summary: Officers received a report from a staff member who stated that after breaking up a fight, a juvenile began to swing at him. The staff member began to swing back, hitting the juvenile “a couple of times” before grabbing the juvenile to prevent him from swinging again. Officer Rice gathered the information and notified the Child Abuse Hotline, because the staff member stated that he hit the juvenile.

raw_content:
FORREST CITY Pxe 1 Incident

ee a
: 3 ae |

FORREST CITY, AR. 72335

Crime / Incident (Primary, Secondary, Tertiary) fale seep bo |

5-13-207 ASSAULT 3RD [on orFror| azzar20n4 | 19:53 | Mon
EI] [to [oaazoee |__| Mon _|

[] [Reported [oa/2z/2024 | 19:53 | Mon _|

Location of Incident 603 Kittle Rd, Forrest City, AR Latitude / Longitude County
Cross Street WOODRIDGE BEHAVIORAL orn
"RP" = Reporting Party "W" = Witness "S" = Suspect "oO"
if Business) Race Age Hair
ea ee el
= £4 DL Number State Work Phone
a 2 a
City, _—_—— Zip Code Local ID # State # Cell Phone
ga
| First, Middle (Firm if Business) Race Sex Age Hair Eyes
ee
es

City, State, Zip Code Local ID # State #
FORREST CITY AR 72335 0
Last, First_ Middle (Firm if Business) Race Sex Age HT WT Hair Eyes Bome Dione
a B | m| 21| 5-08 | 140 |BLK |BRO

Address DOB DL Number State | Work Phone
(870)

City, State, Zip Code SSN Local ID # State # FBI # o Phone
MARIANNA AR 72360
Last, First, Middle (Firm if Business) Race Age Hair Eyes Home Phone
16 120 BLK |BRO

alll DL Number mr Work Phone
(870)

City, es Zip Code Se . —— Local ID # aaa FBI# Cell Phone
0

———— J.LANOS

Continuation PropertyList
Press Domestic Violence
UCR
Gang Related N Victim Senior Citizen CL]
olvability County
Gose”_ STARA

Report Complete/Ready for Review CADICFS Event# 2404220015

Assigned To Detective Andrea Hal/ __—— Date

OfficerID Officer James Rice 567 DAVIS, CURTIS 04/23/2024

222222222222

Printed By/On: 412 / 06/05/2024 10:36:02
CrimeStar® Law Enforcement Records Management System
Licensed to; FORREST CITY AR POLICE DEPARTMENT

FORREST CITY Page = 2
POLICE DEPARTMENT

Crime / Incident (Primary)

Incident conta
Narrative incent# 2404220015

Attempt | Type
5-13-207 ASSAULT 3RD CL]

On April 22, 2024, at approximately 7:53 P.M., I officer Rice was dispatched to
Forrest City Police Department for a walk-in report. Upon arrival I made contact

explained that he was at work breaking up two kids from fighting. ||
explained how the fight started. JJ explained that a kid walked in
the shower and came back out because he seen a discharge in the shower.

Wexplained that the kid that walked in shower and seen the discharge got
into it with another kid because of the discharge.

GR explained that after he got the two kids separated, he asked one of
the j j id he wanted to play spades to calm him down.

that a walking up to him and pushing him. explained
that he wasn't trying to engage with because he didn't want to lose
nis 3b. ia

explained that he began to back up while ae <r
walking up to him. Po

explained that he ended up backing up into a corner
and couldn't move anymore, so a

began to swing at him. PY
explained that he began to swing back and it

a couple times and then
stopped and grabbed so he couldn't swing anymore.

explained

I officer Rice gathered information for the report and notified the Child abuse
Hotline because of the statement that J) gave about hitting the juvenile.

; ; Reviewed By Approved Date
OfficerID Officer James Rice 567 DAVIS, CURTIS YES 04/23/2024
Printed By/On: 412 / 06/05/2024 10:36:03
CrimeStar® Law Enforcement Records Management System
Licensed to: FORREST CITY AR POLICE DEPARTMENT

doc_type: Police Report


state: AR

facility_name: Perimeter Behavioral of Forrest City

summary: A resident was sent to Forrest City Medical Center for evaluation after rolling his ankle while playing basketball.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 020692
Date of Incident: 4/18/2024
Date Received: 4/19/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, was sent by order of Physician to Forrest City
Medical Center to have for an X-ray after complaint of pain to APRN. Resident describes
pain from sports related injury while playing basketball as ?rolling ankle in gym.? Resident
returned to the milieu at 1035 (10:35 am cst) with no issues and no new complaints of pain
Resident is on activity restriction for minimum three days until reassessment by Physician.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 04/19/24 LS White sent inquiry re youth's status. 04/22/24 agency
reports: I just checked with the Nurses report he is doing fine and is still on activity
restriction. No licensing concerns or citations to be noted.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

doc_type: Notice of Incident


summary: Licensing was included in a complaint to the Office of Long Term Care. The complaint states that during the review of three restraint holds at the facility by SAMA founder Larry Hampton and Executive Vice President Lisa Hampton, comments were made about the inappropriate use of SAMA techniques by Perimeter staff. The facility was cited 905.9 as a result of this complaint.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 020873
Date of Incident: 4/18/2024
Date Received: 4/18/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Licensing was included in a complaint to the Office of Long Term Care
on 4/18/2024. Licensing has reviewed the complaint and will be accepting this as a
complaint against Perimeter of Forrest City for Licensing investigation. The complaint
states that during the review of three restraint holds at the facility by SAMA founder Larry
Hampton and Executive Vice President Lisa Hampton comments were made about the
inappropriate use of SAMA techniques by Perimeter staff.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 4/25/2024- After continued review of this report and consultation with
DHS legal, licensing will be investigating this notification as a complaint against the
facility. The program manager spoke to the CEO of Perimeter and requested an in person
meeting to review the comments made by the SAMA foundation. CEO Charlotte Lockhart
reported that she and her on site SAMA instructor will not both be available for a meeting
with Licensing until May 7th. Licensing will visit the agency on May 7th to review the
information and determine any corrective action, if needed. 5/7/2024- Program Manager
and Licensing Specialist visited the agency and discussed the comments made regarding
the restraint holds by the SAMA Program founder. The facility is currently in the process of
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

moving their behavior management program to Handle with Care and is approximately 85%
complete with a goal completion date of July 1, 2024. Licensing will continue to monitor
their progress with the change.


summary: Fire alarm. False alarm.

raw_content:
CFS - Unit Response Times Printed on April 29, 2024

CFS # CFS2416481
Call Taker KATELYN JACKSON
Location 1521 ALBERT ST, FORREST CITY, AR 72335 (WOODRIDGE BEHAVIORAL CENTER)

Location Details
Primary Incident Code ALRF : Fire Alarm

Mod Emergency Fire/Medical
Priority 5
Use Caution No
Primary Disposition Handled By Officer / Deputy
Beat
Zone Forrest City Police Department
Call Time 04/18/24 11:36:22
Completed Time 04/18/24 11:45:27

Reporters

Unknown (Initial Reporter)
Sex

DOB

Address

Report Time 04/18/24 11:36:22
How Reported Phone

From Phone

Contact Phone

Comments

Other Names

Vehicles

Responders
CALL1 : FCFD (Primary) | -
FCMARSHALL (Primary) FD - Sharp, Jeremy FCFD (Primary)

Response Times

Assigned 04/18/24 11:38:24
Enroute 04/18/24 11:38:33
Arrived 04/18/24 11:40:33
Leaving 04/18/24 11:42:07
Arrived At

Completed 04/18/24 11:45:27

IR / External Agency Numbers
FCFD 202400477 _ a i

Officer Addenda :

Unit Response Times

Non Unit Specific Times
04/18/24 11:36:22 | New CFS

SSS

Page 1 of 2

04/18/24 11:37:21 | COMMERCIAL FIRE ALARM. PERIMETER BEHAVIORAL HEALTH. KH NUMBER IS 870-633-
3200.

04/18/24 11:38:10 | NOTIFIED FIRE, ADVISED TRYING TO CONTACT PREMISES AT THIS TIME
04/18/24 11:39:02 | TRIED CALLING 870-633-3200 AND IT WAS NO ANSWER

04/18/24 11:41:58 | FD1 ADV FALSE ALARM

04/18/24 11:49:15 | 2404180007

CALL1
04/18/24 11:38:24 | Assign

CALL1, FCMARSHALL
04/18/24 11:45:27 | Complete

FCMARSHALL

04/18/24 11:38:33 | Enroute
04/18/24 11:40:33 | On Scene
04/18/24 11:42:07 | Leaving Scene

—_]A eeeeSSSSSSSSSSSSSSSSSSSFFFFesee

Page 2 of 2


summary: Licensing visited the facility to review children’s records. No deficiencies cited.

raw_content:
Arkansas Department of Human Services

Placement & Residential Licensing Unit

Licensing Compliance Record

Agency Name: Perimeter Behavioral of Forrest Cit Person In Charge: Charlotte Lockhart
Address: 603 Kittle Rd., Forrest City, AR 72335 Phone: (870) 633-3200
Licensing Specialist: Eleanor White

Date of Visit: 02/29/24 Purpose of Visit: Children’s Records Review

STANDARD COMPLIANCE} DATE
ime: 12:30 PM to 3:00 PM
ensus: 54

Licensing Specialist reviewed the following 10 children’s records per MLS 904:

All records reviewed comply. Required documentation and verifications were
present to include vital stats, demographics, case/treatment plans, daily
observation logs, medication/medical records, and educational records. Case files
are well organized and easy to navigate through. The agency's various
documentation and notations are nicely detailed and up to date.

INo concerns or violations.

COMMENTS of Person receiving form

Eleaner White 04/12/24

PERSON SIGNING AS RECEIVING DATE LICENSING SPECIALIST DATE

doc_type: Compliance Report


summary: A resident was sent to Forrest City Medical Center to have sutures removed.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 020576
Date of Incident: 4/12/2024
Date Received: 4/15/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, , was sent by order of Physician to Forrest City
Medical Center to have sutures removed. Resident returned to the milieu at 1515 (3:15 pm
cst) with no issues. Resident is on activity restriction for the next seven days by order of
Physician.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 04/16/24 agency reports this youth is doing well. No licensing
concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident reported that a staff member hit him while attempting to redirect him back to the proper area. A staff member was terminated as a result of this incident.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 020387
Date of Incident: 4/7/2024
Date Received: 4/8/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident ran out of area into laundry room where a
Mental Health Technician (MHT) followed attempting to redirect him back into the proper
area. Resident, reported alleged physical abuse by Staff
(allegation was that staff hit him).
. Resident was assessed by Nursing team. No bruises,
marks, scratches, or injuries noted and Resident denies pain. Staff was sent home for the
rest of the day pending further investigation by Safety Team.
Interim Action Narrative: Resident was
assessed by the nurse. Staff member sent home pending investigation from the Safety Team.
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns. Licensing Specialist White will follow up with the facility. 04/09/24 LS
White sent follow up email: Please advise if there is any video footage of the incident below?
Please provide a copy of the documentation used to make this report
04/10/24
uploaded agency's responses to the requested information. Please see attached. 4/10/2024-
Program Manager requested nursing notes mentioned in the report. The agency provided
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

them to the PRLU for review and they were uploaded to the case. The Program Manager
also inquired about the status of the staff member who struck the resident. The facility
reported that due to the staff member violating company policy, they decided to terminate
the staff member on 4/9/2024.
04/12/24 LS White reviewed 15
minutes of camera footage regarding the following occurrence of 04/07/24: footage showed
resident going into the laundry room, female staff followed behind him into the laundry
room then a moment later a male staff going into laundry room and the female staff leaving
the laundry room. Then the nurse enters the laundry room. There are no cameras in the
laundry room to verify what occurred in the laundry room. Staff was terminated for violating
company policy 04/09/24. Licensing isn?t prepared to leave a determination of findings at
this time. Requested via email this staff's termination records/paperwork. 05/15/24
. LS White was
unable to substantiate the allegation since the incident occurred in the laundry room area
where there are no cameras. Nursing notes verify no body marks, injuries, or pain. Agency
terminated this employee.


summary: A resident was sent to Forrest City Medical Center for an x-ray after complaining of pain from punching a door.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 020382
Date of Incident: 4/5/2024
Date Received: 4/8/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, , was sent out by order of
Physician to Forrest City Medical Center for for X-ray to right hand, after complaint of pain
to Nurses and swelling noted. Resident describes pain/swelling comes from punching a
door the previous day. Resident returned to the milieu 04.05.2024 at 1335 (1:35 pm cst) with
no new injury noted or new
Interim Action Narrative: Order received for an x-ray at FCMC.
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns. Documentation provided by facility.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center after an injury to his right eye was reopened while playing basketball.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 020333
Date of Incident: 4/4/2024
Date Received: 4/5/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Client was playing basketball in the
gym and was accidently hit by the ball that re-opened the injury to his right eye from
3/27/2024. APRN was notified and an order was obtained to send client to FCMC for
further evaluation and treatment. Laceration without foreign body of right eyelid and
periocular area (received sutures to the affected area). See PCP in 7 to 10 days for suture
removal.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 04/05/24 LS White sent email inquiry re this youth's status after
reviewing occurrence for licensing concerns. 04/09/24 agency reports: Resident has
presented no new issues sense his return. Resident is currently on activity restriction until
further evaluation. No citations as agency acted within the MLS.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center after complaining of pain from jamming his finger while playing basketball.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 020315
Date of Incident: 4/3/2024
Date Received: 4/4/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, was sent out by order of Physician to Forrest
City Medical Center for continuance of care to receive a splint to left hand, after complaint
of pain to Nurses after jamming his finger while playing basketball. Resident returned to
the milieu 04.03.2024 at 1545 (3:45 pm cst) with no new injury noted or new issues.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 04.05.24 After LS White reviewing this occurrence of resident's need
for non-emergency medical assistance no violations can be noted. This incident is not
reportable per MLS 110.17. "The agency shall notify the Licensing Unit by the next business
day of serious injuries requiring EMERGENCY medical treatment, agency vehicle
accidents, arrests, elopements, suicide attempts, or deaths and maintain documentation of
the incident and notification."
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center after he jammed his finger playing basketball.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 020259
Date of Incident: 4/1/2024
Date Received: 4/2/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, , was sent out by order of Physician to Forrest
City Medical Center for further assessment to left hand, pinky finger after complaint of pain
to Nurses. Resident describes the complaint of pain coming from jamming his finger while
playing basketball. Resident returned to the milieu 04.01.2024 at 1400 (2:00 pm cst) with no
issues. Resident is on activity restriction until Orthopedic consult 04/08/2024.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: No concerns as agency is addressing this youth's medical injury from
playing basketball. No violations.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for assessment after complaining of pain from punching walls.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 020260
Date of Incident: 4/1/2024
Date Received: 4/2/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, , was sent out by order of
Physician to Forrest City Medical Center for further assessment to right hand, after
complaint of pain to Nurses. Resident describes the complaint of pain coming from
punching walls. Resident returned to the milieu 04.01.2024 at 1400 (2:00 pm cst) with no
issues.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 04/02/24 LS White sent inquiry re the reason youth was punching the
wall. 04/02/24 agency responded: "Resident describes "too much was going on " around
him. He shares this is what he typically does when he feels overwhelmed. This behavior has
been reported to his Therapist and he also shares that he has his "coping toy" which has
been helping him. No violations as agency is working within the MLS coordinating the
correct care for the needs of this youth.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center after complaining of knee pain from playing basketball.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 020233
Date of Incident: 3/29/2024
Date Received by DCCECE: 4/1/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, , was sent out by order of Physician to Forrest City
Medical Center for further assessment right knee. Resident describes the complaint of pain
coming from ?moving wrong and had to see the nurses? while playing basketball. Resident
returned to the milieu 03.29.2024 at 1655 (8:55 pm cst) with no issues. Resident is on activity
restriction 04/05/2024.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: No concerns as agency reports youth's condition is improving. No
citations as agency acted withing the MLS and sought medical attention for this youth.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center due to complaining of pain after falling while playing outside.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 020185
Date of Incident: 3/28/2024
Date Received by DCCECE: 3/29/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, , was sent out by order of Physician to
Forrest City Medical Center for further assessment left knee. Resident complained of pain
after falling while playing outside. Resident returned to the milieu 03.28.2024 at 1035 (12:40
pm cst) with no issues. Resident is on activity restriction until 04/04/2024.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: No concerns as agency acted within the MLS and sought medical
attention for youth.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center due to receiving a laceration to the forehead while playing sports.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 020161
Date of Incident: 3/27/2024
Date Received by DCCECE: 3/28/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: While playing sports resident
hit his head against another peer which caused a laceration to the right forehead above his
eye. First aid administered. APRN was notified and an order was obtained to send resident
to FCMC for further evaluation and treatment. Diagnosis: laceration without foreign body or
right eye lid and periocular area. Resident received 7 sutures to the affected area and
advised to return 7 to 10 for suture removal.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 04.01.24 LS White sent inquiry re this youth's status via email. 04.02.24
agency responded as follows: "Youth reports no issues at this time and appears to be doing
well. He describes his stiches as ?a little itchy but it?s fine.? He has them cleaned daily with
last cleaning yesterday and will have them cleaned tonight." No concerns as agency acted
within the MLS.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center after complaining of nausea, vomiting, headache, and dizziness.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 020160
Date of Incident: 3/27/2024
Date Received by DCCECE: 3/28/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident complained of
nausea, vomiting, headache, and dizziness. APRN was notified and an order was obtained
to send resident to FCMC for further evaluation and treatment.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 04.01.24 LS White sent inquiry re this youth's status. 04.02.24 agency
responded as follows: "Youth reports no issues at this time and appears to be doing well."
No concerns or violations as agency acted within the MLS.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center after complaining of trouble breathing, congestion, a rash between his buttocks, a laceration behind his right ear, and that his urine was brown.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 020163
Date of Incident: 3/27/2024
Date Received by DCCECE: 3/28/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident presented to
nurse's station and informed the nurse he had breathing and congestion, a rash between his
buttocks, a laceration behind his right ear, and that his urine was brown. APRN was
notified and an order obtained to send resident to FCMC for further evaluation and
treatment for shortness of breath. EKG results pending. Chest x-ray findings - the cardiac
and mediastinal silhouettes are within normal limits. The lungs clear. The osseous
structures are intact. Cardioplumonary abnomality.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 04.01.24 LS White emailed inquiry re youth's status. 04.01.24 agency
responded: placing our Director of Nursing on this email. Resident appeared well today
with no issues, nonetheless, I think it best for Nursing to provide an update for him. I am
aware his consult is still pending, and we have made some other arrangements for him in
the milieu. 04.09.24 no further updates provide therefore LS White emailed another inquiry
regarding this youth's status.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for further assessment after complaining of pain from jamming his finger.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 020058
Date of Incident: 3/22/2024
Date Received by DCCECE: 3/25/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, was sent out to Forrest City
Medical Center for further assessment to his right hand after complaint of pain. Swelling
noted and Resident had a jammed finger. Order was sent by Physician to go to FCMC.
Resident?s original fracture healed improperly. Resident returned to the milieu 03.25.2024 at
1725 (5:25 pm cst) with no issues.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 03/25/24 LS White requested additional information as to how this
resident jammed his finger. 03/25/24 Mr. Morris advised that this youth injured his finger
while playing basketball. No concerns as agency acted within the MLS-no violations to be
noted.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for further assessment of his hip and lumbar after complaining of pain following a brawl with peers.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019987
Date of Incident: 3/21/2024
Date Received by DCCECE: 3/21/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, , was sent out to Forrest City
Medical Center for further assessment to his hip and lumbar after complaint of pain for last
five days. Order was sent by Physician to go to FCMC. Resident describes the pain starting
?after the big brawl? referring to group/peer physical altercation. Please see attached FCMC
discharge paperwork. Resident returned to the milieu 03.21.2024 at 1555 (3:55 pm cst) with
no issues.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 03.21.234 LS White received email from agency with attached
documentation-uploaded to case. Follow up email sent regarding "big brawl". Agency
responded as follows: The "big brawl" is referring to the occurrence on 03.05.2024. This
"brawl" began in the gym over a misunderstanding over who threw the ball at him (the
peer) and was blamed. The fight continued outside where he fell on concrete. First aid
was administered. After investigation, the Safety Team discussed this with all parties
involved for accountability's sake and the Residents reconciled. We have not had any more
fights between those two Residents since. This occurrence was not related to any other
occurrences. No violations to the MLS.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for evaluation after injuring his hand by punching a wall.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019985
Date of Incident: 3/20/2024
Date Received by DCCECE: 3/21/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, , was sent out to Forrest City
Medical Center for further assessment to his right hand after complaint of pain. Redness
and swelling noted and Resident diagnosed with Boxer Fracture. Order was sent by
Physician to go to FCMC. Injury is from Resident punching a wall. Resident returned to the
milieu 03.21.2024 at 2140 (9:40 pm cst) with splint. No other issues presented. Follow up in
5-6 days to place cast. Nursing Department is coordinating with Resident?s insurance for
orthopedic consult due to Resident being out of state.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 03.21.24 LS White received an email with attached documentation
regard this incident-uploaded to case. 03.26.24 it is unknown why these youth were
punching the wall. No citations as agency acted within the MLS.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for further assessment of his right hand after complaints of pain due to punching a wall.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019986
Date of Incident: 3/20/2024
Date Received by DCCECE: 3/21/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, , was sent out to Forrest City
Medical Center for further assessment to his right hand after complaint of pain. Ice pack
applied and ibuprofen administered. Order was sent by Physician to go to FCMC. Injury is
from Resident punching a wall. Please see attached FCMC discharge paperwork.Resident
returned to the milieu 03.21.2024 at 1555 (3:55 pm cst) with no issues.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 03.21.24 LS White sent inquiry regarding 2 residents having injuries
from punching the walls. 03.21.24 LS White received an email with attached documentation
regard this incident-uploaded to case. 03.26.24 no citations as agency acted within the MLS.
It is unknown as to why these residents were punching the wall.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for further assessment of his left hand after a nodule was noticed.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019868
Date of Incident: 3/14/2024
Date Received by DCCECE: 3/15/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, , was sent out to Forrest
City Medical Center for further assessment to his left hand after a nodule was noticed.
Please see attached FCMC discharge paperwork. Resident returned to the milieu 03.14.2024
at 1452 (2:52 pm cst) with no issues.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 03.18.24 LS White uploaded the agency's "serious occurrence
reporting form" and has requested via email details regarding this situation surrounding
this occurrence. While on site this incident was addressed. The agency reported this
resident youth developed the cyst on his hand and they took him for medical treatment for
it. It was not an injury. No violations to the MLS.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for further assessment of his right hand due to complaints of pain resulting from an altercation with a peer.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019801
Date of Incident: 3/11/2024
Date Received by DCCECE: 3/12/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, , was sent out to Forrest City
Medical Center for further assessment to his right hand due to complaint of pain from an
altercation with a peer 03/10/2024. Please see attached FCMC discharge paperwork.
Resident returned to the milieu 03.11.2024 at 1848 (6:48 pm cst) with no issues.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 03/12/24 LS addressed this on-site. Resident is recovering well. Youth
are on peer restriction from each other until mediation is completed. No violations to the
MLS.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for assessment of his head after hitting his head against a wall during an altercation with a peer.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019781
Date of Incident: 3/10/2024
Date Received by DCCECE: 3/11/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, was sent out to Forrest City Medical
Center for further assessment to his head after hitting his head against a wall during an
altercation with another peer. Please see attached FCMC discharge paperwork. Neuro-
checks ordered by Resident Physician. Resident, returned to the milieu 03.10.2024 at 2154
(9:54 pm cst) with no issues.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: Neuro-checks were completed and will be conducted again 03.13.24.
Youth is doing well, no further complications with his head injury. No licensing violations.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for assessment of his nose after an altercation with a peer.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019783
Date of Incident: 3/10/2024
Date Received by DCCECE: 3/11/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, , was sent out to Forrest City
Medical Center for further assessment to his nose after getting hit in his nose during an
altercation with another peer. Please see attached FCMC discharge paperwork. Resident,
returned to the milieu 03.08.2024 at 1330 (1:30 pm cst) with no issues.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: No more issues with his nose, pain has subsided. Residents are on
peer restriction until mediation is complete. No concerns as agency sought immediate
medical attention for this youth. No licensing violations.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for assessment of his left hand following an altercation with a peer.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019784
Date of Incident: 3/8/2024
Date Received by DCCECE: 3/11/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, , was sent out to Forrest City
Medical Center for further assessment to his left hand an altercation with another peer.
Please see attached FCMC discharge paperwork. Resident, returned to the milieu 03.08.2024
at 1557 (3:57 pm cst) with no issues.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: Youth is better. No further issues with his hand. Residents were put
on peer restriction until mediation is completed. No licensing violations.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for further assessment due to complaints of pain from playing basketball.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019785
Date of Incident: 3/8/2024
Date Received by DCCECE: 3/11/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, , was sent out to Forrest
City Medical Center for further assessment to his right due to complaint of pain from
playing basketball. Please see attached FCMC discharge paperwork. Resident returned to
the milieu 03.08.2024 at 1557 (3:57 pm cst) with no issues.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: Resident was on activity restriction for 24 hrs. and RICE (rest ice
compression elevation) was administered. Swelling is down today, and resident is better
back to normal activities. No licensing violations.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident alleged that a staff member punched and choked him. The facility was cited 905.9 as a result of this incident.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019742
Date of Incident: 3/7/2024
Date Received: 3/8/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Dual
Report Description: Resident, , alleged to Nurse that a staff
member punched and choked him. Nurses called the allegation into the AR
. Written staff statements have been
submitted. Interval investigations formally commenced 03.08.2024 during daily morning
Safety meeting. Camera review conducted and multiple Residents, including alleged victim,
were interviewed. Written statements were collected 03.07.2024. No bruising, injury, or
discoloration noted on nursing evaluation. Internal findings do not lead to
abuse/maltreatment at this time. Alleged staff will remain on suspension pending
is conducted. While internal findings do not lead to abuse/maltreatment at
this time, protocol of going into Resident room without immediate supervision at the door
was not followed. Policy will be reviewed with Staff by Program Director.
Interim Action Narrative: Staff was placed on suspension pending investigation.
Maltreatment Narrative: AV is residing in Perimeter Behavioral
where AO works. It was reported that disclosed that he and
were playing earlier until they got upset with each other, punched him in the face and
choked him, its unknown if his breathing was restricted and no injuries were seen.
was questioned about this later but when questioned he refused to talk about this or give a
statement.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: LS is gathering information re then will be
conducting an onsite camera (footage) review visit. 03/11/24 gave
permission for licensing to conduct their investigation. 03/12/24 camera review completed
by Licensing Specialist White. 03/18/24 LS White viewed staff's SAMA certification. Staff is
certified until 06/15/24. Also received a copy of restraint hold on flash drive for upper
management to review. 03/26/24 Agency is cited, inspection created, and compliance
record is completed.

Arkansas Department of Human Services
Placement & Residential Licensing Unit
Licensing Compliance Record
Agency Name: Perimeter Behavioral of Forrest City Person In Charge: Charlotte Lockhart
Address: 603 Kittle Rd., Forrest City, AR 72335 Phone: (870) 633-3200
Licensing Specialist: Eleanor White
Date of Visit: 03/12/24 Purpose of Visit: complaint ELS case 019742
Incident Date: 03/07/24
STANDARD COMPLIANCE DATE
DISCUSSION/OBSERVATION
REVIEWED DATE CORRECTED
Time 1:00 PM to 3:30 PM
Census: 52
Immanuel Morris, Director of Quality/Risk Management assisted Licensing
Specialist with the camera footage review of incident on 03/07/24 for ELS case
0197742 which verified resident was walked out of his room in a restraint hold by
staff member following a pencil and staff’s badge being thrown into the hall from
resident’s room. Once resident and staff (while in the restraint hold) were in the
hallway staff used unnecessary force in taking the child to the floor. It did not
appear that resident was resisting the restraint hold by staff before being taken to
the floor. Facility staff explained that the staff member may have been escalated
from being poked in the back by a pencil by the resident prior to the restraint. The
facility SAMA instructor also viewed the camera footage with licensing and
expressed concerns about the staff’s conduct during the restraint. This staff
member is SAMA certified. His certification expires 06/13/24.
Facility will be cited as follows: 905.9. Physical restraints shall be performed using
minimal force and time necessary. Physical restraint means the application of
N/C
physical force without the use of any device for the purposes of restraining the free
movement of a resident's body. Briefly holding a child without undue force in order
to calm or comfort or holding a hand to safely escort a child from one area to
another, is not considered a physical restraint.
Complaint case regarding the punching and choking of a resident is undetermined
at this time due to no camera in the resident’s bedroom. However, video review did
show the staff member failing to use the minimal force necessary during the
restraint hold.
COMMENTS of Person receiving form:
Eleanor White 03/26/24
PERSON SIGNING AS RECEIVING DATE LICENSING SPECIALIST DATE


summary: A resident was sent to Forrest City Medical Center for further assessment of his nose after he was hit during an altercation with a peer.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019741
Date of Incident: 3/7/2024
Date Received by DCCECE: 3/8/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, , was sent out to Forrest City Medical Center for
further assessment to his nose from trauma to his nose after getting hit by another Resident
in an altercation . Discharge paperwork notes no fractures and recommended ibuprofen for
pain. Resident, returned to the milieu 03.05.2024 at 1742 (5:42 pm cst) with no issues.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 03.11.24 LS initiated inquiry regarding this incident via email. 03.12.24
while LS was on site this incident was addressed. This youth is doing well and is not in
pain. There have been no further complications with his nose injury. Residents are on peer
restriction until mediation is completed. No licensing violations.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for further assessment of his left knee due to complaint of pain after playing basketball in the gym.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019624
Date of Incident: 3/4/2024
Date Received by DCCECE: 3/5/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, , was sent out to Forrest City
Medical Center for further assessment to left knee due to complaint of pain after attempting
a layup while playing basketball in the gym. Resident, returned to the milieu 03.26.2024 at
1822 (6:22 pm cst) with no issues. returned from ER with ace bandage to left knee
that is to be worn for 3 days and taken off at bedtime. He is also activity restrictions for 3
days. PBFC provided wheelchair to Resident 03/05/2024 for further transportation
accommodations.
Interim Action Narrative: Resident sent to FCMC for further assessment. Resident was
placed on activity restrictions.
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns. Program Coordinator inquired about resident's guardianship.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for further assessment due to complaints of dizziness.

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019458
Date of Incident: 2/26/2024
Date Received by PRLU: 2/27/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, DOB , was sent out to Forrest City
Medical Center for further assessment due to compliant of dizziness. Resident initially refused to go
to the ER in order not to miss his pass with his mother and informed Safety team he was ?faking it.?
Resident was still assessed at FCMC. See attached FCMC discharge paperwork. Resident, returned
to the milieu 02.26.2024 at 1448 (10:48 pm cst) with no issues.
Interim Action Narrative:
______________________________________________________________________________
Maltreatment Narrative:
Licensing Narrative: No concerns as agency staff acted in the best interest of this youth seeking
immediate medical attention for him. No violations to the MLS.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for an x-ray due to complaints of facial pain after being punched in the face by a peer.

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019425
Date of Incident: 2/23/2024
Date Received by PRLU: 2/26/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, DOB , was sent out to Forrest City
Medical Center for x-ray to complaint of face pain 02.25.2024. Resident, , was
sent out to Forrest City Medical Center for x-ray to complaint of face pain 02.25.2024.
Interim Action Narrative:
______________________________________________________________________________
Maltreatment Narrative:
Licensing Narrative: 02/27/24 LS requested via email that agency elaborate as to what the
surrounding circumstances were regarding this incident. What was the alleged cause of his facial
pain/contusions? How is he doing today? 02/27/24 agency's response via email: "Resident was in
altercation with another peer who punched him the face resulting in the facial pain. No complaints
of pain/discomfort upon his return to the milieu or today."
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was transported to Forrest City Medical Center for an x-ray due to complaints of facial pain from being kicked in the face by a peer.

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019427
Date of Incident: 2/23/2024
Date Received by PRLU: 2/26/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, was sent out to Forrest City Medical Center for x-
ray to complaint of face pain 02.24.2024. Resident, returned to the milieu 02.24.2024 at 11:20 am
with no issues.
Interim Action Narrative:
______________________________________________________________________________
Maltreatment Narrative:
Licensing Narrative: 02/27/24 LS requested via email that agency elaborate as to what the
surrounding circumstances were regarding this incident. What was the alleged cause of his
contusions? How is he doing today and has there been a follow up visit for continuance of care
regarding this injury with his primary physician? 02/27/24 agency's response via email: " was
kicked in the face during an altercation with another peer by said peer resulting in the facial pain.
Upon his return yesterday, he denied any pain/discomfort. None reported today as well." No
violations as agency acted within the MLS.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Caller advised they have a resident they have found drugs on.

raw_content:
CFS - Command Log Printed on March 20, 2024
_—_ ite on Maric 20, 2024

CFS # CFS2408038
Call Taker ALENA BAILEY
Location 1521 ALBERT ST, FORREST CITY, AR 72335 (WOODRIDGE BEHAVIORAL CENTER)

Location Details
Primary Incident Code CITIZEN COMPLAINT : CComplaint

Mod

Priority 4

Use Caution No

Primary Disposition _ Handled By Officer / Deputy

Beat

Zone Forrest City Police Department

Call Time 02/23/24 14:52:44

Completed Time 02/23/24 15:13:44
Reporters

NORRIS, IMMANUEL (Initial Reporter)

Sex

DOB

Address

Report Time 02/23/24 14:52:44

How Reported

From Phone

Contact Phone (870) 633-3200

Comments

Other Names

Vehicles

Responders

542 542-MITLEFF,DALTON — FCPD (Primary)
544 (Primary) 544 - COTTRELL, MARCUS FCPD (Primary)
545 545 - Mitchell, Trenton FCPD (Primary)

Response Times

Assigned 02/23/24 14:55:47 *
Enroute 02/23/24 14:55:47
Arrived 02/23/24 15:00:42
Leaving

Arrived At

Completed 02/23/24 15:13:44

IR / External Agency Numbers

Officer Addenda

Command Log Filter: All Commands | Details: Hidden | Units: All Units | Revised Entries: Shown
02/23/24 14:52:44 | BAILEY, ALENA | New CFS
02/23/24 14:54:04 | BAILEY, ALENA | CALLER ADVISED THAT HE HAS A RESIDENT THAT THEY HAVE FOUND

AE

Page 1 of 2

DRUGS ON
02/23/24 14:55:47 | BAILEY, ALENA | 544 | Enroute
02/23/24 15:00:42 | BAILEY, ALENA | 544 | On Scene
02/23/24 15:03:23 | BAILEY, ALENA | 545 | On Scene
02/23/24 15:03:58 | BAILEY, ALENA | 542 | On Scene
02/23/24 15:12:52 | MORGAN, SYDNEY | 544 | Available
02/23/24 15:12:57 | MORGAN, SYDNEY | 545 | Available
02/23/24 15:13:44 | MORGAN, SYDNEY | 542 | Complete

CLQ

Requested At
Sent To

Status
Received At
Location '
Accuracy

eee

Page 2 of 2

CES - Unit Response Times Printed on March 20, 2024
on Mac 2, 2024

CFS # CFS2408038
Call Taker ALENA BAILEY
Location 1521 ALBERT ST, FORREST CITY, AR 72335 (WOODRIDGE BEHAVIORAL CENTER)

Location Details
Primary Incident Code CITIZEN COMPLAINT : CComplaint

Mod

Priority 4

Use Caution No

Primary Disposition Handled By Officer / Deputy

Beat

Zone Forrest City Police Department

Call Time 02/23/24 14:52:44

Completed Time 02/23/24 15:13:44
Reporters

NORRIS, IMMANUEL (Initial Reporter)

Sex

DOB

Address

Report Time 02/23/24 14:52:44

How Reported

From Phone

Contact Phone (870) 633-3200

Comments

Other Names

Vehicles

Responders
542 542-MITLEFF,DALTON — FCPD (Primary)
544 (Primary) 544 - COTTRELL, MARCUS FCPD (Primary)
545 545 - Mitchell, Trenton FCPD (Primary)

Response Times

Assigned 02/23/24 14:55:47 *
Enroute 02/23/24 14:55:47
Arrived 02/23/24 15:00:42
Leaving

Arrived At

Completed 02/23/24 15:13:44

IR / External Agency Numbers
Officer Addenda

Unit Response Times

Non Unit Specific Times
02/23/24 14:52:44 | New CFS

Page 1 of 2

02/23/24 14:54:04 | CALLER ADVISED THAT HE HAS A RESIDENT THAT THEY HAVE FOUND DRUGS ON

542
02/23/24 15:03:58 | On Scene

02/23/24 15:13:44 | Complete

544
02/23/24 14:55:47 | Enroute

02/23/24 15:00:42 | On Scene
02/23/24 15:12:52 | Available

545
02/23/24 15:03:23 | On Scene

02/23/24 15:12:57 | Available

eee

Page 2 of 2


summary: A resident was found with a nicotine vape and a THC vape during routine checks. The resident alleged a staff member provided the vape. The facility was cited 109.1 and the staff member was terminated as a result of this incident.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019417
Date of Incident: 2/23/2024
Date Received: 2/26/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Dual
Report Description: Resident, , was found with a
nicotine vape and a THC vape during routine checks. Staff confiscated the vapes and
reported them to the Supervisors/Safety Team. The Safety team interviewed/collected
written statements from Resident, Resident peer, and staff who was alleged the nicotine
vape came from, as well as reviewed camera footage. Camera footage shows staff going into
all Resident?s room for routine bedtime checks but no evidence of vape usage from staff or
Resident(s). Said staff was immediately placed on administrative leave 02/23/2024. AR
. AR
DHS completed an interview with today, 02/26/2024. Forrest City
Police Department were contacted to confiscate both vapes 02/23/2024. Vapes were
confiscated at approximately 3:15 pm. Report pending.
Interim Action Narrative: Staff was suspended pending the maltreatment investigation.
Maltreatment Narrative: AV is . AO is age unknown
. AV is currently admitted to Perimeter Behavioral Health in Forrest City, Arkansas. AV
was caught with a vape. While investigating where the vape came from, video showed that
AO provided the vape to AV. Per AV and his roommates statement AO allowed AV to use
the vape. AO was put on suspension pending investigation. The vape contained nicotine.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: 02.27.24 LS sent email to investigator requesting permission to
proceed with monitoring this incident for MLS violations. 02.29.24 LS reviewed camera
footage of the evening before the "vapes" were found on resident. 03.01.24 AO staff was
terminated. Agency has implemented a more robust search process when admitting new
youth. 3/28/2024- Maltreatment case closed as TRUE.


summary: A resident was transported to Forrest City Medical Center after complaining of sharp chest and back pain.

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019321
Date of Incident: 2/21/2024
Date Received by PRLU: 2/21/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, DOB , complained to Nurses of chest
and back pain described as sharp pain. Nurses took vitals. Physician notified and ordered Resident
to be further evaluated at Forrest City Medical Center ER. Today, 02/21/2024, Resident was
transferred to Arkansas Children?s Hospital for further treatment.
Interim Action Narrative:
______________________________________________________________________________
Maltreatment Narrative:
Licensing Narrative: 02.22.24 LS emailed inquiry regarding this youth status; agency reported on
02.22.24 that this youth was discharged on 02.22.24. No concerns or violations as agency acted
within the MLS.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was transported to Forrest City Medical Center for an x-ray after complaining of right-hand pain from hitting a desk and right toe pain from kicking a peer in the face.

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019344
Date of Incident: 2/21/2024
Date Received by PRLU: 2/22/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, DOB , complained to Nurses of pain
to his right hand. Pain was due to swelling from hitting on the desk. Ice pack and ibuprofen
administered. Resident also complained of right great toe hurting. Pain due to kicking another
Resident in the face. Physician notified and ordered X-Ray at Forrest City Medical Center ER. X-
Ray results are ?No acute fracture or dislocation? to either hand or foot. ?Soft tissues are grossly
unremarkable.? Resident returned 02.21.24 at 1520 (3:20 pm cst). No issues with Resident reentering
the milieu.
Interim Action Narrative:
______________________________________________________________________________
Maltreatment Narrative:
Licensing Narrative: Agency reports resident is recovering nicely-no complications. No concerns
or violations as agency worked within the MLS during this occurrence.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center after falling in the gym and complaining of right ankle pain.

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019284
Date of Incident: 2/19/2024
Date Received by PRLU: 2/20/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: , DOB fell in gym and complained of pain in
right ankle. Nurses assessed and administered ibuprofen 200 mg. Resident was transported to
Forrest City Medical Center for x-ray. Findings are as follows: "No acute fracture or dislocation .
The ankle mortise is intact. Soft tissues are grossly unremarkable." Resident returned to milieu
02.19.2024. Swelling noted and ice pack administered for 15 mins. Resident is currently on activity
restriction.
Interim Action Narrative:
______________________________________________________________________________
Maltreatment Narrative:
Licensing Narrative: 02.20.24 LS sent follow up email. 02.20.24 agency's response: There have
been zero issues noted with Resident reentering the milieu. He is on activity restriction but has had
no noted issues with transitioning to the cafeteria, restroom, education unit, dayroom, etc. No
violations to the MLS-no citations.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident became unresponsive while having seizure-like activity. Staff called 911, and the resident was transported to Forrest City Medical Center for treatment.

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019254
Date of Incident: 2/17/2024
Date Received by PRLU: 2/19/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, DOB , became unresponsive and
having seizure like activity. Staff called a Code Blue, called 911 and gently moved Resident to the
floor. Resident still unresponsive and Nurse initiated compressions. Upon EMS arrival, Resident was
conscious but non-verbal. Resident was transported to Forrest City Medical Center via ambulance.
Several test were conducted. 02/17/2024 at 12:56 pm, Resident had a seizure while at Forrest City
Medical Center and was transported to LeBonheur Children?s hospital. Resident is currently still at
LeBonheur Children?s hospital at the time of this notification. Staff present with Resident while at
Forrest City Medical Center and at LeBonheur Children?s Hospital. Director of Quality and Risk
Management (DQRM) visited Resident and staff 02/17 at approximately 1800 (6:00 pm cst).
DQRM provided Nurses with Caseworker contact information and signed consent to treat form
Interim Action Narrative:
______________________________________________________________________________
Maltreatment Narrative:
Licensing Narrative: Resident was returned to the facility after receiving medical treatment for
seizures. Youth has not had any further complications with seizures since returning. No licensing
violations.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Officers were dispatched to Perimeter to assist EMS with an unresponsive juvenile who was having a seizure.

raw_content:
FORREST CITY Field Interview
POLICE DEPARTMENT Detail Page

225 N. ROSSER ST. Fi# Print Date
2402170004 02/17/2024
Time
09:20

FORREST CITY, AR. 72335
Officer ID Agency
575 Officer Kayla Thomason FCPD

Date Day
02/17/2024 Saturday
District 1 Event # Force

Beat Sector

Address 603 Kittle Rd # 72335, Forrest City, AR
X Street 603 KITTEL RD

SUBJECT INFORMATION
Acaress 603 Kittle Rd aration: 7Z905

City/State/Zip, EQRREST CITY AR 72335
Phone ( )

D.O.B. DL# DL State
a ane
Race Weight Hair Eyes
PS wl 5.05 |" 150 | pro | Bro

___ VEHICLE INFORMATION.
License State VIN #

~ REASON / DETENTION INFORMATIO!

Field Interview

}
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Dispatched to perimeter to assist EMS with an unresponsive juvenile who was having a seziure. Male
was transported by EMS to Forrest City Medical Center.

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NGr Snowe any, DVD <Hut km:

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FORREST CITY Call For Service
POLICE DEPARTMENT Event Detail Page

225 N. ROSSER ST. — —
FORREST CITY, AR. 72335 7 2402170004 02/23/2024

Pas o2/t7/2024|°%” Saturday | ™* 09:20:47 [DsPatcrer'D 4gq [Avery CRD [sure |

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= Location 693 KITTEL RD
> City FORREST CITY County $T FRA State AR
=a REPORTING PARTY INFORMATION
So eee | Se ee ee Bae |
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=
® RESPONSE INFORMATION
Minutes of all
ue 0
=
CALL DETAILS
CallType 43 CONTRIBUTING TO DELINQUENCY OF A MINOR Priority 0

Description :

Disposition A CALL ACTIVE EMD Code

Comments

Printed By/On: 412 / 02/23/2024 08:31:31
CrimeStar® Law Enforcement Records Management System
Licensed to: FORREST CITY AR POLICE DEPARTMENT


summary: A resident alleged to Nurses that a staff member pushed and pinched him in the gym. This complaint was UNFOUNDED by Licensing.

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019253
Date of Incident: 2/16/2024
Date Received by PRLU: 2/19/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Dual
Report Description: Resident, DOBB , alleged to Nurses that a staff
had pushed and pinched him the gym. Nurses assessment did find one bruise appearing fresh and
purple and two other bruises appearing old and brown all in the same right upper bicep area.
Nursing called allegations into AR Child Abuse Hotline and it was accepted. Upon review by Safety
team, no findings of abuse were cited. Resident attempted to elope from gym bathroom and
Resident intervened. Statement gathered from staff around incident. No further injuries noted and
Resident denies pain.
Interim Action Narrative:
______________________________________________________________________________
Maltreatment Narrative: Av is . PRFC is the staff of Perimeter Behavior
Health Care. AO is an employee of Perimeter, . is in DHS custody.
stated that had pushed and pinched him in the gym bathroom for peeing on the floor and
breaking the toilet seat. He said it happened around noon but didn?t report it until 16:35pm. He has
1 purple and 2 brown bruises to his upper right arm. was gone for the day when he reported
it.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: On 02.20.24 LS requested as follows additional information from Immanuel
Morris, Director of Quality and Risk Management: Please advise as to what the hotline
reference/case number is for this accepted report. 03.15.24 Investigator Lorra Wicker completed
investigation as not founded. 03.18.24 LS White reviewed camera footage from 02.16.24 which
showed youth resident in the gym with peers. grabbed the staff clipboard which was then
recovered by staff then while standing in line to exit the gym pulled down his pants and staff
redirecting him to pull his pants back up. Footage did not show
pushing or pinching No violations to be cited. No concerns.


summary: A resident was transported to Forrest City Medical Center for further assessment/x-ray to his left wrist due to swelling following a restraint. The facility was cited 905.9 as a result of this complaint. The staff member involved was terminated for a non-related issue.

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019214
Date of Incident: 2/15/2024
Date Received by PRLU: 2/16/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, DOB , was transported to Forrest City
Medical Center for further assessment /x-ray to his left wrist due to swelling. Resident returned to
facility at 1621 (4:21 pm cst). There were no issues with Resident reentering the milieu. The
following are the findings from x-ray. No acute fracture or dislocation. The proximal and distal
carpal rows are adequately aligned. The soft tissues are grossly unremarkable.
Interim Action Narrative:
______________________________________________________________________________
Maltreatment Narrative:
Licensing Narrative: Resident has fully recovered and has not had any other issues with his wrist.
No licensing violations.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was transported to Forrest City Medical Center for treatment.

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019215
Date of Incident: 2/15/2024
Date Received by PRLU: 2/16/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, was transported to Forrest City Medical Center for
treatment of an . Resident returned to facility at 1533 (3:33 pm cst). There were no issues with
Resident reentering the milieu. Resident prescribed medication that has been reconciled into
medication record.
Interim Action Narrative:
______________________________________________________________________________
Maltreatment Narrative:
Licensing Narrative: Youth has recovered from after completing prescribed antibiotic
treatment. No further medical issues regarding this occurrence. No licensing violations as agency
staff sought immediate medical treatment for this youth when they became aware of his symptoms.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Licensing completed a Buildings and Grounds walkthrough. No deficiencies cited.

raw_content:
521 Visit Compliance Report

Licensee: Perimeter Behavioral of Forrest City

Facility Number: 142

Licensee Address: 603 KITTLE ROAD
FORREST CITY AR 72335

Licensing Specialist: Eleanor White
Person In Charge: Charlotte Lockhart
Record Visit Date: 2/14/2024

Home Visit Date: 2/14/2024

Purpose of Visit: Subsequent Building and Grounds

Regulations Out of Compliance:

Regulations Needing Technical Assistance:

Regulation Not Applicable:

Regulations Not Correctable:

Narrative:

Time: 12:45 PM to 2:15 PM

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

ARKANSAS
) DEPARTMENT OF

|\-7 HUMAN
» "2 SERVICES

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

y

Page 1 of 2

Census: 52

Licensing Specialist did a complete walk through of the facility. Immanuel Morris, Director of Quality
and Risk Management and Clifton Williams, Program Director were the escorts. Viewed bedrooms,
bath/shower rooms, and recreation rooms in stations 1 and 2. No concerns. All areas were clean
and tidy. Viewed nurse’s stations (1 and 2), kitchen, classrooms, seclusion rooms, and gym-no
regulations out of compliance. Fenced outside recreational yard/area was well manicured and
clean-no concerns. Rooms Fire extinguishers comply. Viewed severe weather and fire drill logs-all
are timely and comply. Viewed vehicle inspection logs for all 3 vehicles-inspections were completed
within the last 30 days.

MARS reviewed for 3 residents as follows: i
BG 10 errors.

No regulations out of compliance. No technical assistance needed.

Provider Comments:

CCL Staff Signature : Date: 2/16/2024
Provider Signature : Date: 2/16/2024
hr

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


summary: A resident was transported to Forrest City Medical Center for further assessment/x-ray to his right hand due to an altercation with peer.

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019207
Date of Incident: 2/14/2024
Date Received by PRLU: 2/15/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, DOB , was transported to Forrest City
Medical Center for further assessment /x-ray to his right hand due to altercation with peer. Resident
returned to facility at 1758 (5:58 pm cst). There were no issues with Resident reentering the milieu.
Resident has fracture to right thumb and wears a cast. Resident is on activity restriction and on peer
restriction from the resident whom he was in an altercation with.
Interim Action Narrative:
______________________________________________________________________________
Maltreatment Narrative:
Licensing Narrative: Agency reports this youth is doing well with his cast-no concerns. Agency
also implemented a corrective action plan to keep these residents separated to prevent any further
altercations. No violations to the MLS.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was transported to Forrest City Medical Center for further assessment of his left hand due to an altercation with a peer.

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019183
Date of Incident: 2/13/2024
Date Received by PRLU: 2/14/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, DOB: , was transported to
Forrest City Medical Center for further assessment /x-ray to his left hand due to altercation with
peer.
Interim Action Narrative:
______________________________________________________________________________
Maltreatment Narrative:
Licensing Narrative: No concerns as agency acted within the MLS regarding this occurrence
seeking medical attention for this resident.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident eloped from the gym with two other peers. The resident was returned to the facility by Forrest City Police Department.

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 018979
Date of Incident: 2/4/2024
Date Received by PRLU: 2/5/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, , eloped from the gym with two other peers. Resident
returned to facility at 2055 (8:55 pm cst) by Forrest City Police Department. There were no issues
with Resident reentering the milieu. Resident has since been placed on elopement precautions.
Interim Action Narrative: The police were called and resident was placed on elopement
precautions.
______________________________________________________________________________
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for licensing
concerns. Resident's last name, DOB, and guardian was requested. Program Coordinator inquired
about camera footage. Police reported was requested from Forrest City Police Department.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

DHS Placement and Residential Licensing Unit
Office of the Secretary
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 018980
Date of Incident: 2/4/2024
Date Received by PRLU: 2/5/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, DOB , eloped from the gym with
two other peers. Resident returned to facility at 2055 (8:55 pm cst) by Forrest City Police
Department. There were no issues with Resident reentering the milieu. Resident has since been
placed on elopement precautions.
Interim Action Narrative: Police were called and resident was placed on elopement precautions.
______________________________________________________________________________
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for licensing
concerns and inquired about camera footage and resident's guardian. Program Coordinator
requested police reported from Forrest City Police Department.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

DHS Placement and Residential Licensing Unit
Office of the Secretary
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 018982
Date of Incident: 2/4/2024
Date Received by PRLU: 2/5/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, /DOB , eloped from the gym with two other
peers. Resident returned to facility at 2055 (8:55 pm cst) by Forrest City Police Department. There
were no issues with Resident reentering the milieu. Resident has since been placed on elopement
precautions.
Interim Action Narrative: The police department was called. Resident was placed on elopement
precautions.
______________________________________________________________________________
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for licensing
concerns. Program Coordinator requested police report from Forrest City Police Department.
Program Coordinator inquired about camera footage and resident's guardian.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Officers were dispatched to Perimeter Forrest City in reference to three runaway juveniles.

raw_content:
FORREST CITY Pace 14 Incident

POLICE DEPARTMENT Incident # 2402040015
225 N. ROSSER ST. Beat Ti Se
elo ae et

FORREST CITY, AR. 72335
=a

Crime / Incident (Primary, Secondary, Tertiary)

00-00-07 JUVENILE RUNAWAY | On or Fron} 02/04/2024 | 17:08 | Sun |
| cer

[Reported |o2/04/2024 | 17:08 | Sun_|

Location of Incident 603 Kittle Rd, Forrest City, AR Latitude / Longitude Com
Cross Street WOODRIDGE ST FRA

"RP" = Reporting Party “W" = Witness “S" = Suspect

Last, First, Middle (Firm if Business) Hair Eyes | Home Phone
Pe ee ee 0 00
Address DL Number State Work Phone
City, State, Zip Code SSN Local ID # State # FBI # Cell Phone

Last, First, Middle (Firm if Business) Sex Age HT WT Hair Eyes | Home Phone

s mM | 17 (870)
a DL Number State Work Phone

AR _ | (870)

i iS _—_ | ache
a First, Middle (Firm if Business) Age Hair Eyes | Home Phone
Pe 16 (670)

Address DOB DL Number State | Work Phone
fF | AR_ | (870)

City, State, Zip Code SSN Local ID # State # FBI # Cell Phone
fF 0
Last, First, Middle (Firm if Business) Sex Age HT WT Hair Eyes Home Phone
| m | 16 0

Address DOB DL Number State | Work Phone
Pe P| AR | (870)

City, State, Zi Local ID # FBI# Cell Phone
a 0

Synopsis

Continuation PropertyList
puck 2900 [Pees] eu ee Violence
CR
; 29 Release C] Case
Gang Related N Hate Crime | Victim Senior Citizen CI
Force Used [| Child Abuse [__ |
Solvability County i
Report Complete/Ready for Review LX CAD/CFS Event # 2402040015

Assigned To Date

Reviewed By Approved Date
OficerID Officer Jake Powers Lt. Virginia Edwards 02/04/2024

<H-r-woOrcron
222222222222

Printed By/On: 412 / 02/23/2024 08:17:19
CrimeStar® Law Enforcement Records Management System
Licensed to: FORREST CITY AR POLICE DEPARTMENT

FORREST CITY Page 2 Incident conta
POLICE DEPARTMENT
pn Mooooor suvemuerunanay | | comiatRepot | |

"V" = Victim "RP" = Reporting Party "W" = Witness
Last, First, Middle (Firm if Business)

JENNINGS, ROXANA

Race Home Phone

(870) 633-3200

DOB DL Number State | Work Phone
01/07/1987 AR_ |(870)
0

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Address DOB DL Number State | Work Phone

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DOB DL Number State | Work Phone
ni

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Address DOB DL Number Work Phone

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Address DOB DL Number Work Phone

City, State, Zip Code SSN Local ID # State # Cell Phone

Last, First, Middle (Firm if Business) Age Hair Eyes
DL Number State | Work Phone

li
: Periecperifestas cl
Work Phone

Officer ID . Reviewed By Approved Date
OMicer Jake Powers as Lt. Virginia Edwards 02/04/2024

Hair Eyes

Address

603 KITTLE RD

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City, State, Zip Code
FORREST CITY AR 72335

Last, First, Middle (Firm if Business)

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Last, First, Middle (Firm if Business)

Address

Printed By/On; 412 / 02/23/2024 08:17:21
CrimeStar® Law Enforcement Records Management System
Licensed to: FORREST CITY AR POLICE DEPARTMENT

FORREST CITY Page 3 Incident conta
POLICE DEPARTMENT Narrative
ee qnaoor wwemuerunaway EL | __crmiatRopor ||

On Sunday, February 4, 2024, Officers were dispatched to Perimeter Behavioral
located at 603 Kittle Rd in reference to three runaway juveniles.

Upon arrival contact was made with employee Roxana Jennings. Ms. Jennings stated
that the juveniles F EE 21) three
white males ran kicked the fence down outside and ran toward the Dillard St
area.

Ms. Jennings stated one had a yellow jacket, one had on a red T-shirt, and one
had on a plaid shirt. The area was searched, and no contact was made with either
of the three males.

Reviewed By — Date
Lt. Virginia Edwards YES 02/04/2024

Printed By/On: 412 / 02/23/2024 08:17:21
CrimeStar® Law Enforcement Records Management System
Licensed to: FORREST CITY AR POLICE DEPARTMENT

OfficerID Officer Jake Powers

Supplement

Page 1

FORREST CITY
POLICE DEPARTMENT

225 N. ROSSER ST. —
FORREST CITY, AR. 72335 2402040015

Reported 92/95/2024 01:00 Monday

All three males were found and returned to woodridge unharmed.

Officer ID Agency Reviewed By Date
Sgt. Billy Spencer 507 FCPD
ara a
CrimeStar® Law Enforcement Records Management System

Licensed to: FORREST CITY AR POLICE DEPARTMENT

FORREST CITY Call For Service
POLICE DEPARTMENT Event Detail Page

225 N. ROSSER ST. — oe
FORREST CITY, AR. 72335 2402040015 02/23/2024
Time 17:08:32 Dispatcher ID 461 Agency FCPD

Address

Location WOODRIDGE
City FORREST CITY

County ST FRA State AR
REPORTING PARTY INFORMATION

Phone Requests Contact
870 N

RESPONSE INFORMATION
Unit

Total Consumed
Minutes of all
associated Units :

0

Officer ID Officer ID

Dispatch Time Dispatch Time

Enroute Time Enroute Time

Call For Service / Event

Arrive Time Arrive Time

Dispatch ID 461

Clear Time Clear Time

CALL DETAILS

CallType 24M MISSING PERSON Priority @
Description :

Disposition OR OFFENSE REPORT

Comments

Printed By/On: 412 / 02/23/2024 08:32:49
CrimeStar® Law Enforcement Records Management System
Licensed to: FORREST CITY AR POLICE DEPARTMENT


summary: A resident was taken to Forrest City Medical Center due to right hand swelling from falling out of a chair.

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
Case Number: 018927
Date of Incident: 2/1/2024
Date Received by DCCECE: 2/2/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, DOB was taken to Forrest City Medical
Center due to right hand swelling. Resident stated that he ?fell out of his chair on purpose
and I know what I was doing.? Resident returned to facility at 1240 (12:40 pm cst) from
Forrest City Medical Center with following findings: right hand swelling. No acute fracture
or dislocation. The proximal and distal carpal rows are adequately aligned. The soft tissues
are grossly unremarkable
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: On 02.14.24 during in person visit at the agency discussed this
occurrence. No concerns-violations to be cited.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was taken to Forrest City Medical Center due to an elevated reading of potassium during his labs.

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
Case Number: 018890
Date of Incident: 1/31/2024
Date Received by DCCECE: 2/1/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, date of birth , was taken to Forrest City
Medical Center due to an elevated reading of potassium during his labs. Resident returned
to facility same day at 1640 (4:40 pm cst) from Forrest City Medical Center with following
diagnosis: Hyperkalemia ? resolved Potassium 4.5.
Interim Action Narrative: Resident was transported to FCMC for an evaluation. .
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns. Facility provided documentation for this incident.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was taken to Forrest City Medical Center for evaluation after complaints of nausea and weakness.

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
Case Number: 018866
Date of Incident: 1/30/2024
Date Received by DCCECE: 1/31/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident was taken to Nurses station after complaints of nausea and
weakness. Resident also appeared pale. Resident was sent to Forrest City Emergency Room
for further evaluation. Resident returned to facility at 0203 (2:03 am cst) from the Forrest
City Emergency Room with following diagnosis: Viral Infection, unspecified.
Interim Action Narrative: Resident was assessed by the nurse and sent to FCMC for an
evaluation.
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns. Facility provided documentation for this incident.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was transported to LeBonheur Children’s Hospital for further evaluation after complaints of dizziness, another episode of syncope, head trauma, nausea and vomiting.

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
Case Number: 018824
Date of Incident: 1/29/2024
Date Received by DCCECE: 1/30/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident was transported to LeBonheur Children?s Hospital for further
evaluation after complaints of dizziness, another episode of syncope, head trauma and
nausea and vomiting. The resident returned from Lebonheur with a diagnosis of vasovagal
syncope. The resident had a chest x-ray and EKG and found no abnormalities. No issues
with Resident?s return and reintegration into the milieu.
Interim Action Narrative: Resident was transported to the hospital for an evaluation.
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns. Program Coordinator inquired about resident's guardianship.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident reported allegations of physical abuse by a staff member. This complaint was UNFOUNDED by Licensing.

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 018829
Date of Incident: 1/28/2024
Date Received by PRLU: 1/30/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Dual
Report Description: Resident was taken to Nurses station to share allegations of physical abuse on
another staff. Nursing staff called the and allegation was accepted. A red
bruise was on child?s back.
Interim Action Narrative: Resident was assessed by the nurse. Staff was placed on administrative
leave pending investigation. called and accepted.
______________________________________________________________________________
Maltreatment Narrative: AV is . AO is age unknown . AV is
currently admitted at Perimeter Health Care in Forrest City, AR. AO is a staff member at the facility.
At 0735 (28JAN2024) AV was brought to nurses station and stated he was in room and was doing
his own thing. AO came in, slammed AV down, hit him in the back and kneed him in his head. AV
has a hand print on his back. AV did not give a reason why this happened. AO had worked for
Perimeter Health Care for a month, was suspended (unknown reason) and had only been back to
work for a week when this happened..
Licensing Narrative: Program Coordinator reviewed complaint for licensing concerns. Program
Coordinator inquired about camera footage and referral number. Mr. Morris, Director of Quality &
Risk Management apologized for late reporting. Mr. Morris reported he thought he had to complete
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

internal investigation before reporting to licensing. Mr. Morris also reported he is aware that
incidents will be reported immediately. Program Coordinator will reach out to the investigator for
permission to contact the facility. 1/31/2024, Program Coordinator reviewed camera footage and
documentation provided by the facility. 3/1/2024, Program Coordinator requested an update from
investigator. Investigator Williams reported case was found unsubstantiated.


summary: A resident was taken to Forrest City Medical Center due to nausea and vomiting.

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
Case Number: 018747
Date of Incident: 1/24/2024
Date Received by DCCECE: 1/25/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: was taken to Forrest City Medical Center due to nausea and
vomiting. The resident passed out due to dizziness but no evidence of concussion, head
injury, or bodily injury. The ambulance was called and Resident was transported to the ER
for assessment. Resident returned same day. Resident was diagnosed with ?vomiting? and
prescribed ?ondansetron 4 mg? (oral) as needed.
Interim Action Narrative: Resident was taken to FCMC via ambulance.
Maltreatment Narrative:
Licensing Narrative: Program Coordinator inquired about resident's DOB. 1/26/2024,
Program Coordinator reviewed provider reported incident for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Unresponsive child on scene. Patient transported by EMSA.

raw_content:
CFS - Command Log Printed on January 24, 2024

CFS # CFS2403652
Call Taker KATELYN JACKSON
Location 1521 ALBERT ST, FORREST CITY, AR 72335 (WOODRIDGE BEHAVIORAL CENTER)

Location Details
Primary Incident Code MED : Medical Call

Mod
Priority a
Use Caution No
Primary Disposition Handled By Officer / Deputy
Beat
Zone Forrest City Police Department
Call Time 01/24/24 09:21:22
Completed Time 01/24/24 09:43:46
Reporters

FEMALE ON 911 (Initial Reporter)
Sex

DOB

Address

Report Time 01/24/24 09:21:22
How Reported

From Phone = (870) 970-3475
Contact Phone

Comments

Other Names

Vehicles

Responders
CALL1 FCFD (Primary)
FCE1 (Primary) FCFD, Engine CO 1 FCFD (Primary)
530 530 - HIVELY, VIRGINIA FCPD
532 (Primary) 532 - POWERS, JAKE FCPD

Response Times

Assigned 01/24/24 09:21:44
Enroute 01/24/24 09:23:19
Arrived 01/24/24 09:27:09
Leaving

Arrived At

Completed 01/24/24 09:43:46

IR / External Agency Numbers
FCFD 202400138

Officer Addenda

Command Log Filter: All Commands | Details: Hidden | Units: All Units | Revised Entries: Shown
ee

Page 1 of 2

01/24/24 09:21:22 | JACKSON, KATELYN | New CFS

01/24/24 09:21:37 | JACKSON, KATELYN | UNRESPONSIVE CHILD ON SCENE
01/24/24 09:21:44 | JACKSON, KATELYN | CALL1 | Assign

01/24/24 09:23:06 | JACKSON, KATELYN | EMSA NOTIFIED AND ENROUTE
01/24/24 09:23:19 | FCFD, Engine CO 1 | FCE1 | Enroute

01/24/24 09:23:50 | SHUMATE, DONIYA | 532 | Enroute

01/24/24 09:24:07 | SHUMATE, DONIYA | 530 | Enroute

01/24/24 09:26:42 | JACKSON, KATELYN | ENGINE 1 ADV ON SCENE

01/24/24 09:27:09 | JACKSON, KATELYN | 532 | On Scene

01/24/24 09:27:16 | JACKSON, KATELYN | 530 | On Scene

01/24/24 09:31:40 | JACKSON, KATELYN | 532 | Available

01/24/24 09:32:30 | JACKSON, KATELYN | 530 | Clear Alarms

01/24/24 09:43:38 | JACKSON, KATELYN | PATIENT TRANSPORTED BY EMSA
01/24/24 09:43:39 | FCFD, Engine CO 1 | FCE1 | Available

01/24/24 09:43:42 | JACKSON, KATELYN | FIRE BACK IN

01/24/24 09:43:46 | JACKSON, KATELYN | 530, CALL1 | Complete

01/24/24 09:52:30 | SHUMATE, DONIYA | 252 SFC 251

CLQ

Requested At
Sent To

Status
Received At
Location j
Accuracy

oo
Page 2 of 2

CFS - Unit Response Times

Printed on January 24, 2024

CFS # CFS2403652
Call Taker KATELYN JACKSON
Location 1521 ALBERT ST, FORREST CITY, AR 72335 (WOODRIDGE BEHAVIORAL CENTER)

Location Details

Primary Incident Code MED : Medical Call

Mod

Priority 1

Use Caution No

Primary Disposition Handled By Officer / Deputy
Beat

Zone Forrest City Police Department

Call Time 01/24/24 09:21:22
Completed Time 01/24/24 09:43:46

Reporters

FEMALE ON 911 (initial Reporter)

Sex

DOB

Address

Report Time 01/24/24 09:21:22
How Reported

From Phone (870) 970-3475
Contact Phone

Comments

Other Names

Vehicles
Responders
CALL1 OO a
FCE1 (Primary) FCFD, Engine CO 1
530 530 - HIVELY, VIRGINIA
532 (Primary) 532 - POWERS, JAKE

Response Times
Assigned 01/24/24 09:21:44
Enroute 01/24/24 09:23:19
Arrived 01/24/24 09:27:09
Leaving
Arrived At
Completed 01/24/24 09:43:46

IR / External Agency Numbers
FCFD 202400138

Officer Addenda

Unit Response Times

FCFD (Primary)
FCPD
FCPD

Page 1 of 2

Non Unit Specific Times

01/24/24 09:21:22 | New CFS

01/24/24 09:21:37 | UNRESPONSIVE CHILD ON SCENE
01/24/24 09:23:06 | EMSA NOTIFIED AND ENROUTE
01/24/24 09:26:42 | ENGINE 1 ADV ON SCENE

01/24/24 09:43:38 | PATIENT TRANSPORTED BY EMSA
01/24/24 09:43:42 | FIRE BACK IN

01/24/24 09:52:30 | 252 SFC 251

530
01/24/24 09:24:07 | Enroute

01/24/24 09:27:16 | On Scene
01/24/24 09:32:30 | Clear Alarms

530, CALL1
01/24/24 09:43:46 | Complete

532
01/24/24 09:23:50 | Enroute

01/24/24 09:27:09 | On Scene
01/24/24 09:31:40 | Available

CALL1
01/24/24 09:21:44 | Assign

FCE1
01/24/24 09:23:19 | Enroute

01/24/24 09:43:39 | Available

eee

Page 2 of 2


summary: A resident was sent to Forrest City Medical Center after reporting to staff that he was feeling lightheaded and dizzy.

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
Case Number: 018518
Date of Incident: 1/11/2024
Date Received by DCCECE: 1/12/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Serious injury requiring outside medical attention Residents
Name/DOB: State: Date/Time of incident: 1-11-24/08:39
Please give a description of the incident: Resident reported to staff that he was feeling light
headed and dizzy and he was taken to the nurses station for evaluation. Corrective Actions
Taken: Nurse assessed he was observed to have low blood pressure after consult with
the APRN, APRN ordered that he was sent to Forrest City Medical Center for medical
examination and x-ray. Diagnosed with upper respiratory infection, unspecified. Was given
Tylenol and sent back to the facility for continuance of care. Additional Information: None
currently. Guardian Notified: Parent/Legal Guardian
Interim Action Narrative: Resident was assessed by the nurse, APRN consulted. and
resident sent to FCMC for an evaluation.
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov