summary: Licensing visited the facility to conduct a buildings and grounds walkthrough of the facility.

raw_content:
ARKANSAS
)RPEPARTMENT OF

Pa fee

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot $140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550

521 Visit Compliance Report

Licensee: Elizabeth Mitchell Centers

Facility Number: 157

Licensee Address: 6501 WEST 12TH STREET
LITTLE ROCK AR 72204

Licensing Specialist: Kendra Rice
Person In Charge: Eric Knowles
Record Visit Date: 3/2/2023
Home Visit Date: 3/2/2023

Purpose of Visit: Subsequent Building and Grounds

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

Regulations Not Correctable:

Narrative:

Time of visit: 8:00 am to 8:45 am

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

Census: 47

Licensing Specialist completed a walkthrough of Centers/EMCC with Eric Knowles, Compliance Officer,
Licensing Specials observed the following areas: day area, nurse station, East, South, and North Dorms.

Flooring has been replaced in all dorms including the bedrooms and the ceilings have been repaired. The light
fixtures/lights have been replaced in the ceilings. Licensing Specialist observed wires hanging from the
ceiling where fire alarms will be placed. The nurse station is scheduled to have the flooring replaced soon.
Licensing Specialist observed boxes of base boards that will be placed along the base of the walls.

Licensing Specialist and Mr. Knowles discussed the progress of the repairs being made to EMCC. Mr.
Knowles informed Licensing Specialist that the repairs appear to be on track with estimated time of
completion.

Provider Comments:

CCL Staff Signature : Date: 3/2/2023

Moy vty ,

Provider Signature : Date: 3/2/2023

Se

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


state: AR

facility_name: Centers for Youth and Families - Little Rock

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

raw_content:
521 Visit Compliance Report

Licensee: Elizabeth Mitchell Centers

Facility Number: 157

Licensee Address: 6501 WEST 12TH STREET
LITTLE ROCK AR 72204

Licensing Specialist: Kendra Rice
Person In Charge: Eric Knowles
Record Visit Date: 2/22/2023
Home Visit Date: 2/22/2023

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: 8:45 am to 10:15 am

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: 26

Licensing Specialist completed a buildings and grounds walkthrough of EMAC at Elizabeth Mitchell Centers.
Licensing Specialist observed the following areas: treatment hall, dayrooms, comfort room, rage room,
hygiene closets, library, bedrooms, bathrooms, cafeteria, sand tray room, art therapy room, nurse station, and
grounds.

All four (4) dorms were cleaned. Each bedroom and bathroom were organized and free of debris. Licensing
Specialist observed plants on the window seals in some of the bedrooms. Licensing Specialist was informed
that the plants were part of therapy (seed digging therapy technique). Clients’ rights and emergency escape
plans were observed on the doors or walls of each dorm. Licensing Specialist observed the garden by the cozy
corner.

In two of dayrooms, Licensing Specialist observed where residents are working on puzzles. The hygiene
closets were organized and only staff are allowed in the closets. The grounds were clean with no debris.
Licensing Specialist observed recreational activities for the residents to utilize.

Licensing Specialist observed three (3) classrooms. The bathrooms near the classrooms were clean and free of
debris. Classroom | ratio 3:7, Classroom 2 ratio 3:8, and Classroom 3 ratio 3:7.

Licensing Specialist observed the nursing station. The nurse showed Licensing Specialist where medication is
kept. All medications are kept in a locked closet inside of a metal med cart. The nurse also showed Licensing
Specialist where controlled substances are kept. There are no residents on any controlled substances.

All rooms and areas observed by Licensing Specialist were organized, clean, and free of debris.

Provider Comments:

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

CCL Staff Signature : Date: 2/22/2023

Provider Signature : Date: 2/22/2023

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

doc_type: Compliance Report


summary: A resident reported that a staff member tripped over his legs while he was laying on the floor, then stomped on his leg. The complaint was UNFOUNDED by Licensing.

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: 2/21/2023
Date Received by DCCECE: 2/22/2023
Facility Name: Elizabeth Mitchell Centers
Facility Number: 157
Facility Type:
Incident Type: Dual
Report Description: Resident ( disclosed that staff member stomped
on the top part of his leg near the ankle. Resident said he was being disruptive and was
laying on the floor. He reported that he accidently tripped because he was laying in
the middle of the floor. Resident reported that stomped on his leg after she tripped.
He did not report getting a bruise or mark. No marks were seen. Resident reported this
incident happened weeks ago but he didn't tell anyone because he forgot about it.
called and call accepted, referral #
Interim Action Narrative: called and call accepted. Resident was assessed by staff
no marks noted. 2/22/2023, staff member was placed on suspension pending the
investigation.
Maltreatment Narrative: UNSUBSTANTIATED
Licensing Narrative: 2/22/2023, Program Coordinator reached out to investigator
requesting permission to contact facility. Licensing Specialist informed by the facility staff
member's name is teacher. 2/23/2023 and the ICA. Investigator Walker
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

has not granted permission for licensing to contact the facility. 2/24/2023, Licensing
Specialist will inquire about the name of the nurse. Licensing Specialist informed of nurse's
name, Amy Sims. Program Coordinator informed Licensing Specialist that permission was
granted to contact the facility. Licensing Specialist interviewed residents. 3/1/2023,
Licensing Specialist called and spoke with staff members ( and A. Sims).
informed Licensing Specialist of what happened the day of the alleged incident. A.
Sims informed Licensing Specialist that she did not observe the alleged incident. Licensing
Specialist left a voicemail for staff member (Mr. R) to call. 3/2/2023, Licensing Specialist
spoke with Ms. Amber who reported that she did not remember the alleged incident.
3/3/2023, Licensing Specialist spoke with Mr. Ricardo who reported that he did not witness
the alleged incident. 3/22/2023, Licensing Specialist emailed Investigator Wilson for an
update. Licensing Specialist informed case is still pending. 4/4/2023, Licensing Specialist
received notification that case found unsubstantiated.

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: Elizabeth Mitchell Centers
Facility Number: 157
Licensee Address: 6501 WEST 12TH STREET
LITTLE ROCK AR 72204
Licensing Specialist: Kendra Rice
Person In Charge: Eric Knowles
Record Visit Date: 4/4/2023
Home Visit Date: 4/4/2023
Purpose of Visit: Complaint Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
No in-person licensing visit completed on 4/4/2023.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Licensing Specialist received a complaint on 2/21/2023
This complaint has been UNFOUNDED by licensing.
Provider Comments:
CCL Staff Signature : Date: 4/4/2023
Provider Signature : Date: 4/4/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2

doc_type: Notice of Incident


summary: A resident was sent to Arkansas Children’s Hospital for nausea and vomiting.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 2/20/2023
Date Received by DCCECE: 2/21/2023
Facility Name: Elizabeth Mitchell Centers
Facility Number: 157
Facility Type: Residential
Incident Type: Licensing
Report Description: I wanted to inform you of an incident that occurred at The Centers
(Destiny House) on 02/20/2023. On 02/20/2023, client ( DOB:
began vomiting and told the medical staff he was nauseous. Centers medical
personnel assessed but were unable to determine the cause of
nausea and vomiting. Out of an abundance of caution, was sent to Arkansas
Children?s Hospital (ACH) for further medical evaluation. was transported to
ACH by Centers staff. Once at ACH, medical personnel there diagnosed with
. The attending physician at ACH placed M on
MiraLAX and Pepcid to treat his symptoms. After medical evaluation at ACH,
he was transported back to Destiny House. Centers medical staff will continue to monitor
guardian was notified about this incident. is a
DCFS placement at The Centers. As always, please do not hesitate to contact me if you need
any additional information.
Interim Action Narrative: Resident was assessed by the nurse and transported to AR
Children's Hospital. Diagnosis: . He was prescribed MiraLAX and
Pepcid.
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative:Licensing Specialist reviewed provider reported incident. Licensing
Specialist did not note any licensing concerns.


summary: A resident was transported for acute care after expressing suicidal ideations with a plan.

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: 2/15/2023
Date Received by DCCECE: 2/16/2023
Facility Name: Elizabeth Mitchell Centers
Facility Number: 157
Facility Type: Residential
Incident Type: Licensing
Report Description: I wanted to inform you of an incident that occurred at The Centers
(EMAC) on 02/15/2023. On 02/15/2023, client , DOB:
was having suicidal ideations with a clear plan to attempt suicide. Dr. Thomas determined
would benefit from an acute placement, for her to receive a higher level of care
to keep her safe. was transported to Methodist Behavioral Health by Centers
staff members. s guardian was notified about this incident. is a
private placement at The Centers. As always, please do not hesitate to contact me if you
need any additional information.
Interim Action Narrative: The doctor determined that resident would benefit from an acute
placement to receive a higher level of care to keep her safe. Resident was transported to
Methodist Behavioral Health by Centers staff members.
Maltreatment Narrative:
Licensing Narrative:Licensing Specialist reviewed provider reported incident. Licensing
Specialist will follow-up with facility regarding resident's plan or if any attempts. Licensing
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Specialist informed of resident's stated plan (attempt to commit suicide by choking herself
while in the shower). There were no actual attempts by resident. Sending resident to acute
placement was a precautionary measure to ensure her safety. No licensing concerns noted.


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

raw_content:
521 Visit Compliance Report

Licensee: Elizabeth Mitchell Centers

Facility Number: 157

Licensee Address: 6501 WEST 12TH STREET
LITTLE ROCK AR 72204

Licensing Specialist: Kendra Rice
Person In Charge: Eric Knowles
Record Visit Date: 2/13/2023
Home Visit Date: 2/13/2023

Purpose of Visit: Child Record Review Visit

Regulations Out of Compliance:

Regulations Needing Technical Assistance:

Regulation Not Applicable:

Regulations Not Correctable:

Narrative:

Time of Visit: 2:00 pm to 3:30 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 2

Census: 49
Licensing Specialist reviewed seven (7) files:

All children’s files reviewed complied with the minimum licensing standards.

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


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

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Elizabeth Mitchell Centers
Facility Number: 157
Licensee Address: 6501 WEST 12TH STREET
LITTLE ROCK AR 72204
Licensing Specialist: Kendra Rice
Person In Charge: Eric Knowles
Record Visit Date: 2/3/2023
Home Visit Date: 2/3/2023
Purpose of Visit: Personnel Records
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Time of Visit: 10:45 am to 3:45 pm
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Census: 49
Licensing Specialist reviewed eleven (11) personnel files:
M. Rucker – Registered Nurse PRN
J. Brown – QBHP/Mental Health Technician
S. Cline – QBHP/Mental Health Technician
L. Fey – Registered Nurse
D. Waldroup – QBHP/Mental Health Technician
S. Prado – Clinical Director
All files reviewed complied with the minimum licensing standards.
The following personnel are currently going through orientation. General documentation was in their files and
regulatory checks have been initiated:
C. Green – QBHP/Mental Health Technician
A. Janton – Registered Nurse
C. Kennedy – Registered Nurse
L. Cornelius – Registered Nurse
J. Hart – Mental Health Therapist
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: Officers were dispatched to the facility in response to an alarm. False alarm.

raw_content:
LITTLE ROCK POLICE DEPARTMENT ABBREVIATED INCIDENT REPORT

JUVENILE INFORMATION INCIDENT Report generated: 1/31/2023 9:22 PM

INCIDENT NUMBER UNIT ASSIGNED CALL DATE CALL TIME TYPE OF CALL

2023-012738 2X63 01/31/2023 20:14:00 ALMBRG

INCIDENT DATE LOCATION OF INCIDENT (ADDRESS / BUSINESS NAME)

1/31/2023 8:14:33 PM

6425 W 12TH ST

OFFENSE

FALSE ALARM

| RESPONDED TO 6425 WEST 12TH STREET IN RESPONSE TO AN ALARM. UPON ARRIVAL, | MADE CONTACT WITH A
STAFF MEMBER, WHO ADVISED EVERYTHING WAS OKAY, AND POLICE WERE NOT NEEDED. BWC IN USE 20C634.

ENTRY DATE REPORTING OFFICER ORIGINAL APPROVING SUPERVISOR .
02/01/2023 03:19:57 | WILLIAM SMITH - WILLIAM SMITH - MVR in use

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

doc_type: Police Report


summary: Officers were dispatched to the facility to assist EMS with a patient. Prior to arrival, the call was cancelled.

raw_content:
LITTLE ROCK POLICE DEPARTMENT ABBREVIATED INCIDENT REPORT

JUVENILE INFORMATION INCIDENT Report generated: 1/30/2023 10:18 PM

INCIDENT NUMBER UNIT ASSIGNED CALL DATE CALL TIME TYPE OF CALL

2023-012359 2X71 01/30/2023 17:02:00 ASTMED

INCIDENT DATE LOCATION OF INCIDENT (ADDRESS / BUSINESS NAME)

1/30/2023 5:02:35 PM

6501 W 12TH ST

OFFENSE

NON POLICE INCIDENT

| RESPONDED TO 6501 WEST 12TH STREET TO ASSIST MEDICAL. PRIOR TO ARRIVING ON SCENE, MEMS ADVISED
TO CANCEL.

ENTRY DATE REPORTING OFFICER ORIGINAL APPROVING SUPERVISOR .
01/31/2023 04:13:42 | WILLIAM SMITH - WILLIAM SMITH - L)MVR in use

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


summary: A resident was transported for acute care after she was found in the bathroom, wrapping a shirt around her neck.

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: 1/29/2023
Date Received by DCCECE: 1/30/2023
Facility Name: Elizabeth Mitchell Centers
Facility Number: 157
Facility Type: Residential
Incident Type: Licensing
Report Description: I wanted to inform you of an incident that occurred at The Centers
(EMAC) on 01/29/2023. On 01/29/2023, client ) was
in her dorm bedroom, when she got out of bed and told staff that she needed to use the
restroom. Staff opened the door to allow to use bathroom. When did not
exit the restroom, staff checked on her and found wrapping a piece of clothing
around her neck. Staff members were able to remove the shirt from around
neck. A nurse was called and responded to assess The nurse noted had
no visible signs of injuries and did not display any signs of distress. was placed on
suicidal precautions with line-of-sight protocols. On 01/30/2023, Centers Chief Medical
Officer, Dr. Perkins, spoke with After speaking with and reviewing the
facts connected to this event, Dr. Perkins determined this incident should be classified as an
Attempted Suicide. Dr. Perkins determined would benefit from an acute
placement, for her to receive a higher level of care to keep her safe. As of this report, The
Centers is looking for an acute placement for guardian was notified
about this incident. is a private placement at The Centers. As always, please do
not hesitate to contact me if you need any additional information.
Interim Action Narrative: Clothing was removed from resident by staff. Resident was
assessed by nursing. Resident was placed on suicidal and line of sight precautions. Resident
was assessed by the facility's doctor who determined that resident needed higher level of
care, acute pl
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed provider incident report. Licensing
Specialist will follow-up with facility to see if acute placement has been found for resident.
Licensing Specialist informed acute placement was found for resident on 1/30/2023 and she
was transported by MEMS. No licensing concerns noted.


summary: A resident reported that her peer put her hands down the front of her pants and touched her private parts over her underwear.

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: 1/26/2023
Date Received by DCCECE: 1/27/2023
Facility Name: Elizabeth Mitchell Centers
Facility Number: 157
Facility Type:
Incident Type: Licensing
Report Description: I wanted to inform you of an incident that occurred at The Centers
(EMCC) on 01/26/2023. On 01/26/2023, client
told a Centers staff member that peer put her
( ) hands down the front of s pants and touched her ( ) private parts
over her underwear. did not provide a date or time this incident took place, but
she did say that it occurred in the dorm room. A Centers staff member reported this
allegation to the and the report was accepted (Referral
# The guardians for both clients were notified about this incident. is a
private placement at The Centers. is a DCFS placement at The Centers.
is on sexual precautions and has been placed on an intensive supervision plan. As
always, please do not hesitate to contact me if you need any additional information.
Interim Action Narrative: called. AO resident was placed on sexual
precaution and an intensive supervision plan.
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing Specialist will inquire if an investigator has been assigned.
Licensing Specialist informed that Referral # was screened out. Licensing Specialist
will follow-up with facility. Licensing Specialist informed that due to no specific timeframe
of incident there are not any witness statements or video footage at the moment. It is
unknown what residents were in the bedroom. 1/31/2023, Licensing Specialist inquired
about staff informed of incident. 2/1/2023, Licensing Specialist received intensive
supervision plan. 2/3/2023, Licensing Specialist interviewed resident and staff member
Victoria Reap, therapist. Licensing Specialist will follow-up Ms. Bennett. 2/6/2023,
Licensing Specialist informed resident was not assessed by the nurse due to allegations
occurred outside of the clothing and there was no timeframe of when the incident took
place. 2/13/2023, facility reported that DCFS stated that resident would be picked up
today. Resident was picked up by DCFS. Licensing Specialist informed by Ms. Bennett
that residents are no longer allowed to have bedding outside of their bedrooms. 2/24/2023,
Licensing Specialist informed by Investigator Harris that case was found unsubstantiated.
Licensing Specialist requested documentation once completed. 3/2/2023, Licensing
Specialist emailed Investigator Harris for an update.

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: Elizabeth Mitchell Centers
Facility Number: 157
Licensee Address: 6501 WEST 12TH STREET
LITTLE ROCK AR 72204
Licensing Specialist: Kendra Rice
Person In Charge: Eric Knowles
Record Visit Date: 2/14/2023
Home Visit Date: 2/14/2023
Purpose of Visit: Complaint Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
No in-person licensing visit completed on 2/14/2023.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Licensing Specialist received a complaint on 1/27/2023. AR was called and call was
screened out. On 2/3/2023, Licensing Specialist interviewed a resident and resident's therapist.
Licensing Specialist was informed by Kenleigh Bennett, Director of Residential and Clinical Services, on
2/13/2023 that the facility has purchased ligature bedding for all residents. Ms. Bennett also informed
Licensing Specialist that residents are not allowed to bring any bedding outside of their bedrooms.
The alleged offender (resident) discharged on 2/13/2023.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident reported that peers were touching her on the thighs and private area through her clothes. The complaint was UNFOUNDED by Licensing.

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: 1/26/2023
Date Received by DCCECE: 1/27/2023
Facility Name: Elizabeth Mitchell Centers
Facility Number: 157
Facility Type:
Incident Type: Dual
Report Description: I wanted to inform you of an incident that occurred at The Centers
(EMCC) on 01/26/2023. On 01/26/2023, client
told a Centers staff member that peers and
were touching her ( ) on the thighs and private area
through her clothes. did not provide a date or time this incident took place, but
she did say that it occurred in the dorm room. A Centers staff member reported this
allegation to the and the report was accepted (Referral
# The guardians for all three clients were notified about this incident.
is a private placement at The Centers. is a private placement at The Centers.
is a DCFS placement at The Centers. is on sexual precautions and has
been placed on an intensive supervision plan. has been moved to the EMAC
program to better suit her treatment. has also been placed on LOS protocol. As
always, please do not hesitate to contact me if you need any additional information.
Interim Action Narrative: was called. One AO resident was placed
on sexual precaution and an intensive supervision plan. The other AO resident was moved
to EMAC and placed on line of sight.
Maltreatment Narrative: On 01/26/2023, client
told a Centers staff member that peers and
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

were touching her ( ) on the thighs and private area
through her clothes. did not provide a date or time this incident took place, but
she did say that it occurred in the dorm room. A Centers staff member reported this
allegation to the and the report was accepted (Referral
#
Licensing Narrative: Licensing Specialist will inquire if an investigator has been assigned.
Licensing Specialist informed the assigned investigator is Suzanne Harris. Licensing
Specialist will contact Investigator Harris for permission to contact the facility. Permission
granted to speak with facility. Licensing Specialist informed by facility, that due to no
timeframe there are not witness or nurse's statements. 1/31/2023, Licensing Specialist
inquired about staff informed of incident. 2/1/2023, Licensing Specialist received intensive
supervision plan. 2/3/2023, Licensing Specialist interviewed two residents and one staff
member. Licensing Specialist request a statement from the staff member. 2/6/2023,
Licensing Specialist informed resident was not assessed by the nurse due to allegations
occurred outside of the clothing and there was no timeframe of when the incident took
place. 2/10/2023, Licensing Specialist informed via text that DCFS would not be picking up
resident unless DCFS had other placement regardless of the facility not having the
adequate space to be able to serve resident appropriately. 2/13/2023, facility reported that
DCFS stated that resident would be picked up today. Resident was discharged from
facility. 2/24/2023, Licensing Specialist reached out to Investigator Harris for an update.
Licensing Specialist informed by Investigator Harris that case was found unsubstantiated.
Licensing Specialist requested documentation once completed. 3/2/2023, Licensing
Specialist emailed Investigator Harris for an update.


summary: A resident was transported for acute care after exhibiting aggressive behavior toward staff and peers.

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: 1/25/2023
Date Received by DCCECE: 1/26/2023
Facility Name: Elizabeth Mitchell Centers
Facility Number: 157
Facility Type: Residential
Incident Type: Licensing
Report Description: I wanted to inform you of an incident that occurred at The Centers
(Destiny House) on 01/25/2023. On 01/25/2023, client
) became dysregulated and was oppositional and aggressive towards staff and
peers. To protect from harming himself and others, he ) was placed in
several Emergency Safety Interventions (ESI) by Centers staff members. Centers staff
members attempted to verbally redirect with little success. Once it became
apparent that was not going to comply with the staff?s instructions and efforts
to keep him and others safe, the medical team made the decision required a
higher level of care. The Centers team located an acute placement for at
Rivendell Behavioral Health. was transported to Rivendell by MEMS
ambulance service. did not sustain any injuries because of this incident.
guardian was notified about this incident. is a DCFS placement at
The Centers. As always, please do not hesitate to contact me if you need any additional
information.
Interim Action Narrative: Resident was placed in several emergency safety interventions.
Medical team made a decision that resident needed higher level of care. MEMS transported
resident to acute care.
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing Specialist reviewed provider reported incident. Licensing
Specialist will follow-up with facility. Licensing Specialist informed that resident will be
returning to back to the facility. When he returns, resident will be placed on all precautions.
Licensing Specialist informed that when resident returns he will be placed on all
precautions.


summary: A resident was transported to Ortho Arkansas for evaluation after reporting she injured her hand while playing.

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: 1/25/2023
Date Received by DCCECE: 1/26/2023
Facility Name: Elizabeth Mitchell Centers
Facility Number: 157
Facility Type: Residential
Incident Type: Licensing
Report Description: I wanted to inform you of an incident that occurred at The Centers
(EMCC) on 01/25/2023. On 01/25/2023, client ( )
was at a PCP appointment when she told the APRN she had hurt her right hand while
playing. also said she hit her right hand on a wall. The APRN reported the right
hand was slightly swollen with restricted range of motion. The APRN recommended further
evaluation of the right hand. Out of an abundance of caution, Centers staff transported
to Ortho Arkansas for further medical evaluation. Once at Ortho Arkansas,
right hand was x-rayed, and it was determined there was no evidence of fracture or
dislocation. A soft cast was placed on right hand and a follow up appointment
was scheduled for 01/27/2023. After s medical evaluation at Ortho Arkansas,
she was transported back to EMCC. Centers medical staff will continue to monitor
guardian was notified about this incident. is a DCFS
placement at The Centers. As always, please do not hesitate to contact me if you need any
additional information.
Interim Action Narrative: Resident was assessed by APRN who recommended for resident
to have a further evaluation of right hand. Resident has a follow-up appointment on
1/27/2023 with Ortho Arkansas.
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing Specialist reviewed provider reported incident. Licensing
Specialist will follow-up on resident's ortho appointment scheduled for 1/27/2023.
Licensing Specialist informed resident's right hand diagnosis: fracture to the fourth and
fifth metacarpal. Resident was placed in a soft cast and a follow-up appointment with Ortho
Arkansas scheduled for 2/10/2023 at 10:10 am. No licensing concerns noted.


summary: A resident was transported for acute care after exhibiting aggressive and threatening behavior.

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: 1/19/2023
Date Received by DCCECE: 1/20/2023
Facility Name: Elizabeth Mitchell Centers
Facility Number: 157
Facility Type: Residential
Incident Type: Licensing
Report Description: I wanted to inform you of an incident that occurred at The Centers
(EMAC) on 01/19/2023. On 01/19/2023, client
was dysregulated and began to verbally threaten to ?kill everybody on the dorm.?
said she would go back to jail today because she is sick of these ?bitches?, and she
wants to beat them until they bleed. continued to pace, with her fist clinched
and verbally threatening others. was offered a variety of options to calm her,
but she refused all offers. Dr. Perkins was contacted and determined would
benefit from a higher level of care to keep her and others safe. Dr. Perkins and The Centers
team located an acute placement for at Methodist Behavioral Health.
was transported to Methodist Behavioral Health by MEMS ambulance service.
did not sustain any injuries because of this incident. s guardian
was notified about this incident. is a DCFS placement at The Centers. As
always, please do not hesitate to contact me if you need any additional information.
Interim Action Narrative: Dr. Perkins contacted and decision made for higher level of care.
Resident transported to Methodist Behavioral Health via MEMS.
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing Specialist reviewed Provider Reported Incident. No
licensing concerns noted.


summary: Licensing completed a walkthrough of EMCC. No deficiencies cited.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Elizabeth Mitchell Centers
Facility Number: 157
Licensee Address: 6501 WEST 12TH STREET
LITTLE ROCK AR 72204
Licensing Specialist: Kendra Rice
Person In Charge: Eric Knowles
Record Visit Date: 1/18/2023
Home Visit Date: 1/18/2023
Purpose of Visit: Monitor Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Time of Visit: 7:00 pm to 7:30 pm
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Census: 22
Licensing Specialist completed a walkthrough of EMCC. Licensing Specialist was escorted by Ms. Ashanti,
Lead Supervisor. Ms. Ashanti had Mr. Mike, Program Coordinator, on the telephone while escorting
Licensing Specialist throughout the building. Licensing Specialist also received a phone call from Ms.
Kenleigh, Director of Residential and Clinical Services, while on the premises.
Licensing Specialist observed the following areas: new dorm, treatment hallway, and the classroom. Licensing
Specialist did not observe any debris walking into the building. New dorm, there were two (2) residents laying
down in the common area due to being on line of sight. The other residents were sleeping, laying down, and
two (2) were observed going to the restroom. Ratio 2:6, this is where the girl residents are housed. Classroom,
Licensing Specialist observed four (4) residents who appeared sleep. Ratio 1:4, this is where some of the boy
residents are housed.
On the treatment hallway, Licensing Specialist observed the conference room, group room, and the VIP room.
The conference room, ratio 2:4, the residents were laying down watching television. The group room, ratio
2:4, the residents were laying down watching television. The VIP room, ratio 1:4, the residents were laying
down watching television. Majority of the boy residents are housed on the treatment hallway.
There was one (1) resident sitting by staff in the VIP room. The two (2) residents in the new dorm were laying
on a mattress separately because they were on line of site. All other residents were laying on their beds on top
of their mattresses with covers. Licensing Specialist observed other staff members including a nurse on the
treatment hallway completing chores.
Licensing Specialist was informed by Ms. Ashanti that the residents were adjusting well. Ms. Bennett
informed Licensing Specialist if things go well with the their insurance, the projected date for repairs is
1/30/2023.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: Two residents were sent for acute care after exhibiting aggressive and threatening behavior.

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: 1/13/2023
Date Received by DCCECE: 1/17/2023
Facility Name: Elizabeth Mitchell Centers
Facility Number: 157
Facility Type: Residential
Incident Type: Licensing
Report Description: I wanted to inform you of an incident that occurred at The Centers
(EMAC) on 01/13/2023. On 01/13/2023, at approximately 1650 hours, client
became dysregulated, grabbed a fire extinguisher, and discharged
it in the hallway, causing the fire alarm to be activated. then threw the fire
extinguisher at a female member of the nursing staff. A second client,
who is friends with , became dysregulated and
attempted to join in her outburst. In an attempt to keep them from harming
themselves and others, Centers staff members placed and in
Emergency Safety Interventions (ESI?s). The Little Rock Fire Department (LRFD) and
Little Rock Police Department (LRPD) responded to the facility because of this incident.
Due to the fact and continued to be aggressive and verbally
threaten others, Dr. Perkins made the decision to seek acute placement for both clients.
MEMS transported to Arkansas Children?s Hospital (ACH), where she
remained until she was transferred to Methodist Behavioral Health on 01/14/23. MEMS
transported from Centers to Rivendell Behavioral Health. did
not sustain any injuries because of this incident. ?s guardian was notified
about this incident. is a DCFS placement at The Centers. did
not sustain any injuries because of this incident. ?s guardian was notified
about this incident. is a private placement at The Centers. As always, please
do not hesitate to contact me if you need any additional information. **As of this report,
is at Methodist and is at Rivendell**
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Interim Action Narrative: Dr. Perkins was contacted due to the residents aggressive
behavior and verbal threats to others. A decision was made to seek acute placement for both
residents.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist will follow-up with the facility to schedule a time
to view camera footage. 1/19/2023, Licensing Specialist informed there were no witness
statements. 1/23/2023, Licensing Specialist reviewed camera footage and inquired about
nursing notes.

ItIAXtll
olrartlttat of
HUMAiI
Y(
SERVICEg
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: Elazabeth Mitchell Centers
Facility Number: 157
Licensee Address: 6501 WEST 12TH STREET
LITTLE ROCK AR 72204
Licensing Specialist: Kendra Rice
Person ln Charge: Eric Knowles
Record Visit Oatet 112312023
Home Visit Dale: 112312023
Purpose of Visit: Self Report Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Time of Visit: ll:15 am to l2:15 pm
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 ol3

Census: 43
Licensing Specialist reviewed camera footage for reported incident on ll13l2O23 involving two (2) residents
Licensing Specialist observed resident on the EMAC hallway walking doun the hall. It appeared that
maybe words were exchanged between rcsident and a pccr. Resident walked in the other direction into a
comer where the fire extinguisher was in a case on the wall. Staff (2:l) was observed trying to get thc fire
extinguisher from the resident. She started spraying the fire extinguisher down the hall toward her peers.
Licensing Specialist observed the resident dropping the fire extinguisher to the floor, betbre staff was able to
pick up the fire extinguisher, resident picked up the fire extinguisher and started spraying it toward stafT.
Licensing Specialist observed the fire alarm going off from the flashing ofthe lights on the wall. StafT(4:1)
were able to get the fire extinguisher away liom the resident. Licensing Specialist observed resident pacing up
and down the hall being aggressive toward staff and destroying property. Each a empt that resident tried to
get to another fire extinguisher she rvas blocked by staff. Two (2) Little Rock police offrcers were observed
walking down the hall.
Resident was observed trying to get out thc door of the EMAC's administration hall, ratio 2: l. Licensing
Specialist observed staff attempting to get resident to comply. Rcsident was observcd bcing aggressive v'ith
staffand destroying property. Licensing Specialist observed rcsidcnt running for thc door kicking the door and
at staff, ratio 3: l.
Licensing Specialist u,as unable to observe the resident being placed in a restraint while on the administration
hall due to the angle of the camera. Licensing Specialist also observed three (3) Little Rock tiretighters
walking toward the hallway where the fire extinguisher was sprayed. Residue fiom the lire extinguisher was
observed on the floor.
While outside, Licensing Specialist observed resident walking around the courtyard trying to get into the
building. Staff was observed removing the residents from the area. Licensing Specialist observed resident
being put into a restraint on the ground. A staff member was observed talking on the phone. Resident was
observed being aggressive while in the restraint and receiving a chemical restraint.
Licensing Specialist and Mr. Knowles, Compliant Oflficer, discussed the incident. Mr. Knowles intbrmed
Licensing Specialist that all fire extinguisher cases will be locked. No licensing concems were observed while
viewing camera lootage.
Provider Comments:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 ol3

CCL Staff Signature Dale. 611912023
t,
Provider Signature : Date. 6l'tgt2023
vrww.arkansas.gov/dhs
Serving more than one million Arkansans each year Page


summary: Officers were dispatched to the facility in response to a report of a juvenile hitting a staff member.

raw_content:
LITTLE ROCK POLICE DEPARTMENT INCIDENT REPORT

[ZV] JUVENILE INFORMAT! ON

INCIDENT NUMBER

2023-005444

INCIDENT DATE

1/13/2023 4:51:56 PM

. INCIDENT.
LV Bl

LOCATION OF INCIDENT (ADDRESS / BUSINESS NAME)

Report,generated; 1/13/2023 10:35 PM

ME PE OF CALL

DIS

DISTRICT

6501 W 12TH ST
61

OFFENSE

INCIDENT OFFENSE TYPE

1, ASSAULT 3RD DEGREE

SUSPECTS USED:

CJ(A) Alcohol (C1) Drugs

oO (C) Computer Equip w™ Not Applicable /
Unknown

C8) Buying / Receiving
(1(E) Exploiting Children

{_](D) Distributing / Selling

LOCATION CODE:
Oo (01) Air / Bus / Train Terminal

(_] (02) Bank / Savings & Loan

(_] (03) Bar / Night Club

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

oO (07) Convenience Store

oO (08) Department / Discount Store

Oo (09) Drug Store / DR Office / Hospital
(10) Field / Woods

(JN) Government / Public Building
(](12) Grocery / Supermarket

(113) Highway / Road / Alley

(14) Hotel / Motel / Ete

(5) Jail / Penitentiary

(JU) Lake / Waterway

ay Liquor Store

(](18) Parking Lot / Garage

Cas) Rental / Storage Facility
[J(20) Residence / House

(J21) Restaurant

[7] (22) School / College

(123) Service / Gas Station

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

C137) Abandoned/Condemned Structure
(1038) Amusement Park

139) Arena / Stadium / Fairgrounds
(140) ATM Separate from Bank
(141) Auto Dealership New / Used
(42) Camp / Campground

(FOR BURGLARY ONLY) METHOD OF ENTRY:

NUMBER OF PREMISES ENTERED Oe) Forcible Cw) No Force

[No [Other

NARCAN USED: ["]¥es

ENTRY DATE REPORTING OFFICER
01/14/2023 03:12:20 | MCKENZIE MARTINEZ P|

TYPE OF CRIMINAL ACTIVITY:

C (T) Transport / Transmit / Import Ow) Using / Consuming

OFFENSE STATUS

6-H
AG

GANG RELATED INFO:
Ow Juvenile Gang
([](G) Other Gang
Va) None / Unknown

Attempted
Completed

Attempted
Completed

(©) Cultivate / Manufacture / Publish
Oo) Operating / Promoting / Assisting

Oe) Possessing / Concealing

[](44) Daycare Facility [1G1) Rest Area

(](45) Dock / Wharf / Freight Terminal C11s2) School - College / University
(J46) Farm Facility (163) School - Elementary / Secondary
[_](47) Gambling / Casino / Racetrack — [7](54) Shelter - Mission / Homeless
(](48) Industrial Site [1(55) Shopping Mall

(]«9) Military Installation L116) Tribal Lands

(]s0) Park / Playground C67) Community Center

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

O (50) Poison
[J (60) Explosives
C16s) Fire / Incendiary Device

WEAPON FORCE:
(_](11) Firearm (Unknown)

~~ []12) Handgun

~~ (13) Rifle

~~ (414) Shotgun

~~ (05) Other Firearm

Deo) Knife / Cutting Instr (Axe, etc)

(10) Blunt Object (Club, etc)

(16s) Motor Vehicle (as weapon)

[¥](40) Personal Weapons (hands, etc)

oO (70) Narcotics / Drugs /
Sleeping Pills

(J (85) Asphyxiation
[J (90) Other
Ces) Unknown

O (99) None

ORIGINAL APPROVING SUPERVISOR

HANNAH THOMAS |

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

[VJMVR in use

Page | of 7

INCIDENT NUMBER 2023-005444 Report Copjainsictivsmledntormation Report generated: 1/13/2023 10:35 PM

VICTIM
VICTIM # NAME (Last, First, Middle) or BUSINESS

1 MAHURIN,ANNA
ADDRESS:
6501 W 12TH ST LITTLE ROCK AR

HOME PHONE: WORK PHONE: MOBILE PHONE: OTHER PHONE:
5016668686

sex: [_](M) Male ETHNICITY: [_](H)Hispanic RACE: [¥](W) White [[](B) Black [_](1) American Indian | DATE OF BIRTH
[Z](F) Female ~[[](U) Unk. | [](N) Non-Hispanic [¥](U) Unk. (A) Asian / Pacific Islander [_](U) Unknown 03/26/1999

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

AGE: ; RELATIONSHIP OF THIS VICTIM TO SUSPECTS
Exact Age: 23 SUSPECT(S) VICTIM WAS: (by Suspect Number)
Range: _ Ci BB) 7-364 Days Old (SE) Spouse (AQ) Acquaintance
Jen) Under 24 Hrs. Old [[](99) Over 98 Years Old D.L. ID No. (STATE) —* (FR) Friend
(JayB) 1-6 Days Old (100) Unknown (PA) Parent (NE) Neighbor

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

Mi C2 O03 C4 Os Oe 7 Gs (GP) Grandparents (CF) Child of BF / GF

VICTIM TYPE: i] (1) Individual Ce) Business C1) Financial Inst. Ow) Unknown (Ge) Greadehid; HR) Homoneanial Rel,

L1G) Government [[](R) Religious [-](S) Society / Public [7](O) Other (11) Inlaw —____— XS) Ex-Spouse
(SP) Stepparent (EE) Employee

(SC) Stepchild (ER) Employer
(SS) Stepsibling (OK) Otherwise Known

VICTIM INJURY:
[V](N) None QO (M) Apparent Minor Injury (1B) Apparent Broken Bones
mt) Possible Internal Injury QO (T) Loss of Teeth Oa) Severe Laceration

(OF) Other Family (RU) Relationship Unknown!
im (O) Other Major Injury O (U) Unconsciousness So

(ST) Stranger (VO) Victim Was Suspect

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

(04) Gangland (0s) Juvenile Gang (06) Lover's Quarrel (J07) Mercy Killings

(J(08) Other Felony Involved C09) Other Circumstances Cao) Unknown Circumstances (J20) Criminal Killed by Private Citizen
(121) Criminal Killed by Police Officer [7] (30) Child Playing w/ Weapon (£131) Gun-Cleaning Accident (1 (32) Hunting Accident

(133) Other Negligent Weapon Handling [_](34) Other Negligent Killings

CLOTHING DESCRIPTION

HAT SHIRT
COAT, PANTS/DRESS

Page 2 of 7

INCIDENT NUMBER 2023-005444 4 \GrdHLOTINALION — Report generated: 1/13/2023 10:35 PM

SUSPECT #1

SUSPECT # NAME (Last, First, Middle)

1
ARRESTEE # ADDRESS:

= WORK PHONE; MOBILE PHONE: OTHER PHONE:

SEX: Om) Male ETHNICITY: (_](H)Hispanic RACE: [J(w) white [V](B) Black (J American Indian DATE OF BIRTH
[Z](F) Female = [[](U) Unk. | [[]QN) Non-Hispanic [¥](U) Unk. [J(A) Asian / Pacific Islander [](U) Unknown

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

AGE: SUSPECTS ACTIONS RELATED TO: . HEIGHT: WEAPONS AT ARREST:
Exact Age: 15 Vi V2 v3 v4 Ft —_— (J 01) Unarmed

Ree LISS V6 v7 v8 In :
Range: 2s Ca 1) Firearm (Unk)
[-](09) Over 98 Years Old | DISPOSITION OF JUVENILE: D.L. / ID No. (STATE) WEIGHT: ~~ []12) Handgun

(H) Handled within Department — P
ea) Unknown He Referred outside Department Lbs heen (a3) Rifle
Ci 14) Shotgun

~~ []5) Other Firearm

(9 QaMO\Ne --y)

THIS SUSPECT RELATES TO WHICH OFFENSES? ARREST TYPE: CL) On View Arrest
| C2 C3 (j4 CT s Cle (7 CIs Cis) Summons / Cited males) Taken Into Custody

ARREST LOCATION: ARREST DATE:

[-J(16) Mlegal Cutting Instrument
[]17) Club/Blackjack/Brass

CHARGE: 5-13-207

ARRESTING OFFICERS

OFFICER |: OFFICER 5:
OFFICER 2: OFFICER 6:
OFFICER 3: OFFICER 7:
OFFICER 4: OFFICER 8:

Suspect information continued on next page.

Page 3 of 7

COMPLEXION:

HAIR LENGTH:

(1) Long
(2) Medium

| ](4) Bald(ing)

(6) Unknown

HAIR STYLE;
(OL) Afro

(02) Wavy

(03) Straight
(04) Curly

(05) Braided
(06) Ponytail
(07) Military
(08) Processed
[_](09) Wig/Toupee

| |(10) Other
(11) Unknown

BUILD:

| (2) Medium
|_](3) Heavy

| |(4) Muscular
(5) Unknown

ADDED DESCRIPTION:

Wa

NAME (Last, First, Middle)

HAIR COLOR;
(1) Black
(2) Blonde
(3) Brown
(4) Grey
(5) Red
(6) Sandy

| |(7) Other

(8) Unknown

EYE COLOR:

(1) Blue
(2) Brown
(3) Grey
(4) Green
[_](5) Hazel
| ](6) Other
(7) Unknown

FACIAL HAIR:

(01) Clean Shaven
(02) Unshaven
(03) Full Beard
(04) Must. (hvy)
(05) Must. (thin)
(06) Brows (hvy)

[_](07) Brows (thin)

L_](08) Side Burns

[_](09) Goatee

| }(10) Other

(11) Unknown

CLOTHING DESCRIPTION:

HAT

COAT

SHIRT
PANTS/DRESS
SHOES

DEMEANOR;
(OL) Angry
(02) Apologetic
(03) Calm
(04) Irrational
(05) Nervous
(06) Polite
[_](07) Professional
[_](08) Stupor
[_] 9) Violent
|_|(10) Drunk / High
[ ](11) Other
(12) Unknown

SCAR / MARK:

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

[_] (08) Leg (rt)

[_] (09) Leg (1ft)

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

TATTOO:
(1) Designs
(2) Initials
(3) Names
(4) Pictures
(5) Words
(6) Numbers
(7) Insignia

[_](8) None

[¥](9) Unknown

TATTOO LOC:

(1001) Am (If)
(02) Arm (rt)
(03) Leg (1ft)
(04) Leg (rt)
(05) Hand (lft)
(06) Hand (rt)
(07) Face
(08) Neck
(09) Finger(s)
(10) Chest

[Ja1) Back

Page 4 of 7

INCIDENT NUMBER 2023-005444 Keport OPAANES: IN-GIMAG A HLOIMALION — Report generated: 1/13/2023 10:35 PM

OTHER PERSONS - CONTACT
OTHER PERSON # | NAME (Last, First, Middle)
1 HOPE,AMANDA

ADDRESS:
6501 W 12TH ST LITTLE ROCK AR

WORK PHONE: MOBILE PHONE: OTHER PHONE:
ETHNICITY: [[](H)Hispanic RACE: [[](W) White [[](B) Black [[](1) American Indian | DATE OF BIRTH

HOME PHONE:
5018378074

sex: [[](M) Male

[Z](F) Female [](U) Unk. | [[](N) Non-Hispanic [7](U) Unk. (J(A) Asian / Pacific Islander [¥](U) Unknown

RES. STATUS: [1(8) Resident
[_]N) Nonresident (U) Unknown

MENTALLY AFFLICTED? OCCUPATION / EMPLOYER:

1%) Yes [¥](N) No [[](U) Unk.

AGE:

Exact Age:
Range:

[_J(NN) Under 24 Hrs, Old
[_J(NB) 1-6 Days Old

COMPLEXION:

(1) Light

(2) Medium
(3) Dark

(4) Acne

(5) Freckled
(6) Ruddy
(7) Other

[¥](8) Unknown

HAIR LENGTH

(1) Long

(2) Medium
[](3) Short
[ ](4) Bald(ing)

| |(5) Other

(6) Unknown

(-](BB) 7-364 Days Old

HAIR STYLE:
(](01) Afro

[_](02) Wavy
(03) Straight
(04) Curly
(05) Braided
(06) Ponytail
(07) Military
(08) Processed
(09) Wig/Toupee
: (10) Other
[¥](11) Unknown

BUILD:
(1) Light
(2) Medium
(3) Heavy
(4) Muscular
[-](5) Unknown

[].99) Over 98 Years Old
[-](00) Unknown

HAIR COLOR:

(1) Black
(2) Blonde
(3) Brown
(4) Grey
(5) Red
|_|(6) Sandy

| |(7) Other

(8) Unknown

EYE COLOR:

[](1) Blue

(2) Brown

(3) Grey

(4) Green

(5) Hazel
[_](6) Other
[V](7) Unknown

D.L. / ID No. (STATE)

FACAIL HAIR:

(01) Clean Shaven

(02) Unshaven
(03) Full Beard
(04) Must. (hvy)
(05) Must. (thin)
(06) Brows (hvy)
(07) Brows (thin)
(08) Side Burns

[ ](09) Goatee

| _|(10) Other

(11) Unknown

WEIGHT:

DEMEANOR:

He. Angry

(02) Apologetic

[_](03) Calm
(04) Irrational
(05) Nervous
(06) Polite
(07) Professional
(08) Stupor

| |(09) Violent

| }(10) Drunk / High

(11) Other

(12) Unknown

CLOTHING DESCRIPTION

PANTS/DRESS
SHOES

Lbs

SCAR / MARK:

Be Head

(02) Neck

[_] (03) Hand (rt)
(04) Hand (Ift)
(05) Arm (rt)
(06) Arm (lft)
(07) Body
(08) Leg (rt)
(09) Leg (ft)
(10) Other
(11) None
(12) Unknown

TATTOO:

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

(9) Unknown

TATTOO LOC:

(01) Arm (lft)
(02) Arm (rt)
(03) Leg (1ft)
[](04) Leg (rt)
[J (05) Hand (1ft)
[_](06) Hand (rt)
(07) Face
(08) Neck
(09) Finger(s)
(10) Chest
(11) Back

Page 5 of 7

INCIDENT NUMBER 2023-005444

Arormation Report generated: 1/13/2023 10:35 PM

NARRATIVE

OFFICERS ARRIVED ON SCENE AND MADE CONTACT WITH MAHURIN. MAHURIN ADVISED SHE WAS ATTEMPTING
TO INSTRUCT SUS1 TO DO AN UNKNOWN TASK WHEN SUS1 BECAME ANGRY. MAHURIN ADVISED THE STAFF
ATTEMTPED TO PLACE SUS1 IN A HOLD. SUS1 GOT HER HANDS FREE AND BEGAN TO HIT MAHURIN IN THE SIDE OF
THE FACE. MAHURIN REFUSED MEDICAL ATTENTION. MAHURIN WAS PROVIDED AN INCIDENT NUMBER.

Page 6 of 7

INCIDENT NUMBER 2023-005444 NLOPMALION Report generated: 1/13/2023 10:35 PM

ADDITIONAL HOMICIDE CIRCUMSTANCES (C1) Criminal attacked a civilian (J) Criminal resisted arrest

L(A) Criminal attacked police officer, that officer killed criminal ml) Criminal attempted flight from a crime oo Unable to determine /
[_]®) Criminal attacked police officer, criminal killed by other officer Ce) Criminal killed in commission of a crime not enough information

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

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

(J (11) White (](21) Jewish (1(32) Hispanic [_](41) Male Homosexual (Gay)
[-]12) Black [_](22) Catholic (](33) Other Ethnicity (_] (42) Female Homosexual (Lesbian)
(13) American Indian / [_] (23) Protestant i (3) Homosexual (Gay and Lesbian)
CT iaskan Native [_](24) Istamic (Muslim) raurtmmaisih acs [_](44) Heterosexual
[(-](14) Asian / Pacific Islander [_](25) Other Religion (-1(51) Physical Disability [J (45) Bisexual
[_] (15) Multi-Racial Group (126) Multi-Religious Group [](52) Mental Disability
(17) Atheist/Agnostic

Page 7 of 7


summary: Licensing visited the facility to speak with facility staff about their census and the number of residential and PRTF beds at the facility.

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: Elizabeth Mitchell Centers
Facility Number: 157
Licensee Address: 6501 WEST 12TH STREET
LITTLE ROCK AR 72204
Licensing Specialist: Kendra Rice
Person In Charge: Eric Knowles
Record Visit Date: 1/13/2023
Home Visit Date: 1/13/2023
Purpose of Visit: Monitor Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulations Not Correctable:
Narrative:
Time of Visit: 9:00 am to 9:15 am
Census: 58
Licensing Specialist spoke with Ms. Bennett regarding their census and number of beds for residentials and
PRTFs. Ms. Bennett called Mr. Knowles on the telephone (speaker) to gather the requested information.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year
Page 1 of 2

Mr. Knowles informed Licensing Specialist the following totals:
Current Census: 39 PRTF and 19 Residentials
Residential Beds: 33
PRTF’s Beds: 49
No other information was requested by Licensing Specialist.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year
Page 2 of 2


summary: A facility staff member visited the police station to make a report about a juvenile resident hitting him in the head with his fists. The staff member told officers he was terminated from his position as a result of the incident.

raw_content:
INCIDENT NUMBER 2023-004996 JUVENILE INFORMATION Report generated: 1/16/2023 2:17 PM
NARRATIVE
JASPER (VIC) CAME TO THE 12TH STREET SUBSTATION TO MAKE A BATTERY REPORT.
JASPER TOLD OFFICERS HE WORKED AT THE CENTER FOR YOUTH AND FAMILIES AT THE LISTED LOCATION. HE
SAID ON 1/11/23, AROUND NOON, JUV1 (SUS) BECAME UPSET OVER A BASKETBALL GAME WITH ANOTHER TENANT
OF THE LOCATION. JASPER SAID HE ATTEMPTED TO CALM JUV1 DOWN, BUT JUV1 THREW A WATER BOTTLE AT HIM
AND HIT HIM IN THE HEAD. HE SAID HE THEN ATTEMPTED TO GRAB JUV1 TO CALM THE SITUATION DOWN AND
JUV1 CONTINUALLY STRUCK HIM IN THE HEAD WITH HIS FISTS.
JASPER SHOWED OFFICERS A KNOT ON THE UPPER LEFT SIDE OF HIS FOREHEAD FROM THE ALTERCATION. HE
SAID HE HAD TO GO TO THE HOSPITAL YESTERDAY TO RECEIVE MEDICAL ATTENTION. HE ALSO STATED HE WAS
FIRED FROM HIS JOB TODAY OVER THE ALTERCATION.
JASPER WAS PROVIDED AN INCIDENT NUMBER AND ADVISED WARRANTS.
BWC IN USE.
Page 5 of 6


summary: A staff member pushed a resident into a counter and window after the resident threw a water jug at him and other peers. The staff member was terminated as a result of this incident.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 1/11/2023
Date Received by DCCECE: 1/11/2023
Facility Name: Elizabeth Mitchell Centers
Facility Number: 157
Facility Type: Residential
Incident Type: Licensing
Report Description: Av is . PRFC/AO is (age
unknown), employee of The Centers For youth and Families. was still hype from
fright that just happened outside. He came in the dayroom and threw a water jug at
and his peers. pushed him into the counter and window. started to hit
and was trying to get him under control by grabbing his shirt. They started tussling.
did have bruises but it?s unknown if he got them from the incident outside or the
tussling with . The location of the bruises is unknown. # .
Interim Action Narrative: was called and screened out. The facility reports they
terminated the staff effective 1/12/2023.
Maltreatment Narrative: Outcome:
Licensing Narrative: 1/12/23- Licensing received permission to contact the agency.
Specialist E. Breedlove visited the facility to review camera footage, gather witness
statements, and nursing notes. Program Coordinator called Eric Knowles with the facility
and informed him that this incident was so we will be
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

needing further information including an ICA and witness statements. Mr. Knowles stated
that the staff was suspended but may have since been terminated as he was supposed to
meet with management this afternoon. Mr. Knowles states he will confirm his employment
status and inquire if witness statements have been gathered from staff. 1/13/2023, Licensing
Specialist Rice viewed camera footage.

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: Elizabeth Mitchell Centers
Facility Number: 157
Licensee Address: 6501 WEST 12TH STREET
LITTLE ROCK AR 72204
Licensing Specialist: Ezell Breedlove
Person In Charge: Eric Knowles
Record Visit Date: 1/12/2023
Home Visit Date: 1/12/2023
Purpose of Visit: Complaint Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Visit conducted from
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Current Census
Licensing Specialist E. Breedlove received a complaint stating that resident . was in a physical altercation
when he was brought inside the dayroom on 1/11/2023. Upon entering the dayroom, the resident reportedly
threw a water jug at staff and his peers. Staff then pushed the resident into the counter and window.
The resident began to hit the staff and they began to "tussle".
A review of the camera footage showing the incident was conducted and showed AV( ) was being
uncooperative and failing to respond to the request to calm down. AV( then grabbed a pitcher from a table
and slung it in the direction of AO( hitting him in the face. AO( immediately reacted to being hit in the
face by stepping up to AV( and pushing him into the table, but was then immediately separated. AO(
was walked away by other staff as there were no other interaction between the two.
Licensing obtained witness statements from Staff ( Staff RN ( and staff ( and the nursing notes
showing the assessment of the resident's condition after the altercation.
The facility confirmed that staff is currently suspended pending termination and staff has been
terminated as 1/11/2023.
Licensing is not prepared to leave a finding at this time.
Provider Comments:
CCL Staff Signature : Date: 1/12/2023
Provider Signature : Date: 1/12/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Elizabeth Mitchell Centers
Facility Number: 157
Licensee Address: 6501 WEST 12TH STREET
LITTLE ROCK AR 72204
Licensing Specialist: Kendra Rice
Person In Charge: Eric Knowles
Record Visit Date: 1/13/2023
Home Visit Date: 1/13/2023
Purpose of Visit: Self Report Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Time of Visit: 10:30 am to 12:00 pm
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Census: 39
Licensing Specialist reviewed camera footage for reported incident on 1/11/2023 that involved a resident and
staff member.
Licensing Specialist observed resident walking around the dayroom destroying property. Staff could be
heard trying to get resident to calm down. Licensing Specialist observed resident tear down an exit
sign and running toward what looked like a cabinet and threw a pitcher across the counter. The pitcher hit
staff member ( in the face.
Residents were directed out of the dayroom onto their bedroom hall. Staff ( went toward resident and
grabbed what appeared to be the resident’s shirt. Licensing Specialist observed resident swing at staff
Staff member briefly stood between resident and staff member Staff members and
attempted to remove resident off the counter. Licensing Specialist observed a nurse standing across from
the resident and two staff members. Resident was observed fighting with both staff members. Staff member
and the nurse could be heard requesting for leave the building.
Licensing Specialist and Mr. Knowles discussed the incident. Mr. Knowles informed Licensing Specialist that
staff member was terminated on 1/12/2023.
Provider Comments:
CCL Staff Signature : Date: 1/13/2023
Provider Signature : Date: 1/13/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident was involved in a physical altercation with a staff member after he began destroying property and being aggressive. The resident was sent to Arkansas Children’s Hospital for evaluation after the staff member reportedly put his hands around the resident’s neck, choking him, and hit him in the face and head multiple times. The staff member was terminated as a result of this incident.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 1/11/2023
Date Received by DCCECE: 1/12/2023
Facility Name: Elizabeth Mitchell Centers
Facility Number: 157
Facility Type: Residential
Incident Type: Licensing
Report Description: I wanted to inform you of an incident that occurred at The Centers
(Destiny House) on 01/11/2023. On 01/11/2023, client DOB:
) became dysregulated and began to destroy property (pulling down exit signs
and lighting equipment, knocking over tables and trash cans). Staff members attempted to
verbally calm , at which point he became verbally and physically aggressive
towards staff. During this incident, knocked a female staff to the ground and
staff member intervened by stepping in between the two.
turned his aggression towards and a physical altercation ensued.
appeared to strike with his fists and grabbed by the
neck. and ended up going to the ground during their struggle.
Other staff members immediately separated and . was
immediately removed from the area. Centers medical staff assessed and
noted he did not display any acute distress. Medical personnel did note
sustained bruises, scratches and redness to his neck and chest. did complain
of jaw pain due to this incident. Out of an abundance of caution, was sent to
Arkansas Children?s Hospital (ACH) for further evaluation. Centers staff transported
to ACH. Once at ACH, a CT angiogram was conducted on s head
and returned without issue. After ?s medical evaluation at ACH, he was
transported back to Destiny House. Centers medical staff will continue to monitor .
. ?s guardian was notified about this incident. is a
DCFS placement at The Centers. Due to actions, this incident was reported to
the and the call was accepted (R # ).
was immediately suspended and sent home following this incident. After leadership
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

gathered more information regarding this incident, was terminated on 01/11/23.
As always, please do not hesitate to contact me if you need any additional information.
Interim Action Narrative: Resident was assessed by nursing and transported to AR
Children's Hospital for further evaluation. was accepted. Staff
member was suspended and then terminated.
Maltreatment Narrative: Outcome:
Licensing Narrative: 1/12/23- Licensing received permission to contact the agency.
Specialist E. Breedlove visited the facility to review camera footage, gather witness
statements, and nursing notes. 1/13/2023, Licensing Specialist Rice viewed camera footage.

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: 1/11/2023
Date Received by DCCECE: 1/11/2023
Facility Name: Elizabeth Mitchell Centers
Facility Number: 157
Facility Type: Residential
Incident Type: Dual
Report Description: Av is . PRFC/AO is Unknown (age
and last name are unknown), a staff member of the Centers for Youth and Families.
stated that came from behind and pulled him from the door and
punched him in the jaw. He then put both hand around his neck and choked him affecting
his breathing to some degree. He said hit him in face and head about 5 to 7x.
had purple bruising to his neck and scratches down both arms. Its? unknown if
was arrested. Referral # .
Interim Action Narrative: The report indicates that the staff involved was terminated from
employment.
Maltreatment Narrative: Outcome:
Licensing Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 1/11/2023
Date Received by DCCECE: 1/11/2023
Facility Name: Elizabeth Mitchell Centers
Facility Number: 157
Facility Type: Residential
Incident Type: Dual
Report Description: The av is yo . He is in DCFS.
The ao is staff member . He is a staff member at Centers for Youth and
Family. got into a physical altercation with another peer. They were separated
and brought back into the day room. became physically aggressive with a female
staff and pushed her down to the ground. tried to separate them. Child punched the
in the face. choked and punched him. had bruises on his neck
from being choked. The breathing was not restricted. was able to get away from
the staff trying to break it up and the altercation. There was an additional physical
altercation between and . has been terminated. The police were
not called. The entire altercation was recorded on cameras. Child is being evaluated at ACH
at this time. #
Interim Action Narrative: The report indicated that the staff was terminated from
employment.
Maltreatment Narrative: Outcome:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: SEE CASE 011946

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: Elizabeth Mitchell Centers
Facility Number: 157
Licensee Address: 6501 WEST 12TH STREET
LITTLE ROCK AR 72204
Licensing Specialist: Ezell Breedlove
Person In Charge: Eric Knowles
Record Visit Date: 1/12/2023
Home Visit Date: 1/12/2023
Purpose of Visit: Complaint Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulations Not Correctable:
Narrative:
Visit conducted from
Current Census
www.arkansas.gov/dhs
Serving more than one million Arkansans each year
Page 1 of 2


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

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Elizabeth Mitchell Centers
Facility Number: 157
Licensee Address: 6501 WEST 12TH STREET
LITTLE ROCK AR 72204
Licensing Specialist: Kendra Rice
Person In Charge: Eric Knowles
Record Visit Date: 1/10/2023
Home Visit Date: 1/10/2023
Purpose of Visit: Subsequent Building and Grounds
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulations Not Correctable:
Narrative:
Time of Visit: 1:15 pm to 2:00 pm
Census: 39
Licensing Specialist completed a walkthrough of EMCC of the following areas: new dorm, treatment hallway,
a classroom, and the bathrooms. These are the areas that residents are housed until renovations have been
www.arkansas.gov/dhs
Serving more than one million Arkansans each year
Page 1 of 2

completed due to the damage that the facility sustained on 12/24/2022. Walking through the building,
Licensing Specialist observed contractors removing the flooring and cleaning up the debris.
On the treatment hallway, Licensing Specialist observed the following: Conference Room had four (4) beds,
one (1) toilet behind a door for privacy, and one (1) sink inside the room. Group Room had four (4) beds, one
(1) toilet behind a door for privacy, and one (1) sink inside the room. There was a broken blind that
maintenance replaced while Licensing Specialist was on site. VIP Room had four (4) beds, one (1) sink inside
the room, and one (1) toilet behind a door. Belongings of the residents were near each bed in a white tall
plastic basket. Boy residents are housed on the treatment hallway.
New Dorm consists of three (3) bedrooms, one full bathroom and one bathroom with a sink and shower. Both
bathrooms were cleaned and functioning. The first bedroom had three (3) beds, second bedroom had three (3)
bed, and the third bedroom had two (2) beds. All bedrooms were organized and clean, the bathrooms were
clean, and the day area was clean and free of debris. New Dorm is where the girl residents are housed.
Licensing Specialist observed the classroom where boy residents are being housed, there was a total of five
(5) beds. The bathrooms by the classroom are being used by the boy residents in the classroom and on the
treatment hallway. Th residents on the treatment hallway use the bathrooms by the classroom to take showers.
Facing the classroom door, the bathrooms to the right are full bathrooms. Licensing Specialist observed the
light fixture above the showers were hanging down. The sinks operate by a sensor, a sensor was out on one of
the sinks.
Maintenance was called and fixed the following concerns while Licensing Specialist was on site: the light
fixtures, sink sensor, and replaced the blind in the group room. Licensing Specialist, Ms. Bennett, and Mr.
Knowles discussed the how things were going with the accommodations for the residents. Licensing
Specialist informed Ms. Bennett and Mr. Knowles of the upcoming board meeting.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year
Page 2 of 2


summary: Licensing visited the facility to conduct a buildings and grounds walkthrough of water damage to EMCC.

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: Elizabeth Mitchell Centers
Facility Number: 157
Licensee Address: 6501 WEST 12TH STREET
LITTLE ROCK AR 72204
Licensing Specialist: Kendra Rice
Person In Charge: Eric Knowles
Record Visit Date: 1/4/2023
Home Visit Date: 1/4/2023
Purpose of Visit: Subsequent Building and Grounds
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulations Not Correctable:
Narrative:
Time of Visit: 2:45 pm to 3:45 pm
Census: 42
Licensing Specialist completed a buildings and grounds walkthrough of the water damage of EMCC.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year
Page 1 of 2

Licensing Specialist observed where the restoration company (Service Pro) had cleaned up the water and
removed the debris. The damage was mainly to the common area between the dorms and the North Dorm.
South and East Dorms and including the nurse’s station flooded with water only per staff.
Licensing Specialist was informed the flooring is scheduled to be pulled on 1/5/2023. The wood in the ceiling
has been resealed and will be inspected again on 1/5/2023 to see if wood needs to be resealed. All bids have
been submitted to the insurance company and the facility is hoping that a decision is made soon.
Licensing Specialist and Ms. Knowles discussed the process of the renovations and the alternative plans that
were made for the residents.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year
Page 2 of 2


summary: A resident was transported to Arkansas Children’s Hospital for evaluation after injuring his finger while playing basketball.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 1/2/2023
Date Received by DCCECE: 1/3/2023
Facility Name: Elizabeth Mitchell Centers
Facility Number: 157
Facility Type: Residential
Incident Type: Licensing
Report Description: I wanted to inform you of an incident that occurred at The Centers
(Destiny House) on 01/02/2023. On 01/02/2023, at approximately 1349 hours, client
, DOB: ) reported to Centers staff he had hurt his left
pinky finger playing basketball the previous day (01/01/2023). Centers medical personnel
assessed ?s left hand and noted the fifth digit on his left hand had some slight
swelling. Although had full ROM in the finger, he reported it was painful to
bend. was given an ice pack for the finger, but he denied the ice pack was
effective. The on-call provider was contacted and out of an abundance of caution, gave the
order for to be transported to Arkansas Children?s Hospital (ACH) for
further evaluation. Centers staff transported to ACH. Once at ACH,
?s left hand was x-rayed, and it was determined there were NO fractures present.
After ?s medical evaluation at ACH, he was transported back to Destiny
House. Centers medical staff will continue to monitor . ?s
guardian was notified about this incident. Mr is a DCFS placement at The
Centers. As always, please do not hesitate to contact me if you need any additional
information.
Interim Action Narrative: Resident was assessed by medical personnel and given an ice
pack. On call provider was notified and ordered for resident to be evaluated at AR
Children's Hospital. Diagnosis: no fractures present.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Maltreatment Narrative: Outcome:
Licensing Narrative: Licensing Specialist will inquire about discharge summary from AR
Children's Hospital. 1/5/2023, Licensing Specialist informed that resident was assessed by
nursing this morning. Nursing rewrapped the fourth and fifth fingers (buddy tape) on
residents left hand. Resident refused OTC pain medication. Licensing Specialist was
informed that resident's fingers were buddy tape originally by AR Children's Hospital.


facility_name: Centers for Youth and Families - Monticello

summary: Officers took a report from a parent of a resident who stated that a staff member at the facility grabbed her hair and pinned her down to the bed.

raw_content:
Incident # 25-00669 Monticello Police Department Report Date 09/11/25
Page 1 of 2 Incident Report Report Time 7:45 PM
Status Exception Clearance Date Reporting Officer ORI/Agency
Not Applicable 315 Harvey, Jensen AR0220100
Closed
Assigned Officer Entered By Approving Officer
Harvey, Jensen JHarvey Carpenter, Justi
Assisting Officers
Complainant
SSN/ID/TIN Title Name DOB Age Sex Resident Status
** MASKED ** Mrs 36 F Resident
Race White Ethnicity DL (#, ST) Email
Not Hispanic/Latino ** MASKED ** N/A
Home Phone Work Phone Other Phone Personal Cell Work Cell
(000)000-0000 (000)000-0000 (000)000-0000 (000)000-0000
x000000
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
N/A
Work Address Occupation
N/A N/A ,, N/A
Offenses
Incident Location Zone
936 Jordan DR Monticello, AR 71655
Earliest Possible Date Time Latest Possible Date Time
09/09/2025 23:00 09/09/2025 23:55
# Statute/Code Description Fel/Misd Att/Comp Loc Bias Wpn CATypes
1 INFORMATION INFORMATION ONLY Completed 57 88 99
MO Method Of Entry # Prems
n/a 0
Location Types 13 Hway/Road/Alley 37 Abandoned/Condemned 48 Industrial Site Bias Motivation Codes
14 Hotel/Motel Structure 49 Military Installation 43Lesbian, Gay, Bisexual,
0 0 0 0 0 0 0 0 0 1 1 1 1 2 3 4 5 6 7 8 9 0 1 2 A B B C C C C D D F G G i i a a h o o o e r o r e r u o n r / u m n n p v l B / g d c k N t r s v t / m / e c u / / t e P D S W i S r h r s g n e u u y t i & / / s h r o i S r c T / b e / S c c L t o D t r l y n i i o i C a u o d a c n r c u i p n s l l a n e O / u B n e O g S b t T l f S r d / f f m S i T / e f t t g H o e t r B e a o m r o m l r e r d s k e i p n g p e l a t e l 1 1 1 1 1 F 2 2 2 2 2 5 6 7 8 9 0 1 3 4 5 a c J L L P R R R S S U i a l a i a e p e e e n i q t i k r r e y n s s k l u / k v e i t c n P t o d i a i a / i n c o W r r a e u l e i g w s S l n S r t / a a o y n G L c t t t o n n o / e o e S a O r t r / t r e s a t H / w t o G h g S o r a e a e e m t y r a ra e ti g o e n 3 3 g 4 4 N 4 4 4 M 4 4 8 9 r 0 1 2 4 5 6 7 e o o w A A A C D D F G d u A a a / n r T u a a o a U m e l r d t M m y c m o m n T s s u c k a p e b e / a / s D S C W F / / d l r e r S C i e e m e n a o m h p a t a g c l a i F i a a l n e m s i e d l a r r i a e n r f t i a p c / y u s l u t F t g i h m m P e l r i r i t e o a p y / f F r i u r g o k a n h m i d r t/ Bank 5 5 5 C 5 E 5 M 5 5 5 5 0 1 2 3 4 5 6 7 8 l o i e s l C m l s P R S S S S T C e i y r e o g a c c h h e o i b h h b n n e r e o s m e k o o a t / / t l p t a H U / r m o o e l A P p s r o n L l l r i p y u r l n a m i e - - a / - a n v g S y a n c e i e g t e d M e y r l r c e s s o C a o i s t u l y n s e l n d n d a te ry r A 1 1 A 1 A 1 1 1 O 2 2 N 1 2 3 4 5 6 1 2 m l t a h T W M J C B A A s e e N e k I l m s r a r u a h - a i w a i c t P l a c i e t h t t a i i N i k n e s v a r o - n i r h e c a c l o a i i a c t r f c H i i n v c e A a e s I f I w n r s , i d a c l G a a i i a i n r a n o n d n u e o p o r r r 2 2 2 2 2 3 3 3 L 4 4 3 4 5 6 7 1 2 3 a 1 2 t P I O M A A G L H N in s e r t r i o l t a o u h s o a a h s t y l p e t b m e b t H e i a i ( - r i s s i a m r i n c R s t e t n / i a a p A l c ( e i M n g l a g l e o i t i n g u n o ) r i i s o u c L o l s s a i n o m t t i g r i c n ) ro o up o G 4 4 5 5 6 6 7 7 8 9 r 4 5 1 2 1 2 1 2 8 9 r o T H B P M M F T G N U u r e r i h a e o n e e a p s a m y n t n k n n l e n e e ( s n s e d t x L a s r a g o o e u D G l g l e e w s r a e i D B s n e l N n n a i T d x s d o b e u ) a e n i r a l b r - , i l t C i M y li o ty i n xe fo d rming
Facility/Casino/Race Track
Suspected Of Using Criminal Activity Types Weapon Type(s) 20 Knife/Cutting Instr 65 Fire/Incendiary Device
None B P B P u o y s i s n e g s / s R in e g ce /C iv o in n g cealing C O C O u p l e ti r v a a t t in in g g / / P M ro a m nu o f t / i P n u g b /A li s s s h i i s n t g ing 1 1 1 2 F H i a re n a d r g m u n (A (A ut u o t ) o) 3 3 0 5 B M l o u t n o t r O V b e j h e i c c t le 7 8 0 5 D As ru p g h s y / x N ia a t r i c o . n /Sleeping Pills
D Distributing/Selling T Transport/Import/Transmit 13 Rifle (Auto) 40 Personal Weapons 90 Other
E Exploiting Children U Using/Consuming 14 Shotgun (Auto) 50 Poison 95 Unknown
15 Other Firearm 60 Explosives 99 None
A Simple/Gross Neglect I Intentional Abuse & Torment
F Organized Abuse S Sexual Animal Abuse
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 9/18/2025 8:27:52 AM


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


summary: Licensing conducted an unannounced visit to review fire and severe weather drill logs.

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: The Centers for Youth and Families Monticello
Facility Number: 159
Licensee Address: 936 JORDAN DRIVE
MONTICELLO AR 71657
Licensing Specialist: Clayton DeBoer
Person In Charge: Bernetta Lowe
Record Visit Date: 3/25/2025
Home Visit Date: 3/25/2025
Purpose of Visit: Special Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Unannounced visit conducted to review fire drill and severe weather drill logs. Last 3 months fire drills
reviewed which showed the time and date of the drill, number of participants, and length of time required to
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

reach safety. Last quarterly severe weather drill log reviewed whichshowed the time and date of the drill,
number of participants, and length of time required to reach safety.
Provider Comments:
CCL Staff Signature : Date: 3/25/2025
Provider Signature : Date: 3/25/2025
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident and staff member were involved in a physical altercation following an attempted restraint. Following an investigation into the incident, the facility was cited, and a staff member was terminated.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 027951
Date of Incident: 3/1/2025
Date Received: 3/3/2025
Facility Name: The Centers for Youth and Families Monticello
Facility Number: 159
Incident Type: Licensing
Report Description: On 3/1/2025, client )
was upset and began hitting the window in his bedroom repeatedly. Staff,
, entered the bedroom and attempted to perform a CPI restraint, but was
unsuccessful. It was reported that the client and the staff were involved in a physical
altercation. The nurse on duty, , intervened and separated the client and
staff. The staff was immediately suspended and sent home, pending termination this week.
The client is a and the guardian was notified.
Interim Action Narrative: Staff immediately suspended pending certain termination.
Narrative:
Licensing Narrative: 3/3/25-Reviewed for licensing concerns.
contacted for further information. Phone call made to of Centers
Monticello. Nursing note for client sent to licensing. There is no video footage of incident.
Visit scheduled for 3/11/25. 3/4/25-Nurse who witnessed incident provided a witness
statement which indicated that staff was unprofessional, used an inappropriate hold and
used a disciplinary action that did result in physical injury and threat of bodily harm.
Facility will be cited 109.1g, 905.4g and 905.9. This witness statement and staff termination
papers sent to licensing. 3/10/25-Received notification that staff involved in complaint has
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

completed all background checks and they are approved. 3/11/25-Facility visited and cited
109.1g, 905.4g and 905.9. Licensing complaint founded. 4/21/2025, facility provided
documentation that was uploaded to the case. The case has been closed as founded by
licensing. Approved by Program Coordinator. Case complete.

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: The Centers for Youth and Families Monticello
Facility Number: 159
Licensee Address: 936 JORDAN DRIVE
MONTICELLO AR 71657
Licensing Specialist: Clayton DeBoer
Person In Charge: Bernetta Lowe
Record Visit Date: 3/11/2025
Home Visit Date: 3/11/2025
Purpose of Visit: Complaint Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Regulation Number: 100.109.1.g
Regulation Description: Unprofessional conduct in the practice of child welfare activities shall include, but not
limited to the following:
Finding Description: Staff was unprofessional, used an inappropriate hold and used a disciplinary action that
could result in physical injury and threat of bodily harm.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 3

Action Due Date: 2025-03-01
Action Due Description: Staff was immediately suspended following incident and terminated 3/4/25.
Comply Date:
Sub-Regulation Level 1 Description: Engaging in behavior that could be viewed as sexual, dangerous,
exploitative, or physically harmful to children.
Regulation Number: 900.905.4.g
Regulation Description: The following actions shall not be used, including as discipline:
Finding Description: Staff was unprofessional, used an inappropriate hold and used a disciplinary action that
could result in physical injury and threat of bodily harm.
Action Due Date: 2025-03-01
Action Due Description: Staff was immediately suspended following altercation and terminated 3/4/25.
Comply Date:
Sub-Regulation Level 1 Description: Physical injury or threat of bodily harm;
Regulation Number: 900.905.9
Regulation Description: Physical restraints shall be performed using minimal force and time necessary. Physical
restraint means the application of physical force without the use of any device, for the purposes of restraining the
free movement of a resident's body. Briefly holding a child without undue force in order to calm or comfort, or
holding a hand to safely escort a child from one area to another, is not considered a physical restraint.
Finding Description: Staff was unprofessional, used an inappropriate hold and used a disciplinary action that
could result in physical injury and threat of bodily harm.
Action Due Date: 2025-03-01
Action Due Description: Staff was immediately suspended following altercation and terminated 3/4/25.
Comply Date:
Narrative:
3/11/25-Facility visited in response to licensing complaint that staff was in an altercation with resident. Nurse
who witnessed incident provided a witness statement which indicated that staff was unprofessional, used an
inappropriate hold and used a disciplinary action that could result in physical injury and threat of bodily harm.
Facility cited 109.1g, 905.4g and 905.9. This witness statement and staff termination papers sent to licensing.
Staff file reviewed. Staff involved in altercation hire date is 12/16/24. Handle With Care certificate of
completion 12/19/24 reviewed. Staff has no prior complaints or disciplinary actions in his file. Licensing
confirmed that all background checks were completed and approved.
Licensing complaint is founded.
***** Pursuant to A.C.A. § 9-24-406(e)(3-4): If you believe that the Department’s notice of
noncompliance is in error, you may ask for reconsideration. The request for reconsideration must be in
writing and delivered to the Department by certified mail within twenty (20) business days of receipt of
the notice of noncompliance. The request must specify the parts of the notice that are alleged to be in
error, explain why you believe those parts are in error, and include documentation to support the
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 3

allegation of error. Once received the Department shall issue a decision on your request within twenty
(20) days after receipt of the request.
Provider Comments:
CCL Staff Signature : Date: 3/11/2025
Provider Signature : Date: 3/11/2025
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 3 of 3


summary: Licensing visited the facility to conduct a buildings and grounds walkthrough.

raw_content:
ARKANSAS
DEPARTMENT OF

> HUMAN
=a! SERVICES

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

521 Visit Compliance Report

Licensee: The Centers for Youth and Families Monticello

Facility Number: 159

Licensee Address: 936 JORDAN DRIVE
MONTICELLO AR 71657

Licensing Specialist: Clayton DeBoer
Person In Charge:

Record Visit Date: 1/15/2025

Home Visit Date: 1/15/2025

Purpose of Visit: Subsequent Building and Grounds

Regulations Out of Compliance:

Regulation Number: 900.911.15.f

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

Finding Description: Boys' Hall Room 2 had a string the went along the entire inseam of a jacket.
Action Due Date: 2025-01-15

Action Due Description: Jacket immediately removed. Client will have the option of keeping jacket with string cut
out, or jacket being stored in locked area for personal belongings with string intact.

Comply Date:

Sub-Regulation Level 1 Description: Children’s personal items that contain cords, pull-ties, strings, or other
parts that could be used to inflict self-injury shall not be left in the child’s room unless the dangerous component
has been removed.

Action Due Description: Jacket immediately removed. Client will have the option of keeping jacket with string cut
out, or jacket being stored in locked area for personal belongings with string intact.

Regulations Needing Technical Assistance:

www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 3

Regulation Not Applicable:

Regulations Not Correctable:

Narrative:

Buildings & Grounds conducted. Census:16

Hallway staff/client escorts 1:1, 1:1.
Girls' Hall staff/client ratio 1:1
Classroom staff/client ratio 1:3
Classroom 2 staff/client ratio 3:10

All buildings clean, safe and in good repair. Bathrooms clean and sanitary with functioning sinks, showers
and toilets. Cafeteria clean and sanitary. Grounds clean and free of safety hazards. Client rights and
emergency diagrams posted. Fire extinguishers observed. Boys' Hall Room 2 had a jacket with a string that
went around the entire inseam of the jacket. Facility cited 911.15f. Jacket immediately removed. Client will
have the option of keeping the jacket with the string cut out, or leaving the string in and having jacket stored

in locked personal belongings.

MAR checked for:

Provider Comments:

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

Page 2 of 3

CCL Staff Signature :

F
|p 1)

iI l}/

Provider Signature :

www.arkansas.gov/dhs

Serving more than one million Arkansans each year

Date: 1/15/2025

Date: 1/15/2025

Page 3 of 3


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

raw_content:
ARKANSAS
DEPARTMENT OF

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

P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550

521 Visit Compliance Report

Licensee: The Centers for Youth and Families Monticello

Facility Number: 159

Licensee Address: 936 JORDAN DRIVE
MONTICELLO AR 71657

Licensing Specialist: Clayton DeBoer
Person In Charge: Bernetta Lowe
Record Visit Date: 11/19/2024

Home Visit Date: 11/19/2024

Purpose of Visit: Subsequent Building and Grounds

Regulations Out of Compliance:

Regulations Needing Technical Assistance:

Regulation Not Applicable:

Regulations Not Correctable:

Narrative:

Buildings & Grounds conducted from 10:00AM-11:00AM. Census: 23

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

Clients in hallways being escorted by staff during today's visit. Ratios: 1:1, 1:6, 1:2, 1:1 and 1:1

Buildings clean, safe and in good repair. Sleeping quarters clean and furnished. Bathrooms clean and sanitary.
Emergency diagrams, fire extinguishers observed, and client rights posted. Grounds clean and free of safety
hazards.

MAR checked electronically for:

MAR entries logged and up to date.

Provider Comments:

CCL Staff Signature : Date: 11/19/2024
/ \,
h\ >)
f) ly |
'| Ns
Provider Signature : Date: 11/19/2024
D 1)

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


summary: No deficiencies were cited during the Inspection of Care (IOC) conducted on 09/23/24.

raw_content:
available in the provider’s policy and procedures. AFMC staff explained that these findings were preliminary
and there was still an off-site portion to be completed.
Clinical Summary
As a part of the Quality-of-Care survey of the IOC, an active Fee for Service (FFS) Medicaid client list was
requested, client and/or guardian interviews were conducted, and a clinical record review was completed. The
following is a summary of findings and noted deficiencies.
Client/Guardian Interviews:
There was no active FFS Medicaid clients currently admitted at the time of IOC. Therefore, no client interviews
were conducted.
Program Activity/Service Milieu Observation:
Staff and clients were observed throughout the facility in the classroom setting on the school unit and moving
from the classroom setting to other activities in the education unit. Educational classes and therapeutic group
activities were noted to be in session. Clients were engaged in schoolwork and activities. In the cafeteria there
was one male client that had been separated from the rest of the clients due to an outburst of behavior. There
were two staff members present with the client, one who was standing back to give client space and one staff
member who was having a calm one-on-one conversation with client to help de-escalate the situation. Staff were
calmly interacting with clients and providing a therapeutic environment that was conducive for learning and
treatment therapies.
Medication Pass:
No active FFS Medicaid clients received medications during a medication pass while AFMC staff was onsite.
Due to the observation of non-Medicaid clients not being complaint with the HIPAA minimal necessary rule, no
medication pass was observed. AFMC RN visited with the facility medication nurse who was able to show
AFMC RN the facility policies and procedures regarding medication administration, count, reconciliation, and
handling of controlled substances, and medication discrepancies.
The facility nurse was able to verbalize the step-by-step process of medication delivery including the
demonstration of the five rights of medication administration, documentation of medication delivery,
verification of client taking medication including mouth/cheek checks, and how clients are educated about each
medication. The facility nurse also verbalized the process utilized when a client refuses medication. Tour of
medication room completed no discrepancies with medication storage, cleanliness of medication room, and
knowledge of medication dispensing found.
Clinical Record Review Deficiencies:
There was no active FFS Medicaid clients currently admitted at the time of IOC. Therefore, no clinical records
reviews were conducted.
Respectfully,
Inspection of Care Team
InspectionTeam@afmc.org
1020 W. 4TH ST., SUITE 300
LITTLE ROCK, AR 72201 • afmc.org
The Centers for Youth & Families – Monticello, AR – IOC Report 2 | P ag e

doc_type: IOC Report


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

raw_content:
ARKANSAS
DEPARTMENT OF

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

P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550

521 Visit Compliance Report

Licensee: The Centers for Youth and Families Monticello

Facility Number: 159

Licensee Address: 936 JORDAN DRIVE
MONTICELLO AR 71657

Licensing Specialist: Clayton DeBoer
Person In Charge: Karen Walker
Record Visit Date: 9/17/2024

Home Visit Date: 9/17/2024

Purpose of Visit: Subsequent Building and Grounds

Regulations Out of Compliance:

Regulations Needing Technical Assistance:

Regulation Not Applicable:

Regulations Not Correctable:

Narrative:

Buildings & Grounds conducted from 9:00AM -10:00AM. Census: 20

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

Classroom staff/client ratio: 2:7
Outside area staff/client ratio: 2:12

Grounds clean and free of safety hazards. Cafeteria clean and sanitary. Buildings furnished, clean, safe and in
good repair. A discussion was had about a few small areas on the walls with chipped paint that could become
a future issue. Walls are periodically touched up with paint. Overall paint job on walls in good repair.
Bathrooms clean and sanitary with functioning sinks, showers and toilets. Fire extinguisher, emergency

diagrams and client rights observed.

MAR checked for:

All electronically entered and up to date.

Provider Comments:

CCL Staff Signature :

Provider Signature :

i

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

Date: 9/17/2024

Date: 9/17/2024

Page 2 of 2