summary: Officers were dispatched to the facility in response to a report of a patient causing a disturbance.

raw_content:
Incident Report
Print Date/Time: 05/17/2023 13:14 Fayetteville Police Department
Login ID: wnewman ORI Number: AR0720100
Incident: 2023-00031754
Incident Date/Time: 5/11/2023 6:13:19 PM Incident Type: DISTURBANCE
Location: 4253 N CROSSOVER RD Venue: FAYETTEVILLE
FAYETTEVILLE AR 72703
Phone Number: (817)680-5929 Source: 911
Report Required: No Priority: 1-High
Prior Hazards: No Status: In Progress
LE Case Number: Nature of Call:
Unit/Personnel
Unit Personnel
440 440-MCRAE
453 453-BARNETT
460 460-BAILEY
493 493-ESPINAL
Person(s)
No. Role Name Address Phone Race Sex DOB
1 Caller MCCLELLAND, SABRINA Female
Vehicle(s)
Role Type Year Make Model Color License State
Disposition(s)
Disposition Count
12SUPPF 1
07FARREST 2
01RPTF 1
03NORPT 1
Property
Date Code Type Make Model Description Tag No. Item No.
Page: 1 of 1
Page: 1 of 2

CAD Narrative
05/11/2023 : 19:10:17 lusmith Narrative: EM 52595
05/11/2023 : 19:00:22 lusmith Narrative: BM 52589
05/11/2023 : 18:44:25 lusmith Narrative: 460 10-15
05/11/2023 : 18:39:20 lusmith Narrative: 440 97 AT PINEY RIDGE
05/11/2023 : 18:35:42 lusmith Narrative: PLOTTING IN CIRCLE K GAS STATION AT ZION / CROSSOVER
05/11/2023 : 18:35:11 lusmith Narrative: 440 ADV THEY WERE FLAGGED DOWN
05/11/2023 : 18:21:15 tkelley Narrative: CALLER WILL BE WAITING FOR PD OUTSIDE
05/11/2023 : 18:19:19 tkelley Narrative: C1 SUBJ HAS SCREW SAYING IS GOING TO STAB SOMEONE WITH IT
05/11/2023 : 18:18:59 tkelley Narrative: SUBJ IS SEPARATED FROM OTHER PTS, STAFF ARE PRESENT IN THE DAY ROOM
WITH HIM TO MONITOR HIM
05/11/2023 : 18:17:56 tkelley Narrative: HAS TAKEN ALL OF MEDS FOR MENTAL HEALTH CONDITION, INCLUDING
EMERGENCY MEDICATIONS AND NONE ARE WORKING
05/11/2023 : 18:17:24 tkelley Narrative: IS IN THE DAY ROOM RIGHT NOW PUNCHING THE WALL
05/11/2023 : 18:17:16 tkelley Narrative: IS BREAKING CAMERAS, STABBED A STAFF MEMBER WITH A PENCIL, TRYING
TO SETOFF THE SPRINKLER SYSTEMS
05/11/2023 : 18:16:50 tkelley Narrative: CALLER ADV THAT HAS INJURED OTHER PATIENTS, NO C10 NEEDED
05/11/2023 : 18:16:06 tkelley Narrative: CALLER ADV THAT WHEN OFFICERS GET HERE GO TO THE RESIDENTIAL
BUILDING, CALLER WILL HAVE TO KEY THEM IN
05/11/2023 : 18:15:29 tkelley Narrative: AVERAGE BUILD BRO HAIR RED SHIRT AND BLU
JEANS
05/11/2023 : 18:14:27 tkelley Narrative: PT HERE IS CAUSING A DISTURBANCE,
05/11/2023 : 18:14:06 tkelley Narrative: SUBJ ON THE NORTH UNIT
Page: 2 of 2

Fayetteville Police Department
Summary
Print Date/Time: 07/14/2023 10:24 Fayetteville Police Department
Login ID: ttannehill ORI Number:AR0720100
Case Number: 2023-00031754
Case
Case Number: 2023-00031754 Incident Type: Battery
Location: 4253 N CROSSOVER RD Occurred From: 05/11/2023 18:13
FAYETTEVILLE, AR 72703 Occurred Thru: 05/11/2023 18:13
Reporting Officer ID: 460 - BAILEY Disposition: Arrest - Juvenile
Disposition Date: 05/11/2023
Reported Date: 05/11/2023 18:13 Thursday
Offenses
No. Group/ORI Crime Code Statute Description Counts
1 State 13A 5-13-202 BATTERY II 3
2 State 290 5-38-203(b) Criminal Mischief 1st Degree (Felony) 1
Subjects
Type No.Name Address Phone Race Sex DOB/Age
Suspect 1 4253 N CROSSOVER RD White Male
FAYETTEVILLE, AR 72703
Victim 1 MCCLELLAND, SABRINA White Female
Victim 2 DODSON, KIMBERLY White Female
Victim 3 MALDONADO, OSCAR Hispanic Male
Victim 4 PINEY RIDGE YOUTH CENTER 4253 N CROSSOVER RD (479)442-3974
FAYETTEVILLE, AR 72703
Arrests
Arrest No. Name Address Date/Time Type Age
20230097 J 4253 N CROSSOVER RD 05/11/2023 18:44 On-View Arrest 15
FAYETTEVILLE, AR 72703
Property
Date Code Type Make Model Description Tag No.Item No.
05/11/2023 Destroyed/Damaged Medical/Medical MEDICAL EQUIPMENT, SEE
/Vandalized (4) Lab Equip (70) NARRATIVE
Vehicles
No. Role Vehicle Type Year Make Model Color License Plate State
Routing:
Page: 1 of 8
Page: 1 of 1

Case, Officer: JMBAILEY, Supervisor: MMILLER, Merged By: areznicek
2023-00031754
05/11/2023 18:13 Battery
4253 N CROSSOVER RD
05/11/2023 18:13 05/11/2023 18:13
FAYETTEVILLE, AR
5-13-202
01 3 Commit
BATTERY II
5-38-203(b)
02 1 Commit
Criminal Mischief 1st Degree (Felony)
Juvenile Suspect
4253 N CROSSOVER RD FAYETTEVILLE, AR 72703
White Male Brown Brown
Adult Victim MCCLELLAND, SABRINA
23
White Female Blonde
Adult Victim DODSON, KIMBERLY
43
White Female
460 BAILEY 05/11/2023 MILLER, MICHELE ANN 05/20/2023
Case 2023-00031754 Page 1 OF 5
Page: 2 of 8

2023-00031754
Adult Victim MALDONADO, OSCAR
38
Hispanic Male
Business Victim PINEY RIDGE TREATMENT CENTER,
4253 N CROSSOVER RD FAYETTEVILLE, AR 72703
(844)973-4018
460 BAILEY 05/11/2023 MILLER, MICHELE ANN 05/20/2023
Case 2023-00031754 Page 2 OF 5
Page: 3 of 8

2023-00031754
Destroyed/Damaged/Vandalized (4) $1200.00
1 / Each Medical/Medical Lab Equip (70)
MEDICAL EQUIPMENT, SEE NARRATIVE
460 BAILEY 05/11/2023 MILLER, MICHELE ANN 05/20/2023
Case 2023-00031754 Page 3 OF 5
Page: 4 of 8

2023-00031754
Officer J.M. Bailey #460
Juvenile Arrest of for Battery 2nd x3 and Criminal Mischief 1st (F)
Case #2023-31754
Case Narrative
On May 11, 2023, at approximately 6:13 p.m., I was dispatched to 4253 N Crossover
Road, Piney Ridge, for the report of a disturbance. The caller, Sabrina McClelland
( w/f), who is a nurse at Piney Ridge called stating that
w/m), who is a patient at Piney Ridge was on scene causing a disturbance. Sabrina stated
assaulted several nurses and stabbed another nurse with a pencil.
I arrived on scene, along with Officer Barnett #453 and Officer McCrae #440 and
spoke with Sabrina. I asked her to explain what happened. Sabrina stated took his
medication but for an unknown reason, they were not working. He became increasingly
angry and began striking Sabrina. He threw Sabrina and kicked her in the head causing her
to feel like she might lose consciousness. then kicked Sabrina in the leg. Several
nurses began trying to assist Sabrina. was able to get away and began punching and
kicking Oscar Maldonado ( h/m), several times causing complaint of pain and
injury. Once broke away from Oscar he then walked past Nurse Kimberly Dodson
w/f). Kimberly attempted to restrain but pulled a pencil from his
pocket and stabbed Kimberly in the right arm with the pencil and struck her in the chest and
stomach. It should be noted Sabrina walked with a noticeable limp due to being kicked by
and when I felt the back of her head where she was kicked, I could feel swelling, and
she was sensitive to me touching the area. Photographs were taken and those will be added
to this case file.
Staff was able to get into a central room and locked the doors keeping him
from wandering the facility and causing more damage. Once locked inside that room,
began ripping up multiple chairs located in the room and destroying items. He began
ripping cameras from the wall and smashing them as well as a dry erase board totaling
approximately $1200.00 in damages.
After I finished speaking with Sabrina, she walked myself and the other officers to
where was located. I walked into the room, and was seated in a chair with a
pencil in his hand. I asked him to put the pencil down, but he did not. I removed the pencil
from his hand, and he was placed under arrest. I placed in my patrol vehicle and
began speaking with Kimberly about her injuries while Officer Barnett spoke with Oscar.
See Officer Barnett’s report for further details on his interactions.
I asked Kimberly if she could explain what happened. Kimberly stated she was
460 BAILEY 05/11/2023 MILLER, MICHELE ANN 05/20/2023
Case 2023-00031754 Page 4 OF 5
Page: 5 of 8

2023-00031754
attempting to help restrain when he kicked and punched her multiple times. Kimberly
stated she then back off and began walking around and as he walked past her he
stabbed her in her upper right arm with a pencil. Kimberly showed me where she was
stabbed and there was a wound with what looked like pieces of lead from a pencil inside. I
photographed Kimberly and those will be added to this case file.
I was able to contact father, , via phone and
inform him of what was happening. stated he understood and did not know what else
to do with and putting him in Piney Ridge was already what a felt like a last resort. I
explained there would be a court date he would need to attempt to attend but he stated he
would likely not be able to because he lives in . He was advised of the
ongoing process and to contact the Police Department if he had further questions.
I then transported to the Fayetteville Police Department for juvenile
processing and to complete a preliminary report. I placed in interview room number 1
while I completed the preliminary report and monitored him via the camera system. I then
transported to the Juvenile detention center with no other issues.
For the aforementioned, was charged with Battery 2nd Degree x3 for knowingly
and without legal justification, caused physical injury to a person knew to be an
employee of a correctional facility as well as a certified health care provider in performance
of their duties. As well as Criminal Mischief 1st degree for purposely and without legal
justification destroyed and caused damage to over $1200.00 worth of equipment inside the
Piney Ridge Facility.
Processed by A. Diaz
460 BAILEY 05/11/2023 MILLER, MICHELE ANN 05/20/2023
Case 2023-00031754 Page 5 OF 5
Page: 6 of 8

Case Supp, Officer: JBARNETT, Supervisor: SALLEN, Merged By: JTULGETSKE
2023-00031754
05/11/2023 18:13
4253 N CROSSOVER RD
FAYETTEVILLE, AR
453 BARNETT 05/11/2023 ALLEN, SHAWN CHRISTOPHER 05/23/2023
Case Supp 2023-00031754 Page 1 OF 2
Page: 7 of 8

2023-00031754
Officer J Barnett #453
Case #2023-31754
Case Supplement
On 05-11-2023, at approximately 1800 hours, I responded to 4253 N. Crossover Rd. (Piney
Ridge) for a report of a disturbance. When I arrived, I met with Officer J. Bailey #460. Officer
Bailey was speaking with a staff member. Officer Bailey stated he had determined there
were charges to arrest We entered Piney Ridge and made
contact with was acting calm and went into custody without issue.
After was placed into the rear of Officer Bailey's patrol vehicle, I spoke with Oscar
Maldonado (W/M ). Maldonado is a Behavioral Health Technician with Piney
Ridge. Maldonado stated this situation started the night before. had destroyed some
drywall and pulled an outlet out of the wall. Maldonado stated on 5-11 was not
allowed to play and have fun after last night's incident so he became upset. According to
Maldonado, began punching the wall and destroying property. When Staff attempted
to restrain he began to fight with them. Maldonado attempted to take to the
ground and was striking him in the leg.
ended up destroying three cameras, a dry-erase board, and several chairs. The
approximate cost of repair for the cameras was $300 each. The dry-erase board cost $150.
The chairs approximately cost $150. Photos were not able to be collected of the damages to
the property due to Piney Ridge police. They asked, after the arrest, us to exit the building
and finalize taking the report so other patients could continue to use the building.
This incident was recorded on my Axon body-worn camera.
Processed by E Jones
453 BARNETT 05/11/2023 ALLEN, SHAWN CHRISTOPHER 05/23/2023
Case Supp 2023-00031754 Page 2 OF 2
Page: 8 of 8


state: AR

facility_name: Yellow Rock Behavioral Health (formerly Piney Ridge)

summary: An x-ray was ordered after a resident slid into a wall while playing kickball.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 5/8/2023
Date Received by DCCECE: 5/9/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Facility Type:
Incident Type: Licensing
Report Description: (DOB 7 OOS DHW) on 5/8/2023 reported
that while playing kickball in the gym he slid into a wall. RN on duty notified APRN, K.
Reynolds. APRN ordered an x-ray of the right ankle and foot. X-ray report shows normal x-
ray examination of the foot. No follow up required at this time.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 5/10/2023- Licensing received this incident and reviewed it for any
licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

doc_type: Notice of Incident


summary: A resident was transported to Children’s Hospital for assessment after reporting stomach pain.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 5/8/2023
Date Received by DCCECE: 5/9/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Facility Type:
Incident Type: Licensing
Report Description: (DOB A private) On 5-8-2023
Resident came to nurses? station crying, reporting stomach pain. She was assessed, APRN
was notified, and orders were given to send to ER to rule out appendicitis. Resident was
transported via EMS to AR Children?s hospital. Resident left via EMS at 2340 and a staff
went with her as well. She returned via Piney transportation approx. 0700 05/09/2023. She
had a CT scan, lab work and an ultrasound. She was discharged with diagnosis
She will be treated with anti-inflammatory for the pain as directed.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 5/10/2023- Licensing received the incident report and reviewed it for
any licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Physician Specialty Hospital for treatment after he was found unresponsive in the cafeteria.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 5/3/2023
Date Received by DCCECE: 5/4/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Facility Type:
Incident Type: Licensing
Report Description: On 5-3-23 (DOB private ) It was
reported by staff member that resident was non-responsive while in the cafeteria. The nurse
did sternal rub and resident was responsive for a moment and then went back to no-
responsive state, breathing even and unlabored, VS BP 156/95, P 118, R 16, T 98, APRN
Karen Reynolds was notified and gave order to send patient to Physician Specialty Hospital
for evaluation and treatment. Staff transported by van, he was taken via staff and a nurse. He
returned from the hospital, no new dx or change in medication. The ER was able to pull old
records and show that he did have a history of irregular heart rate.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 5/4/2023- Program Coordinator reviewed the incident report.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: An x-ray was ordered after a resident punched a wall while angry.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 4/17/2023
Date Received by DCCECE: 4/18/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Facility Type:
Incident Type: Licensing
Report Description: On 4/17/23 (DOB DCFS) at
approximately 0850 he was observed to be irate by staff. He stated that he was angry and
then punched the wall with his closed fist. Swelling was noted on his right hand, and he
received an x-ray in house. There were not significant findings on the x-ray.
Interim Action Narrative: Resident was assessed and an in-house x-ray was ordered with
not findings.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed provider reported incident. Licensing
Specialist will follow-up with facility for an update on the resident. Licensing Specialist
informed that resident had not complained about any discomfort from this reported
incident.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Ozark Orthopedics after falling and twisting his ankle.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 4/15/2023
Date Received by DCCECE: 4/17/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Facility Type:
Incident Type: Licensing
Report Description: On 4/15/23 at approximately 1700 (DOB
private) was outside playing basketball with peers from his unit. The resident fell
down and twisted his ankle and stated he heard a loud popping sound. He was provided
first aid; the medical provider was contacted, and an x-ray was performed. In addition,
Isaiah went to Ozark Orthopaedics and he did not have a fracture. He has a follow up
appointment on 5/1/23.
Interim Action Narrative: Resident was assessed and medical provider contacted. X-ray was
ordered. Resident was also evaluated at Ozark Orthopedics.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed provider reported incident. Resident is
scheduled for a follow-up appointment with Ozark Orthopedics on 5/1/2023. Licensing
Specialist will inquire if resident had a sprain. Licensing Specialist informed that resident
sprained his ankle.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: An x-ray was ordered after a resident twisted her ankle when she slipped and fell in the shower.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 4/16/2023
Date Received by DCCECE: 4/17/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Facility Type:
Incident Type: Licensing
Report Description: On 4/16/23 at about 1830 (DOB Arkansas
DCFS) reportedly called for help after slipping and falling as she got into the shower. She
stated that she felt like her ankle twisted and it was in pain. The medical provider was
contacted, and an x-ray was ordered of the right ankle. The x-ray came back negative for
fracture or soft tissue swelling.
Interim Action Narrative: Medical provider was contacted and an x-ray was ordered.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed provider reported incident. Licensing
Specialist will follow-up with facility on prevention. 5/30/2023, Licensing Specialist
inquired about safety measures to prevent future slips in the shower. 6/1/2023, Licensing
Specialist contacted the facility for an update on the safety measures. Licensing Specialist
informed that residents are provided shower shoes to wear if needed. Staff are to check the
bathroom in between residents to make sure there is not excess water or anything on the
floor to slip on.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


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

raw_content:
521 Visit Compliance Report

Licensee: Piney Ridge Treatment Center

Facility Number: 203

Licensee Address: 2805 E ZION RD
FAYETTEVILLE AR 72703

Licensing Specialist: Kendra Rice
Person In Charge: Ronissa Adams
Record Visit Date: 4/11/2023
Home Visit Date: 4/11/2023

Purpose of Visit: Subsequent Building and Grounds

Regulations Out of Compliance:

Regulations Needing Technical Assistance:

Regulation Not Applicable:

Regulations Not Correctable:

Narrative:

Visit conducted from: 1:45 pm to 3:00 pm

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

ARKANSAS
) DEPARTMENT OF

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

P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550

Page 1 of 3

Census: 91

Licensing Specialist completed buildings and grounds on the following the areas: gym, units (East, West,
North, and South), gym, computer lab, classrooms, cafeteria, dining room area, game room, garden area, and
courtyards.

Grounds were clean and free of debris. Licensing Specialist observed the main courtyard and the west
courtyard. Licensing observed a staff member and residents walking through the courtyard, 1:3. Licensing
Specialist observed the playground equipment, two areas where residents can play basketball, and the ga ga
pit (outdoor game). The west unit courtyard was once the garden area.

Licensing Specialist observed residents transitioning to their classrooms, they were coming from lunch.
Licensing Specialist observed classrooms (1, 2, 3, 4, and 5). Some classrooms were empty due to some
residents being in the gym or the game room. Each classroom, game room, and gym were in ratio. The facility
has two (2) game rooms, the music room is now both for music and games.

Licensing Specialist observed the residents’ rights, program rules, activity calendar (April), and evacuation
plans on the walls of the classrooms and units. All units (East, West, North, and South) were clean with the
aroma of cleaning products. Bedrooms were organized and the bathrooms had running water.

Licensing Specialist was informed by Mr. Justin Hoover (CEO) the residents must display safety to participate
in gardening. The garden is behind a locked fence near the main courtyard. Mr. Hoover informed Licensing
Specialist that as of 3/1/2023, the facility has been seclusion free. The seclusion rooms are being used as
storage closets. North Unit had residents on the unit ratio 1:3.

Licensing Specialist reviewed MARs for the following residents on the West Unit:

All initialed and up to date.

Provider Comments:

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

CCL Staff Signature : Date: 4/11/2023

fi

h A Wi) .

je

Provider Signature : Date: 4/11/2023

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

doc_type: Compliance Report


summary: Technical assistance was provided to the facility regarding A.C.A 12-18-402, R102.3.h and R110.9.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Piney Ridge Treatment Center
Facility Number: 203
Licensee Address: 2805 E ZION RD
FAYETTEVILLE AR 72703
Licensing Specialist: Chelsea Vardell
Person In Charge:
Record Visit Date: 3/31/2023
Home Visit Date: 3/31/2023
Purpose of Visit: Technical Assistance Request Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Number: 1. 102. 3 .h
Regulation Description: The following policies of the agency shall be current and available to all employees of
the agency and the Licensing Specialist:
Findings Description:
Action Due Date:
Action Due Description:
Comply Date:
Sub Regulation Description:
Regulation Number: 1. 110. 9
Regulation Description: Any owner/operator, employee, foster parent, or volunteer in a child welfare agency
shall immediately notify the Child Abuse Hotline if he or she has reasonable cause to suspect that a child has
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

been subjected to child maltreatment, died as a result of child maltreatment or if they observe a child being
subjected to conditions or circumstances that would reasonably result in child maltreatment.
Findings Description:
Action Due Date:
Action Due Description:
Comply Date:
Sub Regulation Description:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
After review of your agency’s current mandated reporter policy, it has been determined that it does not
comply with A.C.A. 12-18-402 nor the Minimum Licensing Standards.
Technical assistance was provided to the agency regarding A.C.A. 12-18-402, R102.3.h, and R110.9.
Please ensure that your current policy is updated to reflect the need of all staff to report directly to the child
abuse hotline without delay to come into compliance with A.C.A. 12-18-402, R102.3.h, and 110.9. All reports
will be screened by the Child Abuse Hotline to determine if they meet criteria for investigation. The updated
policy shall be submitted to the Licensing Unit by4/14/23and all applicable staff should be retrained on the
updated policywithin two weeksof the enactment of the updated policy at the agency.
Provider Comments:
CCL Staff Signature : Date: 3/31/2023
Provider Signature : Date: 3/31/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident was sent to Children’s Hospital for a possible fractured nose after he was pushed and hit by a peer.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 3/27/2023
Date Received by DCCECE: 3/28/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Facility Type: Residential
Incident Type: Licensing
Report Description: On 3/27/2023 at approximately 1005, the North unit was lining up after
community group to go to class. (DOB )
pushed and then quickly hit (DOB ). Staff
intervened on the situation. was assessed by nursing; order was received to take
him to Arkansas Children?s hospital due to possible fractured nose. He was having trouble
breathing out his nose and reported numbness. reported pain to his right hand. He
was assessed and order received for x-ray to be completed in house. Resident was
taken to Children?s hospital where he had a CT scan that confirmed a . He
returned to facility with ibuprofen every 6 hours for pain, and a follow-up with ENT on
04/03/2023. had x-ray completed in house of his hand and shows no fracture or
dislocation. He will be treated for pain as needed and also follow-up with APRN as needed.
was placed on precautions for the behavior and was on increased observation.
Interim Action Narrative: Residents were taken for medical care and the aggressor was
placed on precautions and increased observations.
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: 3/29/2023-Licensing Specialist emailed the facility to inquire if this
was one or more punches, if there are peer restrictions in place, and if there is video footage
available for review. The facility confirmed that the hit was a single punch to the face and
the residents were placed on a six foot no interaction safety plan. The punch took place in
line and can be viewed slightly on video at the far end of the room. The facility reports no
clear footage available of the incident. 4/11/2023, Licensing Specialist reviewed camera
footage and witness statements from the residents and a staff member.


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

raw_content:
ARK ANS A S&S
DEPARTMENT OF

+4 HUMAN
<a¥ SERVICES

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550

Notice of Serious Incident

Date of Incident: 3/25/2023

Date Received by DCCECE: 3/27/2023

Facility Name: Piney Ridge Treatment Center
Facility Number: 203

Facility Type: Residential

Incident Type: Licensing

Report Description: On 3/25/2023, resident Po e
dcfs - DOB J) was playing kickball in the gym during RT, she lost her balance
and ran towards the wall. She reported twisting her ankle in the process. Nursing did an
assessment and resident reported pain 8/10 and swelling noted to ankle. Order was received
for x-ray to be completed in house. Resident was playing kickball in the gym during RT, she
lost her balance and ran towards the wall. She reported twisting her ankle in the process.
Nursing did an assessment and resident reported pain 8/10 and swelling noted to ankle.
Order was received for x-ray to be completed in house. X-ray was completed in house, there
is no fracture or dislocation. Nursing will continue to monitor and treat for pain as needed.

Interim Action Narrative:

Maltreatment Narrative:

Licensing Narrative: 3/28/23-Reviewed by licensing, resident accidentally injured her
ankle while playing so an in house Xray was completed and there are no fractures. The
resident will continue to be monitored by nursing staff.

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


summary: A resident was sent to Arkansas Children’s Hospital for assessment after hitting her temple on the floor when she was pushed by a peer.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 3/25/2023
Date Received by DCCECE: 3/27/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Facility Type: Residential
Incident Type: Licensing
Report Description: On 3/25/23 - - DOB )
she was pushed in the cafeteria by another resident,
) DOB during horseplay. She hit her left temple area on the floor.
Nursing assessment shows pupil equal and reactive, no issues noted. Nursing informed the
APRN who ordered the resident go to the emergency room for assessment. She was taken to
Arkansas Childrens ER. She returned at 2250 with order for ice and ibuprofen. No new
issues and injuries we found. Resident will follow-up with APRN today and ordered follow-
up with orthopedist.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 3/28/23- Licensing reviewed the incident which states a resident was
pushed by a peer in the cafeteria while playing and fell and hit her head. The facility took
the resident to the emergency room for an assessment to be sure of no internal head injuries.
Results came back negative and the resident returned to the facility.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Ozark Orthopedics after fracturing his pinky finger while playing basketball.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 3/16/2023
Date Received by DCCECE: 3/20/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Facility Type: Residential
Incident Type: Licensing
Report Description: On 3-16-2023 ( DOB ) was
playing basketball in the gym and went to catch the basketball and hit the ball with his
pinky. He complained of pain 5/10 and was given ice and analgesic. APRN notified and x-
ray was ordered to be obtained in house. The result of x-ray was obtained on 3-17-23 and he
was diagnosed with a fracture to his pinky finger. He was taken to Ozark Orthopedics on 3-
17-23 and a splint was placed. He was discharged on 3-17-23 to the care of his father and his
father was aware of follow up needed.
Interim Action Narrative: Resident was assessed and provided with ice and analgesic.
APRN notified and x-ray ordered. Diagnosis: . Resident
evaluated at Ozark Orthopedics and splint provided.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed provider reported incident. Resident
was discharged to the care of his father and father was made aware of needed follow-up. No
licensing concerns noted.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Children’s Hospital after rolling his ankle while playing basketball.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 2/20/2023
Date Received by DCCECE: 2/24/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Facility Type: Residential
Incident Type: Licensing
Report Description: Resident reported he was playing basketball in the gym when he rolled
his right ankle. He said he heard a pop when he landed. Xray was completed and injury was
treated with ice and Ibuprofen. Xray revealed resident was taken to Children's
Hospital where a soft cast was applied, Will continue to receive ibuprofen for pain. He has a
f/u appt with NW orthopedic scheduled.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative:02/22/2023--licensing specialist Sutton received this report via email
on this date. Ronissa Adams was out of the office with illness. Angie Smith sent the original
notification to DRA, DSPQA, etc. on 2/20/2023, but did not have the correct email address
for specialist Sutton which caused a delay in reporting. 03/02/2023--licensing specialist
reviewed this report. No additional licensing follow up is required at this time. Resident has
received appropriate medical treatment and follow up related to this accidental sports injury.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Officers were dispatched to the facility for a welfare check on a resident.

raw_content:
Ca Incident Report

CITY OF

FAYETTEVILLE
ARKANSAS
Print Date/Time: 02/17/2023 08:06 Fayetteville Police Department
Login ID: hgilbert ORI Number: ARO720100
Incident: 2023-00010062
Incident Date/Time: 2/14/2023 11:58:16 AM Incident Type: WELFARE CONCERN
Location: 2805 E ZION RD Venue: FAYETTEVILLE
FAYETTEVILLE AR 72703
Phone Number: (904)465-9446 Source: Phone
Report Required: No Priority: 3-Low
Prior Hazards: No Status: Not In Progress
LE Case Number: Nature of Call:
Unit/Personnel
Unit Personnel
375 375-GEORGE
Person(s)
No. Role Name Address Phone Race Sex DOB
1 Caller MANN, ALLEN (904)465-9446 02/17/1959
Vehicle(s)
Role Type Year Make Model Color License State
Disposition(s)
Disposition Count
O3NORPT 1
Property
Date Code Type Make Model Description Tag No. Item No.

Page: 1 of2

CAD Narrative

02/14/2023 : 13:31:48 jgeorge Narrative: I spoke with while he was in a therapy session. I asked if he had any injuries or

bruises. The only injury told me about was a scar on the inside of his left leg, approximately three inches above his ankle.

said it was from a dog bite. I contacted Allen Mann and informed him of what I found. I did not observe any marks, injuries, or

bruises on - D3

02/14/2023 : 12:02:16 tbryant Narrative: CALLER WOULD LIKE CONTACT

02/14/2023 : 12:01:19 tbryant Narrative: THERAPIST IN FAYETTEVILLE TOLD THE CALLER HE WAS AT THIS LOC

02/14/2023 : 12:00:47 tbryant Narrative: HE IS LISTED IN AN INVESTIGATION IN FLORIDA AND THEY NEED AN OFCR TO

LAY EYES ON HIM TO MAKE SURE HE IS NOT INJURED AND HAS NO BRUISES

02/14/2023 : 11:59:32 tbryant Narrative: CALLER IS WITH CPS IN FLORIDA, NEEDING A WELFARE CHECK DONE OF
W/M DOB

Page: 2 of 2

doc_type: Police Report


summary: Licensing completed an unannounced bimonthly visit. No deficiencies cited.

raw_content:
521 Visit Compliance Report

Licensee: Piney Ridge Treatment Center

Facility Number: 203

Licensee Address: 2805 E ZION RD
FAYETTEVILLE AR 72703

Licensing Specialist: Michele Sutton
Person In Charge:

Record Visit Date: 2/13/2023

Home Visit Date: 2/13/2023

Purpose of Visit: Monitor Visit

Regulations Out of Compliance:

Regulations Needing Technical Assistance:

Regulation Not Applicable:

Regulations Not Correctable:

Narrative:

Unannounced bimonthly facility visit today.

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

ARKANSAS
) DEPARTMENT OF

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

P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550

Page 1 of 3

Ratio: all classrooms were in ratio at time of visit:

1st classroom- 3:10
2nd classroom: 3:12
3rd classroom: 3:13
4th classroom 3:14
Gym 4:14

5th classroom 2:10

East unit--Viewed rooms 301,304, and 305. Rooms/bathrooms were reasonably clean. No obvious safety
hazards or contraband identified in bedrooms or in the common area of the unit. All required information
posted.

North unit- viewed rooms 203, 208, 202, 205--rooms/bathrooms were clean and free from obvious safety
hazards or contraband. Common area of the unit was clean, and no hazards were identified. All required
information posted.

West unit- rooms viewed were clean and free from obvious safety hazards/contraband. The wooden lining of
Room 106 door has been partially peeled off. Facility provided information that a new door has been order by
Weschi. Facility maintenance stated will sand door while waiting for the new door to arrive to prevent
residents from peeling pieces off of door to use for self-harm. This is not being cited because facility has
provided evidence that they were aware of the issue and are actively addressing the issue. All required
information posted.

South unit--bedrooms viewed on unit were clean and free from obvious safety hazards/contraband.

Viewed MARS for the following residents:

HR -—2.ects regulatory requirements.
HR -11ee1s regulatory requirements.
HE -- ects regulatory requirements.
HE -1cets regulatory requirements.
HE --12eets regulatory requirements.

Activities--facility is providing several opportunities for outings and recreation for the residents. Licensing
specialist viewed activity calendar on the unit. Facility CEO stated that he is working with the residents this
weekend to complete a gaga ball pit for the outdoor recreation area. The girls recently went on an outing to a
ballet, and there are several outings and activities planned. The facility is working on a hydration initiative
prior to spring to ensure the residents stay hydrated while completing outdoor activities during the upcoming
warmer weather months.

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

Viewed 5 personnel records Austin F., Rachel B., Juliana F., Baylee A., Emily C.--no citations--all trainings,
background checks, and other required information up to date.

Viewed 4 children's records 00 citations--each child has a comprehensive master
treatment plan that is updated monthly, and records contained all information and legal documents required by
minimum licensing standards.

Provider Comments:

CCL Staff Signature : Date: 2/13/2023

vf
afta

h

|

Provider Signature : Date: 2/13/2023

lh
Gn Pane/

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


summary: Dispatch was contacted in response to an assault report related to the facility.

raw_content:
ee Incident Report

CITY OF
FAYETTEVILLE
ARKANSAS
Print Date/Time: 02/17/2023 08:05 Fayetteville Police Department
Login ID: hgilbert ORI Number: AR0720100
Incident: 2023-00008336
Incident Date/Time: 2/7/2023 10:24:24 AM Incident Type: ASSAULT BATTERY
Location: 4253 N CROSSOVER RD Venue: FAYETTEVILLE
FAYETTEVILLE AR 72703

Phone Number: {479)769-6787 Source: Phone

Report Required: No Priority: 3-Low

Prior Hazards: No Status: Report

LE Case Number: Nature of Call:
Unit/Personnel
Unit Personnel
467 467-BURNS
Person(s)

No. Role Name Address Phone Race Sex DOB
4 Caller MCKINNEY, KYLA (479)769-6787 Female 02/16/1990

Vehicle(s)
Role Type Year Make Model Color License State
Disposition(s)
Disposition Count
O3NORPT 1
Property
Date Code Type Make Model Description Tag No. Item No.

Page: 1 of 2

CAD Narrative

02/07/2023 : 11:31:51 jburns Narrative: Spoke with about the incident and he stated the kids were playing a game where they
were chasing each other and he was hit in the nose. nose was not broken. D3

02/07/2023 : 10:28:49 hhaberly Narrative: CALLER WOULD LIKE CONTACT

02/07/2023 : 10:27:21 hhaberly Narrative: UNK SUSP INFO

02/07/2023 : 10:27:09 hhaberly Narrative: UNK IF CLS INVOLVED

02/07/2023 : 10:26:48 hhaberly Narrative: DENIED C10

02/07/2023 : 10:26:44 hhaberly Narrative: WHEN SHE SPOKE WITH HE INFORMED HER THAT HE THOUGHT HIS
NOSE WAS BROKEN

02/07/2023 : 10:26:29 hhaberly Narrative: CALLER ADV SHE HAS REACHED OUT TO STAFF AND ALL THEY WOULD TELL
HER WAS THAT SHE NEEDED TO MAKE A REPORT WITH THE POLICE, WOULD NOT RELEASE MUCH INFO TO HER
02/07/2023 : 10:26:06 hhaberly Narrative: CALLER IS CURRENTLY IN FT SMITH BUT ADV SHE CAN COME TO FAY IF
NEEDED

02/07/2023 : 10:25:53 hhaberly Narrative: ADV THAT HE IS CURRENTLY A PT HERE AND WAS ASSAULTED LAST NIGHT
BY ANOTHER RESIDENT

02/07/2023 : 10:25:08 hhaberly Narrative: CALLER IS THE MOTHER OF

Page: 2 of 2


summary: An x-ray was ordered after a resident became upset and hit a wall.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 2/6/2023
Date Received by DCCECE: 2/7/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Facility Type: Residential
Incident Type: Licensing
Report Description: (DOB Arkansas DCFS custody) On 2/6/2023
became upset and hit the wall. The APRN ordered an x-ray in house and a did
not have a fracture and requires no additional care.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: Reviewed incident this date. Appropriate medical care has been
provided to resident. No need for additional licensing follow up at this time.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: An x-ray was ordered after a resident complained of hand pain from playing basketball.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 2/4/2023
Date Received by DCCECE: 2/6/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Facility Type: Residential
Incident Type: Licensing
Report Description: (DOB out of state, private) Resident was
playing basketball, after attempting to catch the ball he complained of pain in his left hand.
APRN was notified and an order for x-ray was obtained. Date of occurrence: 2/04/2023
Corrective Action taken by the agency or follow-up done: X-ray was completed in house.
Resident had a dislocated 5th digit. Splint was placed per order and will follow-up with
Ozark Orthopedic this week.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: Incident reviewed this date. Accident occurred during a recreational
activity and medical treatment has been rendered. No additional licensing follow up is
required at this time.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: An x-ray was ordered after a resident complained of finger and ankle pain from recreational activities.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 2/2/2023
Date Received by DCCECE: 2/3/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Facility Type: Residential
Incident Type: Licensing
Report Description: (DOB out of state dcfs) complained of pain
from recreation to his left pinkie and left ankle. Xray was completed on 2/2/23 with no
significant findings.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: Facility has provided medical care to address resident complaint. No
additional licensing follow-up required at this time.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was seen by the APRN for hand pain after he was involved in an altercation with a peer and hit a wall.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 2/2/2023
Date Received by DCCECE: 2/3/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Facility Type: Residential
Incident Type: Licensing
Report Description: (DOB out of state dcfs) was seen by APRN on
2/1/23 after he complained of pain to his right hand. This had occurred earlier in the week
when he became upset at a peer engaged in a brief altercation and hitting the wall.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: Resident has received medical treatment to address his complaint. No
additional licensing follow up is required at this time.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: An x-ray was ordered after a resident accidently rolled his right ankle.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 1/18/2023
Date Received by DCCECE: 1/19/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Facility Type: Residential
Incident Type: Licensing
Report Description: Child's Name: (DOB out of state DHS
placement) Description of the report: Resident was walking down the hall and miss stepped
on his foot and rolled his right ankle. Resident was seen by the APRN, she ordered an x-ray
and an ankle brace. Date of occurrence: 01/18/2023 Corrective Action taken by the agency
or follow up done: X-ray was completed in house to the right ankle. There is no acute
fracture or dislocation. We will treat the resident for pain if needed, but no further follow-up
is needed at this time.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: received medical treatment/follow up for his injuries
as noted above.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


facility_name: Youth Home

summary: Officers were dispatched to the facility to assist EMS with a patient. Officers made contact with a staff member who reported that a resident was injured in a fight with another resident.

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

Case P25-010115 Printed on October 23, 2025

Status Approved
Report Type Patrol
Primary Officer William Brooks II
Investigator None
Records Technician
Reported At 10/15/25 18:55
Incident Date 10/15/25 18:55
Incident Code BATT : BATTERY
20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
2
Southwest

Disposition CA- Cleared by Arrest
Disposition Date/Time 10/15/25 20:45
Disposition Comments

BS#2495
Review for Gang Activity Not Applicable

Asst Officers
4X72 - Keyes, Josh; 4X71 - Parker, Lance

Primary Narrative By William Brooks Il, 10/15/25 20:58

Domestic Battering 3rd

On 10/15/2025 at approximately 1855 hours Deputy Brooks was dispatched to 20400 Col. Glenn Rd (Youth Home) to
assist ambulance. The call was directed for the Crestview House where it was advised by dispatch that a 15 YOA
female had been fighting.

Upon arrival Deputies made contact with a worker at the Youth Home, Amanda Fields, who stated that

fought another tenant of the Youth Home. Ms. Fields stated that the other tenant had been sent to Children’s
Hospital due to her injuries that she sustained during this incident. Ms. Fields also stated that attempted fight
another tenant but was not successful due to being restraj Parker requested the name of the tenant that
was attacked. Ms. Fields printed an information sheet or MRR ting this was the tenant that was attacked.

Both parties cohabited at the Crestview House at the Youth Home on 20400 Col. Glenn Rd.

Deputy Brooks asked what had taken place today wih stated that | E another female
had been cursing and that told both of them to "Shut up." and they stated “ You ain't talking tous.” __ __ then
stated _told ‘Okay wait until we get outside.” also stated that _ hit when they got off the bus;

did not advise of any further details at this time.
Another staff member asked deputies to step outside. When deputies were outside the staff member stated that

statement wasn't factual and that the other children on the bus stated that the argument was over a boy and
that was actually arguing with another girl and not rhe staff member also stated that the children said

as trying to deescalate the situation and that thought that oa Re up for the girl and that when
exited the bus attacked None of the staff members present at this time witnessed the incident.
At this time Dep. Brooks contacted the on call juvenile intake officer, Shannon Robinson and advised her of the

Case P25-010115 Page 1 of 2

charges for . Robinson provided Dep. Brooks with the next available court date of 11/18/2025.

Deputy Keyes responded to the waiting room for Children's Hospital and made contact with EE advised to
him that she was in a verbal argument with on the bus and that when they exited the bus to return to Crestview
House got on top of her after dragging her to the ground, struck her with _‘ fists in the face and pulled her
hair. Deputy Keyes advised that there was visible si jnjury on (see Keyes supplement for further). Deputy
Keyes completed domestic violence paperwork with ldo took photographs of her which were attached to this
report as evidence. The domestic abuse supplement form as well as the lethality assessment were submitted into
evidence.

At this time was in the custody of MEMS 327 personnel as they were going to transport to Rivendell.
Deputy Brooks advised that is charged with Domestic Battering 3rd and that has a court date of
11/18/2025 at 10:00 A.M.

Scelita Drennon, the director of the youth home, signed the ADR acknowledging the court date and was provided with
the offender copy of the ADR.

CFS 202567665
Supporting Narrative By Josh Keyes, 10/15/25 20:35

Supplement Keyes

On 10/15/25, at around 1915 hours, | responded to 20400 Colonel Glenn Road to assist Deputies with an Assist
Ambulance call for service.

As Communications was relaying the call notes, they advised MEMS requested Deputies to clear the scene prior to
their arrival due to a physical fight. | inquired if the parties were still fighting, to which | was advised it was unknown. |
upgraded, driving code 3 with lights and sirens.

Upon my arrival, | made contact with Deputy Brooks, Deputy Parker and Youth Home workers, who had advised the
location of the subject. Deputy Brooks and Deputy Parker began investigating the incident as | was advised the other
involved party was being evaluated at Children's Hospital Emergency Room. Deputy Parker requested | make contact
with interview filma Children's Hospital, to which | complied.

Upon my arrival at Children's Hospital, | made contact wit dvised she was on the bus coming
back to the Youth Home from school when a verbal disagreement between her and another residence at the Youth

occurred. tated she requested to stop singing so loud, to which refused.
hen involved the bus driver, whic became aggravated, stating she would handle it when they would
get off the bus. Once the bus arrived at the bus stop, stated ran at her, grabbed her hair, punched her in

side of her head, and knocked her to the ground, causing a minor laceration to her right knee. | documented
nd her injuries through photographs which are attached to this report.

| then relayed this information to Deputy Parker and conducted a Domestic Violence Lethality Screen as well as a
Domestic Abuse Supplement Form, which are also attached to this report. The Youth Home worker who was in
attendance with as provided a Laura's Card on behalf, along side the report number associated with
this incident.

| then left the scene without further incident.

Case P25-010115 Page 2 of 2


summary: Officers were dispatched to assist EMS with a patient.

raw_content:
Case P25-009556 Printed on October 23, 2025
Status Approved
Report Type Patrol
Primary Officer Scott Whitehead
Investigator None
Records Technician
Reported At 09/27/25 18:37
Incident Date 09/27/25 18:37
Incident Code ASTA : ASSIST AMBULANCE
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
Zone 2
Beat Southwest
Disposition P- PENDING
Disposition Date/Time 09/27/25 19:29
Disposition Comments
BC 4311
Review for Gang Activity Not Applicable
Asst Officers
4X71 - Parker, Lance
Primary Narrative By Scott Whitehead, 09/27/25 19:35
On Saturday September 27, 2025 at approximately 1837 I was dispatched to an Ambulance Assist at the Youth Home
at 20400 Colonel Glenn Rd.

I made contact with Melissa Simms, an RN at the Youth Home. M. Simms explained that had made
suicidal comments including "I want to die" and "I want to kill myself". M. Simms stated the Youth Home has been
trying to get into a long term facility for Mental Health. A brief discussion with took place before
agreeing to be transported by M.E.M.S. medical personnel to Arkansas Children's Hospital. M.E.M.S. unit #17
personnel Olmsted and Milgrim assisted onto the gurney and into the Ambulance without incident.

CFS- 202563202
Case P25-009556 Page 1 of 1


summary: Officers were dispatched for a phone report in response to an assault that occurred at the facility.

raw_content:
On 09/27/2025 at approximately 1840 hours Deputy Brooks attempted to make contact with Daylen Mack via telephone
in reference to his incident that occurred on 09/23/2025. Mr. Mack did not answer Deputy Brooks' phone call at this
time. Deputy Brooks attempted to contact Mr. Mack to verify if he still wanted to press charges and to advise him of how
to proceed in pressing charges.

No further action taken.
Case P25-009424 Page 2 of 2


summary: Officers took a report of a runaway juvenile from the facility.

raw_content:
Case P25-009104 - UNAPPROVED DRAFT Printed on September 22, 2025
Status Active
Report Type Patrol
Primary Officer Christopher Tatum
Investigator None
Records Technician
Reported At 09/15/25 17:50
Incident Date 09/15/25 17:50
Incident Code RUNJ : RUNAWAY JUVENILE
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
Zone 2
Beat Southwest
Disposition CL- CLOSED
Disposition Date/Time 09/16/25 09:52
Review for Gang Activity None
Case Comments
Juvenile Returned to Youth Home
Primary Narrative By Christopher Tatum, 09/15/25 17:54
Runaway Juvenile
On 09/15/2025 at 1705 hours, Deputies took a report for a runaway juvenile. Contact was made with the house staff at
the Youth Home Inc., Ethel Carter. Carter advised that did not return home from school today.

Carter stated that was last seen wearing a black and white shirt, gray pants, and black and white shoes.
is about 5 feet 6 inches, has red strawberry hair, brown eyes, and is possibly 185lbs. Carter advised
to attend Joe T Robinson Senior High School. Carter stated that left for school this morning on the bus
around 0755 hours and is scheduled to return home around 1630 hours, but she did not. Carter has no idea who she
could be with or her whereabouts. Carter was advised of the report number and advised that if was to return,
let Deputies know so she could be taken out of the runaway system.  was entered into ACIC as a runaway
juvenile with NIC number M508598491.

CFS2025-60146

Supporting Narrative By Douglas Bjork, 09/16/25 09:52
Juvenile Located and Returned to Youth Home
On September 16, 2025, I contacted the Colonel Glenn Youth home and checked the status of the missing juvenile,
 They advised that she was brought back last night by LRPD at approximately 1800 hours, but did not
contact the Sheriff’s Office. I contacted the PCSO Dispatch to confirm if had been taken out of the system. They
advised that she was not reported missing.
Supporting Narrative By Bria Hunt, 09/16/25 20:34
Recovered Juvenile
On 9/15/25 at 1825 I received a Hit Request on ACIC from Little Rock Police Department in regards to missing juvenile
. The juvenile was located at 19 Corlay Rd in Little Rock by Officer Lyles badge
Case P25-009104 Page 1 of 2

number 36190. I then confirmed the missing juvenile and provided them with the number of the Youth Home. The
juvenile was then returned home and I removed the juvenile from ACIC at 1900.

NAME:
NIC: M508598491
OCA: P25-009104
LRPD's REPORT NUMBER: 25-115792
Case P25-009104 Page 2 of 2


summary: Officers were dispatched to the facility in response to a disturbance.

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

Case P25-008316 Printed on September 22, 2025

Approved
Report Type Patrol
Primary Officer Sean Washington
Investigator None
Records Technician
Reported At 08/26/25 09:53
Incident Date 08/26/25 10:00
Incident Code DIST : DISTURBANCE
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
2
Southwest

Disposition P- PENDING
Disposition Date/Time 08/26/25 12:02
Disposition Comments

GD 4303.
Review for Gang Activity None

Asst Officers
3X73 - Paradise, Justin

Primary Narrative By Sean Washington, 08/26/25 12:36

Disturbance

On August 26, 2025, at about 0956 hours, |, Deputy S. Washington, was dispatched to 20400 Colonel Glenn Road
(Colonel Glenn Youth Home) in reference to a disturbance.

Upon my arrival, | met with staff members, who stated ater identified as was Causing a
disturbance. allegedly made threats to "kill someone", and a gun motion to a staff member. Staff was in
agreement that would have to leave. No threats were made in my presence.

For context, and were only there for an admittance interview, was nota
client.

| then spoke with and got some more insight into behavior.

According to _.. has violent tendencies and has been arrested in Mississippi. On the way to Colonel Glenn
Youth Home, he took a knife from that hadin pocket. | advised Gregory that he would have to take

back with him one way or another. did not threaten any staff directly and the staff that | made the gun motion

toward was not present.

A staff member advised that we could take to the Juvenile Detention Center to hold there until Mississippi
came to get | advised that will not be an option.
After staff spoke among each other, they came to an agreement that could stay.

CFS:2025-55038

Case P25-008316 Page 1 of 1


summary: Officers made contact with a facility staff member who reported that she was struck in the nose by a resident.

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

Case P25-008297 Printed on September 22, 2025

Status Approved
Report Type Patrol
Primary Officer Da'Vonti Armant
Investigator None
Records Technician
Reported At 08/25/25 20:36
Incident Date 08/25/25 20:36
Incident Code BATT : BATTERY
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
2
Southwest

Disposition P- PENDING
Disposition Date/Time 08/25/25 20:36
Disposition Comments

GD 4303.
Review for Gang Activity None

Primary Narrative By Da'Vonti Armant, 08/26/25 11:00
Battery

On Monday, August 25, 2025, | (Deputy Armant) was advised by dispatch to make phone contact with, Latarra Hinson,
in reference to a battery that occurred.

Upon making phone contact with Hinson, she was asked for a description of the events that occurred. Hinson advised
that she is an employee at the Youth home located at 20400 Colonel Glenn Road. Hinson stated on today.
came into the facility from

Hinson stated once got into the facility, they started to give the medication that was prescribed to _—_—. Hinson
stated after took medication, stuck fingers down throat in an attempt to throw medication up.
Hinson stated he contacted several co-workers to assist with possible taking control of for actions. Hinson
stated her and the team gave various other options before they restrained

Hinson advised while attemptina to restrain she was struck in the nose by Hinson advised she was not
hurt from the incident with Hinson advised moments later, calmed down and laid in bed.

After approximately two hours, | was dispatched again to the Youth Home for Upon my arrival, contact was
remade with Hinson. Hinson advised that started to misbehave again, which was resulting in beina sent to
Childrens Hospital for further treatment. MEMS unit 31 arrived on scene, assessed and transported to
Children’s Hospital.

Jacksonville CFS’s
2025-54930 and 2025-54941

Case P25-008297 Page 1 of 1


summary: A resident reported to staff that a peer grabbed her butt. The resident reported that she has asked the peer to stop touching her, but the peer has grabbed her by the hips, lays her head on the resident’s shoulder, and engages in sexually inappropriate conversations with her.

raw_content:
Division of Provider Services & Quality Assurance
Office of Long-Term Care
P.O. Box 8059, Slot S404, Little Rock, AR 72203-1437
R
Notice of Serious Incident
Case Number: 032258
Date of Incident: 08/21/2025
Date Received: 08/22/2025
Facility Name: Youth Home, Inc.
Incident Type: DPSQA - Incident & Accident - OLTC
Case Status: Complete
DPSQA - Incident & Accident - OLTC
Report Description: While walking back to the school after RT group, patient came to staff
and reported that a female peer had walked up behind her and brushed her hand across her
backside and grabbed her butt. She reported that she has asked this peer multiple times to
stop touching her, but this peer continues anyways. She reported that this female peer has
grabbed her by her hips, lays her head on her shoulder, and engages in sexually
inappropriate conversations with her. Patient reported that this peer asked her if she has
ever been raped and when patient told her it was none of her business, the peer responded,
'well I have, but its ok because it felt good."
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Division of Provider Services & Quality Assurance
Office of Long-Term Care
P.O. Box 8059, Slot S404, Little Rock, AR 72203-1437
R
Notice of Serious Incident
Case Number: 032318
Date of Incident: 08/21/2025
Date Received: 08/22/2025
Facility Name: Youth Home, Inc.
Incident Type: DPSQA - Incident & Accident - OLTC
Case Status: Complete
DPSQA - Incident & Accident - OLTC
Report Description: While walking back to the school after RT group, it was reported by a
female peer that patient had walked up behind said female peer and brushed her hand
across her backside and grabbed her butt. It was reported that despite being asked multiple
times to stop touching this peer she continues to do so anyways. It was reported that patient
has grabbed this peer by her hips, lays her head on this peer's shoulder, and engages in
sexually inappropriate conversations with her. It was reported that patient has asked this
peer if she has ever been raped and when peer told her it was none of her business, patient
responded, 'well I have, but its ok because it felt good."
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Officers were dispatched to the facility in response to two juvenile runaways.

raw_content:
Case P25-007645 Printed on August 13, 2025
Status Approved
Report Type Patrol
Primary Officer Corlan Taylor
Investigator None
Records Technician
Reported At 08/07/25 17:27
Incident Date 08/07/25 17:27
Incident Code RUNJ : RUNAWAY JUVENILE
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
Zone 2
Beat Southwest
Disposition P- PENDING
Disposition Date/Time 08/07/25 18:47
Disposition Comments
*****Approved 08-08-2025******JAG950
Review for Gang Activity Not Applicable
Asst Officers
4X71 - Parker, Lance
Primary Narrative By Corlan Taylor, 08/07/25 17:27
Runaway Attempt
On August 7th, at approximately 1727 hours, Deputy Parker and I were dispatched to the youth home located at 20400
COLONEL GLENN ROAD in reference to two juvenile females running away from the facility.

Upon arrival, Deputy Parker and I made contact with Joseph Davis (caller). Davis escorted us to the two juveniles
identified as Haylee Pischke and Audrey Grantham. Pischke and Grantham informed Deputy Parker and I that they are
in a relationship and that the reason for them running off was because the staff was wanting to separate them from
each other. The two juveniles were yelling and shouting, and not wanting to listen to what Deputy Parker, myself and
the staff were trying to say. The staff made a final decision to separate the two juveniles for safety precaution and due
to the relationship that they were vocalizing. Grantham was escorted to the Crestview house. Deputy Parker and I
helped the staff escort Pischke to her living area after she refused numerous times and stated that she wasn't going to
the area she was being assigned to. The juveniles only got a short distance up the street from the facility in their
attempt at running away before returning with Davis. Neither of the juveniles were harmed or required medical
attention. Both of them eventually cooperated and went to their assigned living quarters.

I gave this report number to a staff member and advised if they had any issues, questions or concerns to contact the
Sheriff's Office. Nothing further to report.

CFS#2025-50681
Case P25-007645 Page 1 of 1


summary: Officers were dispatched to the facility for an assist ambulance call.

raw_content:
Case P25-007648 Printed on August 19, 2025
Status Approved
Report Type Patrol
Primary Officer Corlan Taylor
Investigator None
Records Technician
Reported At 08/07/25 19:16
Incident Date 08/07/25 19:16
Incident Code ASTA : ASSIST AMBULANCE
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
Zone 2
Beat Southwest
Disposition P- PENDING
Disposition Date/Time 08/07/25 20:02
Disposition Comments
******Approved 08-08-2025******JAG950
Review for Gang Activity Not Applicable
Asst Officers
4X71 - Parker, Lance
Primary Narrative By Corlan Taylor, 08/07/25 19:16
Assist MEMS
On August 7th, 2025, at approximately 1916 hours, Deputy Parker and I were dispatched to the youth home located at
20400 COLONEL GLENN ROAD in reference to assisting MEMS secure the scene for a transport.

Upon arrival, Deputy Parker and I made contact with Joseph Davis (caller). Davis informed Deputy Parker and I that
MEMS will be transporting Haylee Pischke to Rivendell Behavioral Health Services. This is one of the female juveniles
that attempted to run away from the facility earlier on this date. MEMS arrived on scene, escorted Pischke out of the
building and onto MEMS unit #86 and exited the premises. No further incident occurred.

CFS#2025-50689
Case P25-007648 Page 1 of 1


summary: A resident was transported for evaluation after complaining of chest pain, fatigue, and bloody sputum.

raw_content:
R
Notice of Incident
Case Number: 031685
Date of Incident: 7/28/2025
Date Received: 7/29/2025
Facility Name: Youth Home, Inc.
Report Description: transported to due to c/o chest pain, bloody sputum, fatigue, .
transported to via YH van with two staff members.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was transported for evaluation after complaining of coughing up blood clots.

raw_content:
R
Notice of Incident
Case Number: 031591
Date of Incident: 7/22/2025
Date Received: 7/25/2025
Facility Name: Youth Home, Inc.
Report Description: Nurse called to Rose house d/t staff witnessing cough up blood'. Upon
talking to staff on arrival to unit, staff state client coughed 'four small round blood clots' into hand.
States that these were mixed in with more blood and mucus. Estimated a dime to penny size amount
of blood mixed with sputum. During assessment, states 'I'm fine', and voices dislike for going to
doctors office. skin is expected color for ethnicity, no diaphoresis noted. Vitals as follows:
No redness/irritation noted to throat/tonsils. endorsed chest
pain at 4/10, stomach pain at 2/10. states that the stomach pain 'has gone on for awhile'.
Discussed findings w/ provider. taken to per provider. told pt that she
needed to go to as they did not have devices needed to complete thorough assessment.
transported to by staff
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

R
Notice of Incident
Case Number: 031581
Date of Incident: 7/23/2025
Date Received: 7/25/2025
Facility Name: Youth Home, Inc.
Report Description: Nurse called to Rose house d/t staff witnessing cough up blood'. Upon
talking to staff on arrival to unit, staff state client coughed 'four small round blood clots' into hand.
States that these were mixed in with more blood and mucus. Estimated a dime to penny size amount
of blood mixed with sputum. During assessment, states 'I'm fine', and voices dislike for going to
doctors office. skin is expected color for ethnicity, no diaphoresis noted. Vitals as follows:
No redness/irritation noted to throat/tonsils. endorsed chest
pain at 4/10, stomach pain at 2/10. states that the stomach pain 'has gone on for awhile'.
Discussed findings w/ provider. taken to per provider. told that she
needed to go to as they did not have devices needed to complete thorough assessment.
transported to by staff.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


raw_content:
Case P25-006804 Printed on July 23, 2025
Status Approved
Report Type Patrol
Primary Officer Lance Parker
Investigator None
Records Technician
Reported At 07/14/25 21:09
Incident Date 07/14/25 21:53
Incident Code ASTA : ASSIST AMBULANCE
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
Zone 2
Beat Southwest
Disposition P- PENDING
Disposition Date/Time 07/14/25 21:53
Disposition Comments
BS#2495
Review for Gang Activity Not Applicable
Primary Narrative By Lance Parker, 07/14/25 22:26
Assist Ambulance
On 7/14/25 at approximately 2109 hours I, Deputy L. Parker, was dispatched to the Youth Home located at 20400
COLONEL GLENN RD in reference to an assist ambulance call.

Upon arrival I made contact with Youth Home staff who advised that was to be transported by MEMS to
Pinnacle Pointe, and MEMS was just waiting for our arrival on scene to advise them it was secure. was being
calm and cooperative; I advised MEMS that the scene was secure. MEMS unit 12 arrived on scene and picked up
for transport to Pinnacle Pointe without further incident.

CFS: 2025-45182
Case P25-006804 Page 1 of 1


summary: A resident reported that she feels uncomfortable with a nurse due to him making “weird” comments.

raw_content:
R
Notice of Incident
Case Number: 031303
Date of Incident: 7/12/2025
Date Received: 7/15/2025
Facility Name: Youth Home, Inc.
Report Description: This morning, Nurse was conducting lice checks, however client
appeared hesitant and began to refuse the check. and I pulled client aside to better
understand her reasons for refusing the lice check and to see if there her. Client stated that she once
had a rash between her breast and Nurse made the comment "your boobs aren't big enough to
cause a rash, so that's definitely not the reason." Client also stated that she feels very uncomfortable
due to him making weird comments and him reminding her of someone that has sexually assaulted
her in the past.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Three residents eloped from the facility after returning from an outing.

raw_content:
Division of Provider Services & Quality Assurance
Office of Long-Term Care
P.O. Box 8059, Slot S404, Little Rock, AR 72203-1437
R
Notice of Serious Incident
Case Number: 031001
Date of Incident: 07/04/2025
Date Received: 07/08/2025
Facility Name: Youth Home, Inc.
Incident Type: DPSQA - Incident & Accident - OLTC
Case Status: Complete
Report Description:
Client was on an outing for the fourth of July fireworks and returned early due to suspicious
behavior(walking ahead of staff and making statements like "we need to stretch our legs
out:) and upon getting out of the van client ran away from staff. A Dr Scholls was called and
the nurse was present and notified. The on call therapist was called along with sheriffs
department. Staff spoke to deputy Keys and the report number was p25-006436.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Division of Provider Services & Quality Assurance
Office of Long-Term Care
P.O. Box 8059, Slot S404, Little Rock, AR 72203-1437
R
Notice of Serious Incident
Case Number: 031004
Date of Incident: 07/04/2025
Date Received: 07/08/2025
Facility Name: Youth Home, Inc.
Incident Type: DPSQA - Incident & Accident - OLTC
Case Status: Closed
Report Description:
Client was on an outing for the fourth of July fireworks and returned early due to suspicious
behavior(walking ahead of staff and making statements like "we need to stretch our legs
out:) and upon getting out of the van client ran away from staff. A Dr Scholls was called and
the nurse was present and notified. The on call therapist was called along with sheriffs
department. Staff spoke to deputy Keys and the report number was p25-006436.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Division of Provider Services & Quality Assurance
Office of Long-Term Care
P.O. Box 8059, Slot S404, Little Rock, AR 72203-1437
R
Notice of Serious Incident
Case Number: 031005
Date of Incident: 07/04/2025
Date Received: 07/08/2025
Facility Name: Youth Home, Inc.
Incident Type: DPSQA - Incident & Accident - OLTC
Case Status: Complete
Report Description:
Client was on an outing for the fourth of July fireworks and returned early due to suspicious
behavior(walking ahead of staff and making statements like "we need to stretch our legs
out:) and upon getting out of the van client ran away from staff. A Dr Scholls was called and
the nurse was present and notified. The on call therapist was called along with sheriffs
department. Staff spoke to deputy Keys and the report number was p25-006436.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Officers were dispatched to the facility in response to three runaway juveniles.

raw_content:
Case P25-006436 - UNAPPROVED DRAFT Printed on July 23, 2025
Status Active
Report Type Patrol
Primary Officer Josh Keyes
Investigator None
Records Technician
Reported At 07/04/25 23:07
Incident Date 07/04/25 23:07
Incident Code RUNJ : RUNAWAY JUVENILE
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
Zone 2
Beat Southwest
Disposition P- PENDING
Disposition Date/Time 07/04/25 23:07
Disposition Comments
BS#2495
Review for Gang Activity Not Applicable
Primary Narrative By Josh Keyes, 07/05/25 03:57
Runaway Juvenile
On 7/4/25, at around 2300 hours, I responded to 20400 Colonel Glenn Road in reference to three runaway juveniles at
the Youth Home.

  Upon my arrival, I made contact with the nurse, Melissa Sims, who advised
had returned to the facility after seeing the fireworks, and upon the door opening to the van, the three juveniles
then ran off into the woods. I conducted missing person reports for the three juveniles and notified communications of
the missing persons reports.

  Melissa was provided a copy of each Missing Person Report as well as a copy of the report number. She was
advised to notify dispatch should they return or be found.

CFS2025-42884
Supporting Narrative By Sean Washington, 07/05/25 12:02
Supplement
On July 5, 2025, at 1056 hours, I, Deputy S. Washington was dispatched to 20400 Colonel Glenn Road (Youth Home)
in reference to supplement information.

Upon my arrival, I made contact with Matt, who is one of the nurses there. Matt advised me that was not there
and wanted to add some information on the runaway juveniles

Case P25-006436 Page 1 of 2

Matt made phone contact .

advised me that, the juveniles were at a home of a former patients, in Lonoke County. Matt then
made contact with , mother of and advised him that the juveniles were picked up from her home and
transported to possibly Lonoke County Sheriff's Office.

At about 1216 hours, I was contacted by dispatched to contact via phone. I made phone contact with , and he
advised me that the three juveniles were picked up by Lonoke Police Department and wanted to know if we would
transport them. I advised that if I transported, I could only transport two.

Per Sgt. Wheeler, we would not transport. I advised of this information.

202543040
Supporting Narrative By Karnaicia Graham, 07/05/25 12:21
Runaway Juveniles Located
On July 5, 2025 at approximately 1109 hours, Cabot Police Department sent over a Hit
Confirmation Request on a runaway juveniles
. I pulled the cards at this time and confirmed the runaway juveniles via
ACIC. I requested that Cabot provide their recovering officer’s name, their report
number, the location of the juveniles. Cabot advised that their recovering officer was
Deputy Krablin, that their report number is 25-01221, the juvenile was located at
Cabot notified the Youth Home On Colonel Glenn of the
location via telephone. I notified the Investigations Sergeant Mems via email to notify
them of the juveniles’ location, and cleared the juveniles from ACIC/NCIC at
approximately 1107, 1109, 1111 hours.

Cabot Report # 25-01221

PCSO P25-006436
Case P25-006436 Page 2 of 2


summary: Multiple deficiencies were noted during the Complaint Survey performed on 7/3/2025. A Corrective Action Plan was submitted and approved.

raw_content:
Division of Provider Services
& Quality Assurance
P.O. Box 8059, Slot S404
Little Rock, AR 72203-8059
July 25, 2025
David Napier, Administrator
Youth Home Inc
20400 Colonel Glenn Road
Little Rock, AR 72210-5323
Dear Mr. Napier:
On July 3, 2025, we conducted a Complaint Investigation survey at your facility. You have alleged that
the deficiencies cited on that survey have been corrected. We are accepting your allegation of
compliance and have approved your plan of correction and presume that you will achieve substantial
correction by July 28, 2025.
We will be conducting a revisit of your facility to verify that substantial correction has been achieved
and maintained.
If you have any questions, please contact your reviewer: Stephanie Lester at 501-396-6013 or email
to: stephanie.lester@dhs.arkansas.gov.
Sincerely,
for Jeff Rosenbaum
Stephanie Lester, RN QA Reviewer
DPSQA/Office of Long Term Care
Survey & Certification Section
sl
David Napier - Youth Home Inc -- -- (AOLTC-14) Page 1

Division of Provider Services
& Quality Assurance
P.O. Box 8059, Slot S404
Little Rock, AR 72203-8059
July 28, 2025
David Napier, Administrator
Youth Home Inc
20400 Colonel Glenn Road
Little Rock, AR 72210-5323
Dear Aministrator:
During the Complaint Survey conducted on July 03, 2025 your facility was found to be in compliance
with program requirements.
If you have any questions, please contact your reviewer:Stephanie Lester at 501-396-6013 or email to
stephanie.lester@dhs.arkansas.gov.
Sincerely,
for Jeff Rosenbaum
Stepahnie Lester, RN QA Reviewer
DPSQA/Office of Long Term Care
Survey and Certification Section
sl

doc_type: Complaint Survey


summary: Officers were dispatched to investigate a report of four juveniles running away from the facility.

raw_content:
Case P25-005977 Printed on July 23, 2025
Status Approved
Report Type Patrol
Primary Officer James Tallent
Investigator None
Records Technician
Reported At 06/21/25 13:47
Incident Date 06/21/25 13:47
Incident Code RUNJ : RUNAWAY JUVENILE
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
Zone 2
Beat Southwest
Disposition P- PENDING
Disposition Date/Time 06/21/25 13:47
Disposition Comments
APPROVED L36 JDW
Review for Gang Activity Not Applicable
Asst Officers
3X71 - Washington, Sean
Primary Narrative By James Tallent, 06/21/25 13:47
Runaway
On 6-21-25 at approximately 1347 hours Deputies were dispatched to 20400 Colonel Glenn Road to investigate the
report of four juveniles running away from the Colonel Glenn Youth Home.

As the call was being dispatched I was in front of the address and did not see any juvenile running. Contact was then
made with staff and I was advised that there had been at least a five minute time lapse from the juveniles running and
the phone call to 911 being made.

I then proceeded east from that location to the Area of Talley Ho Trail and Angela Drive where an unsecured trailer
was located. The residence was cleared with negative result in making contact with the juveniles.

After canvassing the area deputies returned to the Youth Home Where contact was made with Brittney Hubbard and
she stated that she was the subject that had called 911 to report the juveniles running away. stated
that she was on the basketball court with when a
basketball was thrown over the fence of the basketball court. stated that when the four juveniles went to
get the basketball all four of them ran east into the wooded area and disappeared.

While collecting information for the report staff advised that someone had seen the four juveniles walking on
Burlingame Road north of Stewart Road. Both myself and Deputy Washing went to the area and all four juveniles were
located just south of Top Hill Road. The juveniles were advised to stop walking in which they complied.

Deputy Washington transported two juveniles as I transported the other two back to the Colonel Glenn Youth Home.
The juveniles were turned over to Ms. Hubbard

CFS2025-39750
Case P25-005977 Page 1 of 2

Case P25-005977 Page 2 of 2


summary: Four residents eloped from the facility while outside playing basketball.

raw_content:
R
Notice of Incident
Case Number: 031344
Date of Incident: 6/21/2025
Date Received: 7/15/2025
Facility Name: Youth Home, Inc.
Report Description: At approximately 1 :35 PM, while engaging in a recreational game of
basketball, the basketball was intentionally thrown over the fence and into the wooded area. In
response, and her peer proceeded to retrieve the ball. questioned the clients and inquired about
their intended actions. Despite being questioned, the clients suddenly ran toward the woods,
ignoring staff instructions and attempts to engage them. Staff immediately attempted to intervene
verbally, but the clients continued to run into the wooded area. All
clients were found on Burlingame and returned to the facility at approximately 3:45PM
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Four residents left their bedrooms without permission, ran through the milieu, kicked through the front door, and eloped from the facility.

raw_content:
R
Notice of Incident
Case Number: 030608
Date of Incident: 6/18/2025
Date Received: 6/20/2025
Facility Name: Youth Home, Inc.
Report Description: Incident Date: 6/18/25 at 8:05 PM Incident type: Elopement - 4 clients
involved All clients returned to campus on 6/19/25 at 9 PM by ,
then were subsequently sent to for assessment. Client 1:
At bedtime, the 4 clients came
out of their room, all dressed in black, and proceeded to kick open the front door. The nurse was
called and staff paged a "Doctor Scholls" (YH's code for elopement). Staff attempted to locate
clients, but were unable to and the clients successfully made it off campus. All 4 clients were
returned to campus on 6/19/25 at 9pm. Clients were then taken to for assessment per
Youth Home policy.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Officers were dispatched to the facility in response to a runaway call for service.

raw_content:
Case P25-005901 Printed on July 18, 2025
Status Approved
Report Type Patrol
Primary Officer Cody Olds
Investigator None
Records Technician
Reported At 06/18/25 20:18
Incident Date 06/18/25 20:06
Incident Code RUNJ : RUNAWAY JUVENILE
Location 20400 Colonel Glenn Rd, LITTLE ROCK, AR 72204
Zone 2
Beat Southwest
Disposition P- PENDING
Disposition Date/Time 06/19/25 02:58
Disposition Comments
Approved JD
Review for Gang Activity None
Primary Narrative By Cody Olds, 06/19/25 03:46
Runaway Juvenile
On 06/18/2025 at around 2040 hours, I arrived at the Youth Home at 20400 Colonel Glenn Road in response to a
runaway juvenile call for service. Upon arrival, I made contact with the complainant (Taymahnee Gordon) in regards to
the incident.

Gordon advised that she was a staff member, and that she was preparing the juvenile residents for bedtime at around
2006 hours. While doing so, 4 of the juveniles ( ) ran
through the front door of the residence. Gordon stated that the 4 juveniles then ran down the driveway before turning
toward the wood line and running eastbound through the trees.

Gordon said that was last seen wearing a black Nike sweatshirt, black Nike sweatpants, and red and white Nike
Air Force tennis shoes. was last seen wearing a black t-shirt and hoodie, black sweatpants, and purple and
gray Nike Air Jordans. was last seen wearing a black and white denim jacket, blue denim pants, and white Nike
Air Forces. was last seen wearing a black long sleeve shirt, black sweatpants, and brown New Balance tennis
shoes. Gordon then stated that there was no concern for their immediate danger, aside from the fact that they ran
away from the Youth Home.

I then canvassed the area of Colonel Glenn Road and Lawson Road extensively (after being informed that they were
possibly headed to a business named Smoke Buddies on Colonel Glenn Road). After being unable to locate the
juveniles, I was later informed that they were found attempting to hitch hike on Burlingame Road. I also spent a
considerable amount of time canvassing Burlingame Road, but was met with negative results.

I then returned to the youth home, and issued Gordon a report number after completing Missing Person forms. Gordon
later advised me that the Youth Home staff would contact the family members of the juveniles in regards to the
incident. All 4 juveniles were later entered into ACIC as missing prior to returning to service.

NCIC # for juveniles:

Tuck: M018450107
Case P25-005901 Page 1 of 3

Afterward, the juveniles were removed from A.C.I.C. as missing.
Case P25-005901 Page 3 of 3


summary: A resident ingested two gulps of paint in an attempt to harm herself.

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Notice of Incident
Case Number: 030558
Date of Incident: 6/16/2025
Date Received: 6/18/2025
Facility Name: Youth Home, Inc.
Report Description: Client: Resides in
house Incident Date: 6/16/25 8:03 PM in Rose House Staff Ratio at the time : 2 staff : 11 Clients
Staff involved:
vents Leading: Patient grabbed a paint bottle
out of the rec room and placed it under her shirt where staff couldn't see and went into the
bathroom. She then drunk (two swallows her words) of paint and came out of the bathroom. When
she came out of the bathroom, she told a peer what she did refusing to tell staff, the peer told a
certain staff when she walked back into the house. When the staff member went into the rec room,
showed staff her mouth and pulled the bottle out from under her shirt. Patient expressed that
she wanted to kill herself, staff then alerted the nurse and everyone else that needed to be aware.
Nursing Assessment 6/16/25 @ 8:49 PM: Nurse was called to assess the patient after she reportedly
ingested two gulps of Curate + Colour paint. The patient stated she consumed the paint in an
attempt to harm herself, taking it from the rec room to the bathroom where the ingestion occurred.
When asked about her reasoning, the patient shared that she no longer wanted to live. Upon further
questioning, the patient stated she informed a peer, who then alerted staff. She explained that she
chose to tell someone because she "didn't want to die alone." When asked if she had any additional
plans to harm herself, the patient responded yes--she had also considered drinking bleach.
on room air. The patient
reported a headache and stomach discomfort rated 4/10 but declined medication at this time. She
also expressed feeling very anxious. The nurse provided therapeutic support and discussed healthier
coping strategies for managing anxiety. At the time of nurse departure, the patient was seated in the
milieu area with staff supervision. Additional Nursing Progress Note: This nurse was called by house
staff at 2012 about pt drank some paint. when this nurse showed up at the house the pt was yelling,
"I want to die." "I am not worth it and I'm never going to be worth anything." Staff gave this nurse
a 16oz bottle of Curate + Colour paint. Staff informed this nurse that she drank most of the bottle.
It felt like there was only a few ounces left in the bottle. This nurse called and they
informed this nurse, "Watch for any vomiting or stomach cramping. After talking with the pt she
doesn't feel like she will be any better than a druggy, wouldn't amount to anything. Pt did state she
wants to die. On call was notified about what happened and pt was placed on Eyeball, FOH, and
supportive status. There was a one time order for 25mg to give by mouth for anxiety.
Consent was given by her mom, Client was placed on Front of House, Eyeball, and
Supportive Status Guardian was contacted regarding the incident 6/16/25 @ 9:20 PM Paint has
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now been moved from the rec room, in the house, and locked up in the staff room, where clients do
not have access.


summary: Complaints #AR00035482, #AR00035909, #AR00037097, #AR00031862 were in compliance.

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se re

ARKANSAS
DEPARTMENT OF

Ww) HUMAN
a! SERVICES

June 16, 2025

Division of Provider Services
& Quality Assurance
P.O, Box 8059, Slot $404
Little Rock, AR 72203-8059

David Napier, Administrator
Youth Home Inc

20400 Colonel Glenn Road
Little Rock, AR 72210-5323

Dear Mr. Napier:

A Complaint Investigation Survey was conducted on June 12, 2025. We are pleased to inform you that
no deficiencies were cited during the survey and that your facility was in compliance with the
requirements of 42 CFR Part 483, Subpart G, Requirements for Psychiatric Residential Treatment
Facilities. Your certification remains in effect unless terminated due to non-compliance with program
requirements or voluntary withdrawal from the program.

We have enclosed form CMS 2567, “Statement of Deficiencies and Plan of Correction” for the June
12, 2025 Complaint Investigation. survey conducted at your facility for participation in the Medicaid
program. CMS 2567 is enclosed, indicating your facility's compliance status. Please Sign and date
the 2567 and email to breanna.marengo@dhs.arkansas. gov.

If you have any questions please contact your reviewer at 501-320-6280.

Sincerely,

Le for Jeff Rosenbaum
Breanna Marengo, RN QA Reviewer
DPSQA/Office of Long Term Care
Survey and Certification Section

bbm

cc: DRA

David Napier - Youth Home Inc - 06/16/2025- (AOLTC - PRTF No Def) Page 1]

. PRINTED: 06/16/2025
DEPARTMENT OF HEALTH AND HUMAN SERVICES FORM APPROVED
| + > CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0301

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY

AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING COMPLETED
iL 04L.107 8. WING 06/12/2025
H NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

20400 COLONEL GLENN ROAD
LITTLE ROCK, AR 72210

SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION (x8)

(EACH DEFICIENCY MUST BE PRECEDED 8Y FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETION
REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DATE

| DEFICIENCY)
|
|

YOUTH HOME INC

Initial Comments

Note: The CMS-2567 (Statement of Deficiencies)
is an official, legal document. All information must
remain unchanged except for entering the plan of
correction, correction dates, and the signature
space. Any discrepancy in the original deficiency
citation(s) will be reported to the Dallas Regional
Office (RO) for referral to the Office of the
Inspector General (OIG) for possible fraud. If
information is inadvertently changed by the
provider/supplier, the State Survey Agency (SA)
should be notified immediately.Census 47

( CN# N/A (ARO0035482) was in compliance.
; CN# N/A (ARO0035909) was in compliance.
CN# N/A (ARO0037097) was in compliance.
CN# N/A (ARO0031862) was in compliance.
The facility was in compliance with §483, Subpart

G - Conditions of Participation for Psychiatric |
Residential Treatment Center.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that
other safeguards provide sufficient protection to the patients . (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days
following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14

days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued
program participation.

FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: LLHO11 Facility ID: 3006 \f continuation sheet Page 1 of 4


summary: Officers took a report from a staff member who stated that a resident threw objects at him, stuck out their tongue at him, and flipped him off.

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

Case P25-005591 Printed on June 17, 2025

Approved
Report Type Patrol
Primary Officer Adrianne Chambers
Investigator None
Records Technician
Reported At 06/10/25 09:39
Incident Date 06/10/25 09:39
Incident Code ASST : ASSAULT
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
Zone 2
Beat Southwest

Disposition P- PENDING
Disposition Date/Time 06/10/25 09:40
Disposition Comments

MW #4461
Review for Gang Activity Not Applicable

Offense Information

Offense ASSAULT - 3RD DEGREE / CREATES APPREHENSION OF IMMINENT INJURY
Statute 5-13-207

NIBRS Code 13B - Simple Assault

Counts 1

Include In NIBRS Yes

Completed Yes

Bias Motivation None (no bias)

Location Government/Public Property

Entry Forced No

Forces Used None

Primary Narrative By Adrianne Chambers, 06/10/25 11:43

Assult

On June 10, 2025 at approximately 0939 hours, Clytrell Daniel arrived at 2900 S. Woodrow to
file an incident report.

Daniel stated that he is an employee at the Youth Home located at 20400 Colonel —

_ ae that yesterday at approximately 1500 hours, a patient by the name of
at the began to throw objects at him. Daniel stated that thw a water bottle,

paper plates, toothpaste container, tissue, monopoly money, and a piece of a board game which
hit his leg. Daniel stated that | also flipped him off a his tongue out at him.
Daniels stated that he does not have any injuries and that was transfered to Pinnacle
Point last night. Daniel stated that at this time mother, Shantana Conley has not been
made aware of the incident. Daniel was provided with this incident number.

Case P25-005591 Page 1 of 1


summary: Officers were dispatched to the facility to assist EMS responders with a call.

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

Case P25-005586 Printed on June 17, 2025

Status Approved
Report Type Patrol
Primary Officer Matthew Knobloch
Investigator None
Records Technician
Reported At 06/09/25 21:00
Incident Date 06/09/25 21:00
Incident Code ASTA : ASSIST AMBULANCE
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
2
Southwest

Disposition P- PENDING
Disposition Date/Time 06/09/25 21:38
Disposition Comments

Approved JD
Review for Gang Activity Not Applicable

Asst Officers
2X71 - Bass, Steven

Case Comments
CFS2025-36992

Primary Narrative By Matthew Knobloch, 06/09/25 22:45

Assist Ambulance

On 6/9/25, at approximately 2100 hours, |, Deputy Knobloch, was dispatched to The Youth Home located at 20400
Colonel Glenn Ra, Little Rock, AR 72210 in regards to an assist ambulance.

Staff member, Broderick Parker, had called needing assistance with having juvenile, iN, transported by
M.E.M.S. to Pinnacle Point for treatment. Upon arrival, | spoke with Parker who advised me that had been
attacking other residents, staff, and having outbursts throughout the day.

| then requested Parker go me so | could speak with him, and met him in a secluded room away from
other residents. | informed that he would be going to Pinnacle Point to which he began questioning why.
was informed as to why and told to sit on the couch.

Parker then went to retrieve some clothes for || and began trying to leave the room. Fearing he may
want to attack staff or residents again, | placed my hand on his shoulder and told him to sit back down. IEEE then
slapped my hands away, and stated “get your fucking hands off me”. Because of this action, | grabbed by the
arm and shirt, pulled him face down into the couch, and placed him in handcuffs.

Sgt. Marler and Deputy Byers soon “| the scene, and were informed of the situation. M.E.M.S. unit 819

soon arrived on scene, and transported to Pinnacle Point. EEE was not charged in this incident. No
further action was taken.

Case P25-005586 Page 1 of 1

doc_type: CFS Report


summary: A resident became angry and cursed staff and threw objects at them. Later the resident punched a peer in the face unprovoked.

raw_content:
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Notice of Incident
Case Number: 030395
Date of Incident: 6/9/2025
Date Received: 6/10/2025
Facility Name: Youth Home, Inc.
Report Description: Incident Report for
client in our PRTF program and resides in Sturgis House Incident Report date/time: 06/09/25
5:25pm Location of Incident: Sturgis House Intervention Type: Acute Placement Incident
Description: Aggressive to Peers Staff Involved:
Events Leading: Patient was placed on Freeze
earlier in the day because he cursed at a peer that came across as bullying. When staff told him this
he became extremely angry and started to curse at staff and throw objects at them. He also flipped
over a trash can and flipped over tables. He ended up talking with a staff member in the comfort
room for about 15 - 20 minutes and calmed down. He then spoke with the nurse before going back
to his room. He then started to come out of his room constantly saying he needed to go to the
bathroom. He kept walking by a particular patient and this patient became frustrated and said that
was instigating and cursing at him. This peer tried to distance himself as much as possible
and staff spoke with this peer in private to help them calm down. Afterwards this patient got in line
to go to the cafeteria. then walked towards the line and punched this patient in the face and
laughed. Staff did not restrain him but he walked him to the comfort room. Nursing Assessment
date/time: 06/09/25 6:00pm: Client reportedly attacked peer unprovoked. Client was administered
Zydis 5mg ODT. Client right hand 3rd digit has small abrasion to the proximal phalange. TAO and
clean bandage applied. Client is processing with staff and showing signs of calming down. Client
states he could not control himself and he hit peer ZS in the face. Client went to his room and
rested. . Client left via around 9:35pm. Guardian was
notified on 06/10/25 at 1:58pm. was discharged from Youth Home due to his payer and
will be readmitted upon discharge from acute.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov