. Client remains at
facility. Continue to monitor. Facility visited 3/2/23. See Inspection #059985.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

seen exiting the cafeteria towards client , at which point an altercation is briefly heard
but not seen, as it is out of camera view. Staff are constantly present and are seen and heard
attempting to deescalate and separate clients. At no time is staff seen showing
unprofessional conduct. Staff viewed to be providing supervision to ensure the safety and
well-being of the clients.


summary: Officers secured the scene for MEMS on a suicidal juvenile.

raw_content:
LITTLE ROCK POLICE DEPARTMENT ABBREVIATED INCIDENT REPORT

INCIDENT Report generated: 2/22/2023 7:32 PM

INCIDENT NUMBER UNIT ASSIGNED | CALL DATE CALL TIME TYPE OF CALL
2023-021238 2X54 02/22/2023 19:06:00 ASTMED

INCIDENT DATE LOCATION OF INCIDENT (ADDRESS / BUSINESS NAME) DISTRICT

2/22/2023 7:06:23 PM 2002 S FILLMORE ST 5 -

OFFENSE

NON POLICE INCIDENT

OFFICERS SECURED THE SCENE FOR MEMS ON A SUICIDAL JUVENILE WITHOUT INCIDENT. THE JUVENILE WAS
TRANSPORTED BY MEMS TO CHILDRENS HOSPITAL. MVR AND BWC IN USE.

ENTRY DATE REPORTING OFFICER ORIGINAL APPROVING SUPERVISOR MVRi
02/23/2023 01:31:33 | JORDAN RUF} JORDAN RUFF [i VR in use


summary: Caller cancelled before officers arrived due to the juvenile returning to the facility.

raw_content:
LITTLE ROCK POLICE DEPARTMENT ABBREVIATED INCIDENT REPORT

Report generated: 2/13/2023 8:24 PM

INCIDENT

[JUVENILE INFORMATION
INCIDENT NUMBER UNIT ASSIGNED | CALL DATE CALL TIME TYPE OF CALL
2023-017263 2X50 02/12/2023 18:51:00 MISPER
DISTRICT

LOCATION OF INCIDENT (ADDRESS / BUSINESS NAME)

INCIDENT DATE
2002 S FILLMORE ST
54

2/12/2023 6:51:57 PM

NON POLICE INCIDENT

CALLER CANCLED BEFFORE OFFICERS ARRIVED DUE TO THE JUVENILE RETURNING.

ENTRY DATE REPORTING OFFICER ORIGINAL APPROVING SUPERVISOR MVR i
02/14/2023 02:19:38 | AUSTIN KURCZ P| AUSTIN kuRcz R in use
LRPD Form 5501-01 Rev. RMS-2019-01-23

Page | of |


summary: Officers responded to the facility in relation to a missing person. Before officers could make contact with facility staff, the runaway returned.

raw_content:
LITTLE ROCK POLICE DEPARTMENT ABBREVIATED INCIDENT REPORT

INCIDENT Report generated: 1/30/2023 9:36 PM

INCIDENT NUMBER UNIT ASSIGNED | CALL DATE CALL TIME TYPE OF CALL
2023-012394 2X54 01/30/2023 18:34:00 MISPER

INCIDENT DATE LOCATION OF INCIDENT (ADDRESS / BUSINESS NAME) DISTRICT
2002 S FILLMORE ST

1/30/2023 6:34:40 PM 54

OFFENSE

NON POLICE INCIDENT

OFFICERS RESPONDED TO THE LISTED LOCATION IN RELATION TO A MISSING PERSON CALL. BEFORE OFFICERS
COULD MAKE CONTACT WITH THE METHODIST CHURCH MEMBER THE RUNAWAY HAD RETURNED WITH NO
FURTHER INCIDENT.

ENTRY DATE REPORTING OFFICER ORIGINAL APPROVING SUPERVISOR MVRi
01/31/2023 03:34:05 | MELANIE wooo J MELANIE wooo i Rin use

LRPD Form 5501-01 Rev. RMS-2019-01-23 Page | of |


summary: Officers transported a juvenile to the facility.

raw_content:
LITTLE ROCK POLICE DEPARTMENT ABBREVIATED INCIDENT REPORT

INCIDENT Report generated: 1/26/2023 6:26 PM

INCIDENT NUMBER UNIT ASSIGNED | CALL DATE CALL TIME TYPE OF CALL
2023-010761 2Y54 01/26/2023 16:43:00 ASTPTY

INCIDENT DATE LOCATION OF INCIDENT (ADDRESS / BUSINESS NAME) DISTRICT

4200 W 12TH ST

1/26/2023 4:43:56 PM 55

OFFENSE

NON POLICE INCIDENT

OFFICERS TRANSPORTED A W/M JUVENILE TO METHODIST CHILDRENS HOME. OFFICERS MADE CONTACT WITH
TAMICA SMITH 07/14/1974 TO TAKE POSSESSION OF THE JUVENILE.

MVR/BWC IN USE.

ENTRY DATE REPORTING OFFICER ORIGINAL APPROVING SUPERVISOR MVR j
01/27/2023 00:22:20 | BREONNA JOHNSO BREONNA JOHNSON in use

LRPD Form 5501-01 Rev. RMS-2019-01-23 Page | of 1

LITTLE ROCK POLICE DEPARTMENT ABBREVIATED INCIDENT REPORT

Report generated: 1/26/2023 6:26 PM

INCIDENT
2023-010778 01/26/2023 17:22:00 MISPER
INCIDENT DATE LOCATION OF INCIDENT (ADDRESS / BUSINESS NAME) DISTRICT
2002 S FILLMORE ST 54

1/26/2023 5:22:00 PM

OFFENSE

NON POLICE INCIDENT

REFER TO INCIDENT #2023-010761.

MVR/BWC IN USE

ENTRY DATE REPORTING OFFICER ORIGINAL APPROVING SUPERVISOR MVR ij
01/27/2023 00:19:56 | BREONNA JOHNSO BREONNA JOHNSON ml mi ee
Page | of |

LRPD Form 5501-01 Rev. RMS-2019-01-23


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

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Licensee Address: 2002 SOUTH FILLMORE
LITTLE ROCK AR 72204
Licensing Specialist: Clayton DeBoer
Person In Charge:
Record Visit Date: 1/19/2023
Home Visit Date: 1/19/2023
Purpose of Visit: Monitor Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulations Not Correctable:
Narrative:
Buildings & Grounds conducted from 10:30AM-11:30AM. Census: 27
Boys' area observed to be furnished, clean, safe and in good repair. Bathrooms clean and sanitary.
Cafeteria observed to be clean and sanitary.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year
Page 1 of 2

Gym observed to be clean and free of safety hazards. Staff/child ratio in gym: 2:7
2 classrooms observed. Staff/client ratios: 4:12 and 2:4.
Staff/client ratio observed in milieu: 1:1
MAR checked for:
All initialed and up to date.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year
Page 2 of 2


summary: A resident was transported to Arkansas Children’s Hospital due to low blood pressure and increased heart rate.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 1/8/2023
Date Received by DCCECE: 1/9/2023
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Facility Type: Residential
Incident Type: Licensing
Report Description: , who is in private placement was
transported to Arkansas Children's Hospital on 1/8/2023 due to low blood pressure and
increase heart rate. is diagnosed with . She was admitted to
Children's Hospital and is currently hospitalized at Children's.
Interim Action Narrative:
Maltreatment Narrative: Outcome:
Licensing Narrative: On 1/8/23 client was transported to ACH due to low
blood pressure and increased heart rate. Client is diagnosed with . Client
remains at ACH as of 1/9/23. Continue to monitor. Email sent to facility 1/9/23 to notify
licensing upon her return. Email received from facility 1/10/23 that had returned to
facility. No new information on client at this time.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was transported to Arkansas Children’s Hospital due to complaining of head and chest pain after she became upset and began banging her head on a wall.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 1/6/2023
Date Received by DCCECE: 1/9/2023
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Facility Type: Residential
Incident Type: Licensing
Report Description: , who is in AR-DHS custody.
was transported to Arkansas Children's Hospital on 1/6/2023, around 430 pm. On 1/5/23,
became upset during a structure activity when staff told all clients they were going to
work on their preventative teachings. began yelling stating the first shift staff had her
point card and that staff needed to find her point card. was redirected by staff for poor
conversation skills, continues to yell and curse at staff. ran out of the dayroom
and slammed the door; she then began banging her head on the wall. Staff continue to
redirect the client's behavior until she stopped banging her head. complained of head
pain and that she was having chest pains on 1/6/2023. was transported to Children's
for further evaluation. There were no findings of swelling or discoloration at the ER. The
medical doctor at Arkansas Children's provided with a dose of ibuprofen and released
her to return back to the facility the same day.
Interim Action Narrative:
Maltreatment Narrative: Outcome:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: On 1/6/23 client complained of chest pains and a
headache. Client was transported to ACH for further evaluation. No findings of swelling or
discoloration at the ER. Client was provided ibuprofen and returned to facility.


facility_name: Millcreek Behavioral Health / Habilitation Center, Inc.

summary: A complaint received reported that a staff member called a resident a derogatory name. The complaint also states that the staff member grabbed him by his hair and forced him down to the floor.

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: 032366
Date of Incident: 08/23/2025
Date Received: 08/25/2025
Facility Name: Millcreek of Arkansas PRTF
Incident Type: DPSQA - Complaint
Case Status: Under Review
DPSQA - Complaint
Report Description: AV is . Out of home AO is a staff member, only
known by PRFC is mother and has ,
. is currently a patient at Mill Creek Behavioral, where he was
admitted about three weeks ago. There is no discharge date at this point. It was reported
that disclosed that a staff member called him the n-word, using the hard r. The
director of Mill Creek was contacted and informed, and she said she looked into the claim
but did not find any validation for it. The director said she arranged additional training for
the staff member. contacted today and said that a staff member, , had
been abusing him. said that picked him up and slammed him on to his bed.
said that also grabbed him by his hair and forced him all the way down to the
floor. did not report any injuries, and he did not disclose what led to the incidents.
said that is the only staff member that has been abusing him, and he said that
he is tired of being abused.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A complaint received reported that a resident has head sores due to lice not being treated, though she told the nurse 3 weeks prior. The complaint also states that staff failed to help the resident with hygiene.

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: 032363
Date of Incident: 08/23/2025
Date Received: 08/25/2025
Facility Name: Millcreek of Arkansas PRTF
Incident Type: DPSQA - Complaint
Case Status: Under Review
DPSQA - Complaint
Report Description:
. She is a nurse at MillCreek. She is a
nurse on the girls wings of hall. spoke to last night when she got home
with for her weekend visit due to having headlice. She has head sores due to her
lice not being treated when she told the nurse 3 weeks ago. has and needs help
with her daily hygiene but the worker at Millcreek has failed to treat her headlice or help her
with her hygiene.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was transported for an x-ray after complaining of pain from punching a plexiglass window.

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: 032307
Date of Incident: 08/18/2025
Date Received: 08/22/2025
Facility Name: Millcreek of Arkansas PRTF
Incident Type: DPSQA - Incident & Accident - OLTC
Case Status: Complete
DPSQA - Incident & Accident - OLTC
Report Description: Patient became agitated on 08/18/2025 with another peer.
The staff was able to encourage patients to separate then punched a plexiglass
window with his right hand. After the incident on 8/18/25 the patient was seen by nursing
staff patient had full range of motion, no visible injuries, and patient reported no pain. On
8/20/25 patient complained of pain to right hand below 5th digit 4 out of 10, swelling noted,
and good range of motion. Patient was transported to on
08/21/25 for an x-ray.
On 8/21/25 at 1345 nursing received an order from to
splint right hand.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Officers responded to the facility after multiple 911 calls stating several physical altercations were taking place at the location.

raw_content:
Incident # 25-00300 Fordyce Police Department Report Date 08/17/25
Page 1 of 2 Incident Report Report Time 12:24 PM
Status Exception Clearance Date Reporting Officer ORI/Agency
Not Applicable 302 Sisson, Andrew AR0200100
Closed
Assigned Officer Entered By Approving Officer
Sisson, Andrew ASisson
Assisting Officers
Archer, Kevin Jenkins, Willie
Complainant
Name Contact Name
Millcreek Of Arkansas
Business Address Business Phone
1828 Industrial DR,Fordyce, AR 71742 8558847729
Offenses
Incident Location Zone
1828 Industrial DR Fordyce, AR 71742
Earliest Possible Date Time Latest Possible Date Time
08/16/2025 14:03 08/17/2025 12:24
# Statute/Code Description Fel/Misd Att/Comp Loc Bias Wpn CATypes
1 INFORMATION INFORMATION Completed 25 88 99
MO Method Of Entry # Prems
n/a 0
Location Types 13 Hway/Road/Alley 37 Abandoned/Condemned 48 Industrial Site Bias Motivation Codes
14 Hotel/Motel Structure 49 Military Installation 43Lesbian, Gay, Bisexual,
0 0 0 0 0 0 0 0 0 1 1 1 1 2 3 4 5 6 7 8 9 0 1 2 A B B C C C C D D F G G i i a a h o o o e r o r e r u o n r / u m n n p v l B / g d c k N t r s v t / m / e c u / / t e P D S W i S r h r s g n e u u y t i & / / h s r o i S r c T / b e / S c c L t o D t r l y n i i o i C a u o d a c n r c u i p n s l l a n e O / u B n e O g S b t T l f S r d / f f m i S T / e f t t g H o e t r B e a o m r o m l r e r d s k e i p n g p e l a t e l 1 1 1 1 1 F 2 2 2 2 2 5 6 7 8 9 0 1 3 4 5 a c J L L P R R R S S U i a l a i a e p e e e n i q t i k r r e y n s s k l u / k v e i t c n P t o d i a i a / i n c o W r r a e u l e i g w s S l n S r t / a a o y n G L c t t t o n n o / e o e S a O r t r / t r e s a t H / w t o G h g S o r a e a e e m t y r a ra e ti g o e n 3 3 g 4 4 N 4 4 4 M 4 4 8 9 r 0 1 2 4 5 6 7 e o o w A A A C D D F G d u A a a / n r T u a a o a U m e l r d t M m y c m o m n T s s u c k a p e b e / a / s D S C W F / / d l r e r S C i e e m e n a o m h p a t a g c l a i F i a a l n e m s i e d l a r r i a e n r f t i a p c / y u s l u t F t g i h m m P e l r i r i t e o a p y / f F r i u r g o k a n h m i d r t/ Bank 5 5 5 C 5 E 5 M 5 5 5 5 0 1 2 3 4 5 6 7 8 l o i e s l C m l s P R S S S S T C e i y r e o g a c c h h e o i b h h b n n e r e o s m e k o o a t / / t l p t a H U / r m o o e l A P p s r o n L l l r i p y u r l n a m i e - - a / - a n v g S y a n c e i e g t e d M e y r l r c e s s o C a o i s t u l y n s e l n d n d a te ry r A 1 1 A 1 A 1 1 1 O 2 2 N 1 2 3 4 5 6 1 2 m l t a h T W M J C B A A s e e N e k I l m s r a r u a h - a i w a i c t P l a c i e t h t t a i i N i k n e s v a r o - n i r h e c a c l o a i i a c t r f c H i i n v c e A a e s I f I w n r s , i d a c l G a a i i a i n r a n o n d n u e o p o r r r 2 2 2 2 2 3 3 3 L 4 4 3 4 5 6 7 1 2 3 a 1 2 t P I O M A A G L H N in s e r t r i o l t a o u h s o a a h s t y l p e t b m e b t H e i a i ( - r i s s i a m r i n c R s t e t n / i a a p A l c ( e i M n g l a g l e o i t i n g u n o ) r i i s o u c L o l s s a i n o m t t i g r i c n ) ro o up o G 4 4 5 5 6 6 7 7 8 9 r 4 5 1 2 1 2 1 2 8 9 r o T H B P M M F T G N U u r e r i h a e o n e e a p s a m y n t n k n n l e n e e ( s n s e d t x L a s r a g o o e u D G l g l e e w s r a e i D B s n e l N n n a i T d x s d o b e u ) a e n i r a l b r - , i l t C i M y li o ty i n xe fo d rming
Facility/Casino/Race Track
Suspected Of Using Criminal Activity Types Weapon Type(s) 20 Knife/Cutting Instr 65 Fire/Incendiary Device
None B P B P u o y s i s n e g s / s R in e g ce /C iv o in n g cealing C O C O u p l e ti r v a a t t in in g g / / P M ro a m nu o f t / i P n u g b /A li s s s h i i s n t g ing 1 1 1 2 F H i a re n a d r g m u n (A (A ut u o t ) o) 3 3 0 5 B M l o u t n o t r O V b e j h e i c c t le 7 8 0 5 D As ru p g h s y / x N ia a t r i c o . n /Sleeping Pills
D Distributing/Selling T Transport/Import/Transmit 13 Rifle (Auto) 40 Personal Weapons 90 Other
E Exploiting Children U Using/Consuming 14 Shotgun (Auto) 50 Poison 95 Unknown
15 Other Firearm 60 Explosives 99 None
A Simple/Gross Neglect I Intentional Abuse & Torment
F Organized Abuse S Sexual Animal Abuse
Victim #1 Is Complainant Event #s Related 1
Name Contact Name
Millcreek Of Arkansas
Business Address Business Phone
1828 Industrial DR,Fordyce, AR 71742 8558847729
Victim Type Injury Type Aggravated Assault/Homicide Circumstances Relationship To Suspect
Business None, None #1 N/A
Justifiable Homicide Circumstances Taken to: (Hospital Name)
None
Injury Description
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 8/22/2025 2:49:44 PM

Incident # 25-00300 Fordyce Police Department Report Date 08/17/25
Page 2 of 2 Incident Report Report Time 12:24 PM
Suspect #1
SSN/ID/TIN Title Name DOB Age Sex Resident Status
U Unknown
Race Unknown Ethnicity DL (#, ST) Email
Unknown ,
Home Phone Work Phone Other Phone Personal Cell Work Cell
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
Work Address Occupation
AKA
Height Weight Eyes Build AKA
- -
Narrative & Statements
Narrative - Sisson, Andrew - 8/17/2025 1:57:18 PM (Initial)
On 08/16/2025, in the approximate time of 14:03, Officer Andrew Sisson was
dispatched to a “Millcreek of Arkansas” facility located at 1828 Industrial Drive.
Central Dispatch advised Officer Sisson that they had received multiple 911 calls
stating several physical altercations were taking place at the location, and staff
were unable to contain or separate the involved parties. While Officer Sisson
was enroute, Central Dispatch broadcasted that they were on 911 with a
Millcreek staff member stating they were needing “any available units” to
respond. Following this update, Lieutenant Kevin Archer and Sergeant Willie
Jenkins were promptly attached to the call for service and began response.
Officer Sisson, Lieutenant Archer, and Sergeant Willie Jenkins all arrived at the
location simultaneously. Upon their arrival, several different staff members with
the Millcreek facility began pointing in various different and inconsistent
locations of the property in attempts to show where the fights were or had taken
place. No active physical altercations were visible. While units were standing by
at the location, an unidentified black male, wearing a blue shirt and blue shorts
began shouting at the Officer’s on-scene. This unidentified male made
comments such as “If y’all take them badges off, I’ll whoop y’alls ass.” and “I
don’t care about the police, fuck 12”. These were repeated several times in a
verbally berating manner. Upon a Millcreek staff member approaching this male,
he returned to the Millcreek building without further unruly conduct. After
establishing that everything at the location was back under control by Millcreek
staff, and no involved parties stepping forward wishing to speak to Officer’s,
units on-scene cleared from the call for service without incident.
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 8/22/2025 2:49:44 PM


summary: An x-ray was ordered after a resident complained of finger pain from falling outside approximately a week earlier.

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: 032120
Date of Incident: 08/12/2025
Date Received: 08/14/2025
Facility Name: Millcreek of Arkansas PRTF
Incident Type: DPSQA - Incident & Accident - OLTC
Case Status: Complete
DPSQA - Incident & Accident - OLTC
Report Description: Patient reports he had been playing outside during recreational
activities and fell approximately a week earlier and he did not report this to the nurse. Once
the patient was seen by the APRN on 8/11/25 he made her aware and the x-ray was
scheduled.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident reported that during a verbal altercation at the school, the principal tried to choke and bite him. The facility was cited as a result of this incident.

raw_content:
Division of Provider Services & Quality Assurance
Office of Long-Term Care
P.O. Box 8059, Slot S404, Little Rock, AR 72203-1437
R
Notice of Serious Incident
Case Number: 032061
Date of Incident: 08/12/2025
Date Received: 08/13/2025
Facility Name: Millcreek of Arkansas PRTF
Incident Type: DPSQA - Incident & Accident - OLTC
Case Status: Under Review
DPSQA - Incident & Accident - OLTC
Report Description: reported, during a verbal altercation at the school,
allegedly tried to choke him and attempted to bite him. This
incident was discussed with and she denies the allegations. At this time
has been placed on administrative leave pending the results of the investigation.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was found attempting to tie a shirt around her neck.

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: 031940
Date of Incident: 08/03/2025
Date Received: 08/08/2025
Facility Name: Millcreek of Arkansas PRTF
Incident Type: DPSQA - Complaint
Case Status: Not Submitted
DPSQA - Complaint
Report Description: became agitated due to being placed on unit restriction.
took a shirt and attempted to tie it around her neck. Staff intervened, and
physically attacked the supervisor by hitting them. The supervisor was present and
the nurse notified. was placed in a physical restraint from 1541 to 1601 for 20
minutes. Due to her inability to calm down, was administered a chemical at 1546.
Staff will continue to monitor.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov