summary: A resident was transported to acute care after an incident in which he began beating on walls, slamming doors, cursing and threatening staff.

raw_content:
towel to cool down. Once out of restraint, client sat down on their bed and was calm. Client
was then looked over by nursing. Patient Debriefing date/time: 01/28/25 9:30pm: Client
claimed that he just wanted to draw and that staff "stole" his water bottle from him. Staff
reassured client that his water bottle wasn't stolen and was still allowed to get water when
needed. Staff members comforted client and explained to them that bed time is the same
time every night and that next time, client should opt for better coping skills. Staff also
reminded client that they could not make threats and put hands on others. Client talked to
guardians on the phone after incident as well. While on the phone, client seemed to have a
little bit of a hard time taking full accountability but did appear remorseful. Nursing
Assessment date/time: 01/28/25 9:00pm: Client required personal restraint due to physical
aggression towards staff. Client was released and began to process with staff. Client reports
left thumb is "broken". Client has limited ROM to left thumb due to pain, declined PRN
pain medications, declined ice. Left hand skin appears intact, brisk capillary refill noted.
Client is alert and oriented, gait is steady, vitals are stable. Client reports that he is still
angry at staff, encouraged client to forgive staff. Client was offered water and allowed to
speak with family on the phone. Client tearful afterwards, he was instructed to go to his
room and go to bed. He refused at first, but then went voluntarily. Client will need to be
reevaluated in the morning. Injury to staff or client: Client reports left thumb is "broken".
Follow-up to Injury: Client has limited ROM to left thumb due to pain, declined PRN pain
medications, declined ice. Left hand skin appears intact, brisk capillary refill noted.
Guardian was notified on 01/28/25 at 9:37pm. was transported by to
for an on 01/29/25 at 12:45am.
Interim Action Narrative: Resident placed in restraint for safety, assessed by the nurse, and
transported to .
Narrative:
Licensing Narrative: Facility provided documentation for this provider reported incident.
Licensing reviewed provider reported incident for licensing concerns. 1/30/2025, licensing
inquired about resident's reported injury. Facility reported: There was no follow up before
acute as nursing had planned to re-evaluate the injury the next day. However, he then went
to acute. We have not received word on his physical status.


state: AR

facility_name: Youth Home

summary: An officer was dispatched to the facility in reference to a battery. The victim’s mother stated that her daughter was the victim of an unprovoked assault on 1/19/25 and 1/25/25.

raw_content:
Pulaski County
Office of the Sheriff
Eric S. Higgins, Sheriff
2900 S. Woodrow Street, Little Rock, AR 72204
7 Tel: (501) 340-6600
Case P25-000796 Printed on February 20, 2025

Status Approved
Report Type Patrol
Primary Officer Justin Paradise
Investigator None
Records Technician
Reported At 01/27/25 13:39
Incident Date 01/27/25 13:39
Incident Code BATT : BATTERY
20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
2
Southwest

Disposition P- PENDING
Disposition Date/Time 01/27/25 14:03
Disposition Comments

bs#2495
Review for Gang Activity Not Applicable

Primary Narrative By Justin Paradise, 01/27/25 15:32
Battery

On 01/27/25 at approximately 1339 hours |, Deputy Paradise, was dispatched to 20400 Colonel Glenn Rd for Battery.

| made contact with ae. victims mother. BB states that her daughter 2: assaulted on
01/19/25 & on 01/25/25. tated that [was attacked on the 01/19/25 unprovoked by. —

tated that as attacked again unprovoked on 01/25/25 by mics taken by staff
on 01/25/25 to Arkansas Children's Hospital to treat her injuries.

HE stated she wanted to pursue charges for both incidents that had occurred. was provided with the
incident number and advised of the warrant process.

| was able to obtain video footage of both incidents along with the staff members report that was completed. All of the
items were submitted into property as evidence. While attempting to upload evidence into the property section item
001 and 002 failed to load properly resulting in the evidence to start with item 003.

The staff member that had completed the reports were not on scene to obtain statements as to what they had
observed.

CFS2025-05831

Case P25-000796 Page 1 of 1

doc_type: Police Report


summary: A resident was transported to the emergency room by MEMS after experiencing seizure-like episodes while in the gym.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 027091
Date of Incident: 1/26/2025
Date Received: 1/27/2025
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for Private
placement client in our PRTF program and resides in House Incident Report
date/time: 01/26/25 6:50pm Location of Incident: Gymnasium Incident Description:
Staff Involved: Tatiana Shelor, Gregory
Nesdahl, Brianna Alexander, Don Rose, Matthew Chrysler Events Leading: Client was
playing Basketball with staff and peers in the gym. Client appeared to be hot/ overheating
then as staff was talking to her about getting water her eyes twitched and she had a
controlled fall to the floor because staff and peers caught her as she was falling. Nursing
Assessment 1 date/time: 01/26/25 6:55pm: Patient presents in gym on floor laying on back
with staff member and peers present. This nurse arrived and repositioned patient to her side
in case of aspiration occurs. Patient presents with reoccurring with
and displayed. Patient non-responsive to verbal stimuli and painful
stimuli. Patient vitals obtained at 7:14pm and unremarkable BP118/83, Pulse 115,
Respiration 17/minute. Multiple vitals obtained and unremarkable and pulse ox always
above 97% on room air. Vitals at 7:27pm blood pressure125/98, pulse 113/minute. Called on-
call provider and reported incident at 7:07pm and orders received to monitor patient and
provide supportive and comfort and monitor vital signs. Patient at time of initial occurrence
reported to be overheated and perspiration was noted. Staff provided supportive comfort and
care and attempted to fan patient and cool patient with cool compresses. Practitioner
updated frequently on patient status and practitioner advised to continue monitoring and
provide supportive care. Nursing Assessment 2 date/time: 01/26/25 7:35pm:
.
Patient is not responding to painful or verbal stimuli. Patient presented with
. Patient vitals at 7:45pm were
pressure 109/81, and pulse 108, pulse ox 97% at all times, respiration 16/minute and even
and unlabored. Dr. Shy updated frequently on patient condition and advised to provide
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

supportive comfort care and monitor vital signs. Nursing Assessment 3 date/time: 01/26/25
8:30pm: pt currently laying on the floor on her R side, appears calm with no rigidity or
movements. pupils reactive to light. airway clear as witnessed by even/unlabored
respirations. pt not alert and not arousing to verbal/tactile/painful stimuli. GCS 3. VS
132/82, HR 99, RR 16, Spo2 97% on RA. Nurse Don and Matt given report on pt condition
and on current MD instructions to provide safe and supportive care to the pt and monitor
condition and VS. Nursing Assessment 4 date/time: 01/26/25 8:37pm: Arrived to the gym to
assess the patient who was laying on her right side unresponsive. Blood pressure was
132/82, pulse 99 and pulse ox of 98%. Shortly after arriving, patient began to have at least 3
uncontrolled seizures lasting 10-15 seconds. MD order obtained to transport patient to
via . Last blood pressure before arrived was 119/83, pulse 105 and pulse
OX of 98% Respirations even and unlabored when patient not having . arrived
to the scene at approximately 2115. Patient continued to once placed on the gurney.
Nursing Assessment 5 date/time: 01/26/25 9:44pm: THIS IS NOT A FACE TO FACE:
was called 2046 for transport to While on the phone she had
about . Pt left with around 2138. Nursing Assessment 6
date/time: 01/27/25 1:50am: THIS IS NOT A FACE TO FACE: Pt returned back from
around 0150. On call provider notified. Order received to give pt her and
. As well as hold her , due to her receiving this in her am
medications within the next couple hours and . She can go
to school after lunch due to getting back from the so late. Pt was in her bed on left side,
eyes close, responded to verbal stimuli. she had even gait, no slurring of words, even tone
and non-pressure speech. She verbalized understanding. Nursing Assessment 7 date/time:
01/27/25 2:10am: Patient assessed after returning from . Blood pressure 98/69, pulse
72. Patient appears alert and oriented and pleasant. Moves all extremities. Patient states that
she does not remember the events of the prior evening. Guardian notified on 01/26/25 at
8:51pm.
Interim Action Narrative: Resident was assessed by the nurse and evaluated at .
Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Facility provided licensing with documentation for this provider reported incident.
Licensing inquired if resident was placed on any safety precautions. Documentation
reviewed and uploaded. 1/28/2025, facility reported upon resident's return from the she

was allowed to sleep in. Once she woke up, no additional issues were noticed and resident
reported feeling great.

doc_type: Notice of Incident


summary: A resident was struck in the head several times by a peer. Due to the amount of bleeding and dizziness reported after the incident, the resident was transported to the emergency room for evaluation.

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: 026965
Date of Incident: 1/19/2025
Date Received: 1/21/2025
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Client: Private Placement PRTF Client in
House Incident Date and Time: 1/19/25 6:40 PM Staff involved: Kelton Johnson
(Reporting and observed), Charles Murphy (observed), Tatiana Shelor (nurse), Don Rose
(nurse) Events Leading: Client was laying down in the rec room watching tv minding her
business, Another client came in and attacked her. I grabbed the other client from attacking
her. Client did not fight back she tried to protect herself. No restrictive interventions used
with this client. Nursing face-to-face assessment: 1/19/25 @ 6:44 PM: Upon this RNs
arrival, pt found in the rec room laying on the floor, alert and able to follow directions. Pt
instructed to sit up and assisted to sit against the wall. Pt noted with dry blood on her face
that appeared to have come from the nostril. Pt nose has mild hemorrhage and pt was
holding pressure with paper towel. Pt a/o x4 and able to answer questions with no difficulty.
Coherent speech. Reports that was hit on the head several times with a fist and that peer hit
her head against the floor. Pt reports that she remembers feeling hazy during the attack.
Unsure if had complete LOC. c/o feeling dizzy, HA 10/10 and pain to L eye with decreased
vision to L eye. also reports aching all over. NO bumps noted to pt head on palpation, scalp
skin intact. Pt neuro checks WNL. PERRLA. VS 129/88, HR 91, RR 16, temp 96.9, SPO2
98% on RA. Resp even/unlabored. no s/sx of acute physical distress. calm/cooperative. Pt
R UA noted with redness throughout the R UA, pt reported that peer grabbed her on it. No
broken skin. Full ROM noted to all extremities/joints during the assessment. No
deformities observed. Dr McClellan notified of the assessment and ordered for staff to take
pt to for evaluation. UM on call notified of the order at 6:55 pm. Follow-up
Nursing post visit: 1/19/25 @ 11:35 PM: Patient returned from with staff. Patient
examined: Pupils are equal and both reactive to light. Grip strength good bilaterally. Moves
all extremities. No complaints of dizziness. Appears alert and oriented. Patient last
medicated for pain in the at 9:47pm with All vitals within normal limits. 111/77,
pulse 79, SATS 98% on room air. Respirations 18. Denies pain presently. Guardian
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

notification of incident 1/19/25 7:01 PM Guardian notification upon return from 1/19/25
11:45 PM
Interim Action Narrative: Staff intervened, resident was assessed by the nurse, and resident
was evaluated at the Peer was placed on freeze.
Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Facility provided documentation for this incident with the discharge summary to follow.
1/24/2025, licensing inquried about discharge summary and if peer was placed on any
restrictions. discharge summary reviewed and uploaded. 1/27/2025, licensing inquired
about restrictions for peer involved. Per facility, the resident was placed on freeze after the
incident. Facility reported that the resident's guardians will be pressing charges against the
peer.


summary: A resident tried to strangle herself with her pajamas and was placed into a restraint. Once released, the resident continued self-harming behaviors and was restrained again.

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: 026838
Date of Incident: 1/14/2025
Date Received: 1/15/2025
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for Private placement
client in our PRTF program and resides in House Incident Report date/time:
01/14/25 6:51pm Location of Incident: House Incident Description: Suicidal, Threat
to Safety Staff Involved: Kelton Johnson, Joseph Davis, Lauryn Gilmore, Montez Peterson,
Zharieah Foreman, Meredith Reddin, Dejuan Williams Events Leading: Client was upset
after getting news of not moving in treatment phase in her weekly staffing feedback. Client
was trying to strangle herself with her pajamas. Client was asked to remove her pajamas
from her neck, or staff will have to remove the pajamas from her neck to keep her safe.
6:51pm-Personal Restraint: Client had to be restrained in her room. Client had clothing tied
around her neck. Client did not want staff to take clothing wrapped around her neck. Staff
have to remove the clothing from her neck. 6:55pm-Personal Restraint: Client had to be
walked into the hallway because she was being unsafe. Client would not be compliant.
Client was refusing to stop trying to self-harm herself. Client had to be restrained until she
complied. 7:00pm-Personal Restraint End: Client finally complied with staff and stop
fighting staff. Client started doing breathing exercises. Client started to process with staff
about the situation 7:05pm-Personal Restraint: Client started to self-harming again. Client
started to scratch herself real hard. Client had to be restrained in the hallway until she
contracted to safety. Client started to bag her head on the wall. Staff had to keep her head
up to keep her from banging her head. 7:08pm-Personal Restraint End: Client finally shown
that she could contract to safety. Client agreed to come up to the FOH. She called her mom,
and told her that she was not practicing safe behaviors. Patient Debriefing was completed
on 01/14/25 at 7:10pm Injuries to staff or client: Pt denies pain/injury. Redness present to
anterior neck, no bruising at this time. Skin intact. Follow-up to injury: Nursing monitored
for changes. Nursing Assessment date/time: 01/14/25 7:30pm: This nurse responded to all-
call. Per staff, pt had attempted to wrap an article of clothing around neck in order to
strangle self. Upon arrival, pt is sitting on bed attempting to get hands around neck to
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

strangle self. Pt placed in PR and escorted from room d/t unsafe bx. Pt released from PR
and attempted to scratch self. Placed in PR d/t attempt to scratch self. Pt released from PR,
then began to attempt to strangle self again. Pt in PR for under thirty minutes. Offered
water, bathroom breaks. After calming, showing cooperative bx, and agreeing not to harm
self, pt released from PR. Upon nurses assessment, pt is alert and oriented to self/situation.
Pt states that she is upset that she 'is not on working' when she has been here for 'several
months'. Pt ref to contract to safety at this time, states 'I want to harm myself, by
scratching. I want to kill myself by strangling and I may try to, I don't know'. Pt's vitals are
as follows: BP 137/86, HR 111, RR 19, temp 97.9. Eyes PERRLA. Skin even, expected color
for ethnicity. Full ROM noted in all extremities. Gait steady. Pt denies pain/injury. Redness
present to anterior neck, no bruising at this time. Skin intact. Scars present to bilat arms.
Redness/irritation noted to existing scars. No new SH marks noted. No bruising at this
time. Skin intact. Pinpoint petechiae noted to upper R forearm. Petechiae present in two
horizontal lines with some spots following veins down arm, appear red/purple. Therapist on
call notified. Provider notified. Pt talked w/ on call therapist for several minutes. After
conversation, pt able to find goal and contract for safety. States that she would talk to staff
present or call for nurse if she beings to feel urge to SH or if she notices any SI. Pt placed on
eyeball/FOH/SS. No further findings. No further needs at this time. Guardian was notified
on 01/14/25 at 8:00pm and 8:30pm.
Interim Action Narrative: Resident was placed in restraints for safety. Resident was
assessed by the nurse. Resident was placed on eyeball/FOH/SS.
Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Facility provided documentation for this provider reported incident on 1/15/2025 via email.
Documenation uploaded on 1/16/2025.


summary: A resident was involved in an altercation with a peer during snow day outside activities. The resident complained of dizziness and nausea after the incident and was transported to the emergency room for evaluation.

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: 026817
Date of Incident: 1/13/2025
Date Received: 1/14/2025
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for Private
placement client in our PRTF program and resides in House Incident Report
date/time: 01/13/25 11:16am Location of Incident: Outdoors on Youth Home campus
Incident Description: Aggressive to Peers, Threat to Safety,
), Patient Injury Staff Involved: Terrence McDaniel, Robert Page, Marilyn
Howell, Shelly Zellner Events Leading: Sturgis house had a snow day outside consisting of
snowman building, snow dye, and snowball fight. A peer decided to pick up a big piece of
ice and threw it at client striking him in the head. Client became enraged and began
charging any peer he could. Staff intervened by holding him back. 11:15am-Personal
Restraint: Staff intervened by holding him back, personal restraint begins. Patient
responded well to verbal commands provided by staff. 11:16am-Personal Restraint End: Due
to pt ceasing in charging, personal restraint ended at this time. Client went down to the
ground holding his head. 11:17am-Personal Restraint: A client then said quit crying like a
bitch, which set client off again and he did attack client and started hitting him. Client was
restrained for a second time until he was able to calm down. Client responded well to staff
verbal support. 11:18am-Personal Restraint End: The restraint ended at this time and the
patient walked to the Recreation office with staff. He was calm and able to process with
staff in the office. Patient Debriefing date/time: 01/13/25 11:30am: Client was able to walk
to the Recreation office with staff. While calming down in the office, he talked about the
incident and what made him so angry with his peers. He calmed himself down quickly and
was able to process about his part in the incident. Client was able to verbalize his
understanding of how his actions made the situation unsafe for himself and peers. We
discussed that he would be placed on Freeze PA due to charging a peer and hitting a staff
member. He understood this precaution and was able to take responsibility for his actions.
Client left the office calm and was able to go the nursing station without a problem. Client
was transported to be a Team Member to be evaluated to rule out a concussion.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Client returned from at 10:25pm. Nursing Assessment date/time: 01/13/25
11:30am: Received client sitting calmly in rec. director's office after being restrained. Pt.
states that he was hit on the left side of his head with a "20lb ball of ice". Pt. states that he
was placed in a restraint twice for beating up a peer for stating "gone ahead and cry like a
little bitch" after he was hit in head in ball of ice. Pt. is AAOx4, PERRLA, speech clear. Pt.
denies any nausea, vomiting, numbness or tingling at this time. Left side of head is tender
to touch but pt denies pain in this area; no injury or deformities noted. Left ear is red,
painful to touch, and has bleeding noted behind it from scratches, area cleaned & tribiotic
ointment applied. Right grip is weaker than left grip, states that this is not new, it is from
his previous shoulder injury. Left knee & shin area is red, blanches to touch, denies pain but
states it is sensitive. Has brace noted to right knee. Abnormal gait noted when ambulating,
pt. states that he from his right knee injury. VS: 97.2, 95% on RA, 146/89, 101, 22. No acute
distress noted, no other signs of injury noted. Pt. was able to ambulate back to house with
this nurse without any issues. Guardian was notified on 01/13/25 at 1:05pm: Mother states
that she was informed about the fight & restraint by the client & therapist about 30mins
prior to me calling during a session. At this time, I also informed her that we were sending
out to the to get evaluated for possible concussion due to current c/o dizziness,
nausea, & headaches since he has a past history of concussions. Mother thanked me for the
update.
Interim Action Narrative: Resident was placed in a restraint, assessed by the nurse, and
transported to the for an evaluation.
Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Facility provided documentation for this incident. 1/17/2025, documentation was reviewed
and uploaded.


summary: A resident attempted to forcefully open the door from the administration building to flee the facility. The resident was placed into a restraint to prevent an elopement.

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: 026806
Date of Incident: 1/13/2025
Date Received: 1/14/2025
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for Private
placement client in our PRTF program and resides in House Incident Report
date/time: 01/13/25 11:47am Location: CBS Building Incident Description: Threat to
Safety, Property Destruction Staff Involved: Caitlin Henthorne, Robert Page, Clytrell Daniel,
Shelly Zellner, Melissa Rhude, Kara Brooks Events Leading: Pt continues to have peer
conflict with others, especially a particular peer. However, pt continues to place himself
close to the peer in line. Staff attempted to remind pt of his proximity to others that irritate
him and pt began to argue. When redirected, pt became angry and began forcefully trying to
open the door leading from the administration building to the outside in an attempt to flee.
11:47am-personal restraint: Pt began to struggle while in restraint and kicked the door. The
door broke causing glass to hit pt. Pt remained in restraint at this time to prevent elopement
and further injury due to the broken glass. Staff offered verbal support. 11:50am-personal
restraint end: Pt was verbally deescalated quickly and became compliant. Pt was able to be
released from hold. He was then taken to the nurse. Patient Debriefing date/time: 01/13/25
11:55am: Pt was taken to the nursing station in the administration building following
interventions. Pt expressed frustrations about his peers and stated he was trying to leave the
facility. Pt was placed on run risk and will remain on close observation as well.
Interim Action Narrative: Resident placed in a restraint for safety, placed on run risk, and
close observation.
Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing informed of provider reported incident via email along with
pictures of damage & repair. 1/14/2025, licensing reviewed provider reported incident for
licensing concerns and uploaded pictures and documentation. Door was repaired on the
same day, 1/13/2025.


summary: Officers were dispatched to the facility in response to a report that a resident was assaulting staff members.

raw_content:
Pulaski County

Office of the Sheriff
x Eric S. Higgins, Sheriff
ve \ 2900 S. Woodrow Street, Little Rock, AR 72204
" Tel: (501) 340-6600
Case P25-000283 - UNAPPROVED DRAFT Printed on January 17, 2025

Status Active
Report Type Patrol
Primary Officer Tierra Coffey
Investigator None
Records Technician
Reported At 01/10/25 12:51
Incident Date 01/10/25 12:51
Incident Code ASST : ASSAULT
20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
2
Southwest

Disposition P- PENDING
Disposition Date/Time 01/10/25 16:53
Disposition Comments

BC 4311
Review for Gang Activity Not Applicable

Asst Officers
1X72 - Wharton, Matthew

Primary Narrative By Tierra Coffey, 01/10/25 16:45

Assault

On January 10, 2025, at approximately 12:51 p.m., Deputy Wharton and | responded to Youth Home, Inc. 20400
Colonel Glenn Road, Little Rock in reference to an Assault.

Staff member, Kennedy Goldman, reported she was bit in the right shoulder by while trying to
restrain Ms.Goldman said was out of .... assigned area. Ms.Goldman said she and other staff members
advised to go back to area but did not. sat on the floor and began to kick, scream,
and punch _._.__.. in the legs. Ms. Goldman said she and the staff gave multiple opportunities to get off the
floor so that _... could be escorted to the seclusion room. However. was still refusing. Ms. Goldman said
that she and another staff member grabbed by the arms and escorted to the seclusion room. Ms.
Goldman did not have any visible injury. Ms. Goldman said she was provided medical attention by the Youth Home's
nurse and that she was fine.

Ms. Goldman advised she wanted to pursue charges against 7 _ was cited and released with the
charge, Assault 3rd 5-13-207 C/M and court date for February 5, 2025 at 10:00 a.m at Pulaski County Juvenile Court. |
took photos of Ms. Goldman's right shoulder and they are attached to the report. . said had a bruise on
the inside of _ right arm from when was being restrained. said "ie of
and they are attached to the report. | made contact with by phone and
informed her of the incident. EEE advised she understood. The Youth Home advised they will be contacting
as well.

Pulaski County Juvenile Intake was contacted.

CFS2025-02200

Case P25-000283 Page 1 of 1


summary: A resident was transported for acute placement due to self-harm, aggressive behavior, and property destruction.

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: 026731
Date of Incident: 1/8/2025
Date Received: 1/9/2025
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: from 01/07/25. is a
client from in our PRTF program and resides in House.
was transported to on 01/07/25 and then transported to at
6:25am 01/08/25 for an . will not be returning to Youth Home and was
discharged from our PRTF program on 01/08/25.
Interim Action Narrative: Resident was transported to acute placement.
Narrative:
Licensing Narrative: Licensing informed of provider reported incident via email. Facility
provided licensing with documentation for this provider reported incident. Per facility,
resident was involved in 3 different incidents on 1/7/2025. Facility reported that resident
will not be returning to the facility. 1/10/2025, facility reported being unable to submit the
provider reported incident into ELS due to receiveing error messages after 3 attempts.
Program Coordinator entered provider reported incident and uploaded provided
documentation. Licensing requested for camera footage to be saved to be reviewed.
1/15/2025, Program Coordinator visited the facility and reviewed camera footage. Program
Coordinator observed all three incidents.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Officers were dispatched to the facility in response to a resident making suicidal ideations and trying to harm herself.

raw_content:
Case P25-000225 Printed on January 17, 2025
Status Approved
Report Type Patrol
Primary Officer Karen Escamilla
Investigator None
Records Technician
Reported At 01/07/25 20:03
Incident Date 01/07/25 20:03
Incident Code DIST : DISTURBANCE
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
Zone 2
Beat Southwest
Disposition P- PENDING
Disposition Date/Time 01/07/25 20:04
Review for Gang Activity None
Asst Officers
2X71 - Bass, Steven
Case Comments
CFS2025-01574
Primary Narrative By Karen Escamilla, 01/07/25 21:15
CFS2025-01574 - Disturbance
CFS2025-01574

On January 7, 2025 at approximately 2003 hours, Deputy Bass and I were dispatched to 20400 Colonel Glenn Rd in
reference to a disturbance.

We made contact with Merideth Reddin, the charge nurse, who advised that was making suicidal
idealizations and trying to harm herself. Merideth also advised that earlier during the day, was in altercations
with a few of the staff members. The staff members involved in the altercations from earlier today were no longer on
scene and had left for the day.

We made contact with who advised us that she has been making suicidal idealizations and trying to harm
herself. She advised that she put her braids around her throat and she was trying to cut herself with staples. Merideth
stated that was also swallowing the staples.

Mems unit 624 arrived on scene and transported to Children's Hospital.

Merideth was advised that if the other staff members wanted to report the physical altercation that happened earlier
during the day to call the sheriff’s office.
Case P25-000225 Page 1 of 1


summary: Officers were dispatched to the facility to assist Emergency Medical Services.

raw_content:
Case P25-000191 Printed on January 17, 2025
Status Approved
Report Type Patrol
Primary Officer Karen Escamilla
Investigator None
Records Technician
Reported At 01/06/25 20:09
Incident Date 01/06/25 20:09
Incident Code ASTA : ASSIST AMBULANCE
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
Zone 2
Beat Southwest
Disposition P- PENDING
Disposition Date/Time 01/06/25 20:51
Review for Gang Activity None
Asst Officers
2X71 - Bass, Steven; 2X72 - Knobloch, Matthew
Case Comments
CFS2025-01363
Primary Narrative By Karen Escamilla, 01/06/25 21:16
CFS2025-01363 - Assist Ambulance
CFS2025-01363

On January 6, 2025 at approximately 2009 hours, Deputy Bass and I were dispatched to 20400 Colonel Glenn Rd
(Youth Home) in reference to an assist ambulance incident.

We made contact with Ebony Galmore and she advised that was making suicidal threats and
broke the plastic off of the light fixture in his room. already had his personal items with him and was sitting
with another staff member.

MEMS unit 720 arrived on scene and transported to Pinnacle Point.
Case P25-000191 Page 1 of 1


summary: A resident was transported for acute placement after an incident where he began self-harming and slamming and hitting objects in his room.

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: 026715
Date of Incident: 1/6/2025
Date Received: 1/10/2025
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for Private
placement client in our PRTF program and resides in Incident Report
date/time: 01/06/25 3:09pm Location of Incident: Incident Description:
Aggressive to Adults Staff Involved: Dejuan Williams, Ben Malone, Anthony White,
Jonathan Pulliam, Valerie Alvarez Events Leading: Client became upset due to remaining
on run risk although he was taken off house restriction. Client stated that his mother was
bringing him new shoes and he would not be able to wear them on run risk. Client became
more upset due to his peers coming in from school being loud. Client went in his room
slamming and hitting objects, so the staff opened his door, and he slammed it hitting staff
with the door. 3:09pm-Personal Restraint: Client was placed into a restraint and was
escorted to the seclusion area. Client is yelling and cursing at staff as staff continue trying to
talk to him. 3:15pm-Personal Restraint End: Client begins to struggle and attempts to kick
staff. Client continues to yell, curse and threaten staff as they continue trying to talk with
him and ask him what he needs. Client begins to stop struggling and is able to be released
from the personal restraint. 3:16pm-Unlocked Seclusion: Client is in unlocked seclusion
where staff begin talking with him about what happened and how they much rather talk
with him like this. Client stated that no facility can hold him. Client remains calm while
talking with staff. Client is offered bathroom and water which he declines. 3:20pm-Unlocked
Seclusion End: After contacting for safety, the client was able to be released from the
personal restraint. Client was able to return to his area. 3:50pm-Other/None: After the client
was de-escalated and walked out of the seclusion room, approx. 20 mins later, the client
started to self-harm. He was redirected several times about this matter, which he eventually
stopped, and was seen by the nurse after several minutes of asking. Patient Debriefing
date/time: 01/06/25 3:45pm: Staff and talked about why he became upset and trying to
use better coping skills like asking staff to talk with him. Nursing Assessment 1 date/time:
01/06/25 3:21pm: was observed processing with team members. He appeared
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

annoyed with information team members relayed as he stood with stooped posture and
rolling his eyes. He became giddy and laughing when his posture and eye rolls were
addressed. Calm and cooperative during this time. He admits he became angry and began
throwing things in his room when he learned he is still on run risk. He also admits he
became overstimulated when the boys returned to chestnut house and admits to slamming
the door on a team member. AAOx4. No signs of respiratory distress. No apparent physical
markings, erythema, bruising, abrasions, scratches, or edema. He appeared avoidant and
rushed past this nurse in attempt to return to his room. When asked to assess his arms, he
would flash them quickly then walk off. Skin intact. Good circulation. Hygiene appears to
be lacking today as his shirt appears soiled and some sort of debris/residue that could be
rubbed off easily noted to his arm. Active ROM to all extremities. Gait is steady. Denies any
pain, soreness, or injuries from intervention. Gait is steady. He denies he nor staff could
have intervened differently in order to prevent the intervention. This nurse explored coping
skills with . With assistance, he was able to identify listening to music, pacing, and
the comfort room when upset, irritated, and/or overwhelmed. This nurse then explained
how one transitions from house restriction, run risk, to no safety precautions in which he
appeared receptive. He then began laughing and explained he just realized this nurse is
shorten in height than him. Pt placed on freeze for physical aggression. Nursing
Assessment 2 date/time: 01/06/25 8:51pm: At 7:52 PM, the nurse received an order from the
on-call provider for the patient to be admitted to an . Consent for the
admission was obtained from the patient's parent at 8:05 PM. Police arrived at 8:20 PM,
followed by at 8:41 PM. The patient was compliant with both police and
workers. He had his belongings with him and was in no physical distress upon departure.
The patient left the facility at 8:51 PM via for acute placement Guardian was notified
on 01/06/25 at 4:35pm with the following notes: Guardian voiced that while on the phone
with last night, he was upset and voiced that he did not want to be at YH. She
voiced that he was making threats to harm hurt himself and explained he doesn't
understand why they (his parents) can't bring him home and give him chance. He
reportedly explained to them (his parents) on the phone last night that he has learned his
lesson and ready to return home. Guardian, "he is obviously still making demands" and is
hopeful he will begin working on this treatment. APRN notified of guardian's concern and
threats on their call last night. Order for Eyeball and front of house safety
precaution received. This nurse then learned was at chestnut house after breaking
the plastic off the light cover and threatened to stab team members. This nurse found
packing his items to move rooms. APRN gave order to administer to
prevent further incident. stated, "I'm not taking shit. I'm not even going to take my
meds". Guardian was also contacted at 8:05pm on 01/06/25 with the following notes: At
7:52 PM, the nurse received an order from the on-call provider for the patient to be admitted
to an . Consent for the admission was obtained from the patient's parent at
8:05 PM. Police arrived at 8:20 PM, followed by at 8:41 PM. The patient departed the
facility at 8:51 PM via for .

Interim Action Narrative: Resident was placed in a restraint/seclusion for safety, assessed
by the nurse, and ordered for .
Narrative:
Licensing Narrative: Licensing informed of provider reported incident and documentation
provided. 1/10/2024, licensing reviewed provider reported incident for licensing concerns.
Provided documentation uploaded. Licensing inquired if resident would return to the
facility after . Resident will return to the facility after .


summary: A resident reported that a peer “grabbed her butt” and that she was uncomfortable.

raw_content:
Licensing Narrative: Program Coordinator reviewed complaint for licensing concerns.
Program Coordinator will request permission to contact the facility and inquire about a
safety plan. Facility reported, residents have been placed on a peer limit. They are not
allowed within 6 feet of one another and also cannot communicate with one another.
12/26/2024, followed up with for permission to contact the facility. 1/3/2025, per
. 1/24/2025, licensing checked .
1/31/2024, Program Coordinator checked . Incident report
provided by the facility reviewed. This has been unfounded by licensing. Case completed.


summary: Licensing visited the facility to perform a staff background documentation check. No deficiencies cited.

raw_content:
521 Visit Compliance Report

Licensee: Youth Home, Inc.

Facility Number: 128

Licensee Address: 20400 COLONEL GLENN ROAD
LITTLE ROCK AR 72210

Licensing Specialist: Kendra Slade
Person In Charge: Adria Riley
Record Visit Date: 12/10/2024
Home Visit Date: 12/10/2024

Purpose of Visit: Staff Record Review Visit

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

Regulations Not Correctable:

Narrative:

Time of Visit: 11:15 am to 12:30 pm

www. arkansas. govidhs : nee : =
Serving more than one million Arkansans each ven :

A RK AHSBA SE
x }7 HUMAN
SERVICES
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550

~Page.1-of 2

Census: 37

Program Coordinator Slade checked the background documentation for staff members at Youth Home. Ms.
Diana Simon provided evidence of background and maltreatment (adult and child).

Program Coordinator reviewed background documentation for the following positions: Nursing Staff,
Recreation Specialist, Therapist, Interventions Manager, Clinical Residential Services Manager, Unit
Manager, and Recreation Director.

All 39 staff members’ files reviewed had documentation (background and maltreatment) indicating approved
and no maltreatment found.

Provider Comments:

CCL Staff Signature : Date: 12/10/2024

Provider Signature : Date: 12/10/2024

Abbe. Sangoma

www.arkansas.govidhs

Serving more than one million Arkansans each year i = —em es Page 2 of 2

doc_type: Compliance Report


summary: A resident was transported to Arkansas Children’s Hospital emergency room due to elevated blood pressure.

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: 026014
Date of Incident: 12/8/2024
Date Received: 12/10/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
placement client in our PRTF program and resides in Rose House Incident Report
date/time: 12/08/24 6:43am Location of Incident: Rose House Incident Description:
Medical Emergency(Trip to ER/Urgent Care) Staff Involved: Tryneese Settles, Gregory
Nesdahl Events Leading: Presenting at nurse station for vital sign recording. Patient
anxious and cooperative. Annoyed by having to do twice daily vital sign checks. Per
collaborative with off going nurse vital sign blood pressure obtained and two consecutive
elevated blood pressures obtained being 156/110 and 158/101. Practitioner notified and order
received to be transported to ACH ER for evaluation for hypertension. Nursing Assessment
1 date/time: 12/08/24 7:23am: Patient needing medical evaluation due to elevated blood
pressure by overnight shift nurse and orders received for transport to ACH ER for
evaluation. Patient upset about missing peer outing but understanding of need to evaluate
for safety. Patient alert and oriented to person place time and event. Nursing Assessments 2
date/time: 12/08/24 1:35pm: Patient recent return from ACH ER. Patient calm and
cooperative and stable condition. Practitioner notified of patient return. ACH provider
recommendations are for patient to get scheduled appointment with PCP for follow-up. Per
collaborative with patient mother she is having an appointment set up for 12/18/24.
Guardian notified on 12/08/24 at 8:15am. Incident Report and ER paperwork was emailed
to Kendra Slade on 12/09/24.
Interim Action Narrative: Resident was assessed by the nurse and evaluated at ACH for
recommendations.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Maltreatment Narrative:
Licensing Narrative: Licensing informed of provider reported incident via email and
provided documentation for this incident. 12/10/2024, Licensing reviewed provider reported
incident for licensing concerns.


raw_content:
S ARM ANSA S
DEPARTMENT OF

AR) \ 7 HUMAN
“at SERVICES
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot $140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550

521 Visit Compliance Report

Licensee: Youth Home, Inc.

Facility Number: 128

Licensee Address: 20400 COLONEL GLENN ROAD
LITTLE ROCK AR 72210

Licensing Specialist: Kendra Slade
Person In Charge: Adria Riley
Record Visit Date: 11/26/2024
Home Visit Date: 11/26/2024

Purpose of Visit: Special Visit

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

Regulations Not Correctable:

Narrative:

Time of Visit: 9:15 am to 10:30 am

www.arkansas.gov/dhs

Serving more than one million Arkansans each year Page 1 of 2

Census: 32.

Program Coordinator Slade checked the background documentation for staff members at Cartwright and
Crestview houses. Ms. Diana Simon provided evidence of background and maltreatment (adult and child).

All 34 staff members’ files had documentation (background and maltreatment) that indicated approved and no
maltreatment found.

Provider Comments:
CCL Staff Signature Date: 11/26/2024

Provider Signature :

Date: 11/26/2024

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 assessment due to left leg pain after falling off a picnic table.

raw_content:
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns. Facility provided documentation for this incident. Resident will follow
up with ortho in a week.


summary: Licensing completed an after hour visit from 5:15 – 6:15pm for the PRTFs at Youth Home. All houses were in ratio and no issues were noted by Licensing.

raw_content:
521 Visit Compliance Report

Licensee: Youth Home, Inc.

Facility Number: 128

Licensee Address: 20400 COLONEL GLENN ROAD
LITTLE ROCK AR 72210

Licensing Specialist: Kendra Slade
Person In Charge: Adria Riley
Record Visit Date: 10/29/2024
Home Visit Date: 10/29/2024

Purpose of Visit: Monitor Visit

Regulations Out of Compliance:

Regulations Needing Technical Assistance:

Regulation Not Applicable:
Regulations Not Correctable:

Narrative:

Time of Visit: 5:15 pm to 6:15 pm

www.arkansas.govidhs og
Serving more than one million Aikansans each. year EES

BS ARK ANS A S
ea OKPARTMENT OF

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

Page.10f 2

Census: 33

Program Coordinator completed an after hour visit for the PRTFs at Youth Home. The following was
observed:

Chestnut House — Ratio 1:1 — Halloween decoration was observed outside the house walking to the door. Per
staff the other residents were outside on the courtyard with staff for recreational time. The one resident at the
house was working on restorative work.

Sturgis House — Ratio 1:4 — Two (2) residents were sitting in the dayroom/common area watching television.
One (1) resident was in his bedroom eating dinner by choice. Another resident was in his bedroom by choice.
Staff reported that he was going to inform the resident to come eat dinner. The dinner menu consisted of
chicken, rice, smothered potatoes, and a biscuit. The other residents were with staff on the courtyard for

recreational time.

Napier House — Ratio 1:1 — The resident was observed sitting in the dayroom/common area searching for
something to watch on television. When asked what she likes to watch, the resident stated cat videos.

Rose House — Ratio 3:6. Halloween decoration was observed on the door. The residents were completing
hygiene, and some were on pause. Per staff, three (3) residents were gone on an outing.

Mabee House — Ratio 4:9 — The residents were doing arts and crafts with Mr. T. They were working on a fall
project. One (1) resident was in the nurse’s office.

All houses were in ratio.

Provider Comments:

CCL Staff Signature : Date: 10/30/2024
Provider Signature : Date: 10/30/2024

wwwarkansas.govidhs

Serving more than one million Arkansans each year ee Oe “Page 2 of 2


summary: A resident was transported for acute care after not following staff directions and exhibiting self-harming behaviors.

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: 025028
Date of Incident: 10/28/2024
Date Received: 10/29/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Reports for
client in our PRTF program and resides in Rose House Incident Report 1
date/time: 10/28/24 5:54pm Location of Incident: Rose House Incident Description: Self
Injury (Not Suicidal), Aggressive to Adults, Threat to Safety Staff Involved: Brittney
Hubbard, Brayjana Pettigrew, Joseph Davis, Ashley Sims, Tyreesha McCollum, Zharieah
Foreman, Matthew Chrysler Events Leading: Client was escalated since the beginning of
the shift and non compliant and not following staff directions. Client earlier in the day was
jumping on furniture, not staying in her area, grabbing things that did not belong to her,
scratching her cuts and making them bleed, banging on tables and chairs and putting
objects over her face and head. Client reported she was hungry and this is why she was
acting out. Client then continued to escalate and began walking around the room and not
following directions. Client continued to scratch her scabs and cuts. Client would not
comply and continued to do unsafe behaviors and would not accept redirection. Client
began tearing things off the wall. 5:55pm-Personal Restraint: Client was placed in a sitting
personal restraint by staff due to increasingly escalated behaviors and unstable,
unpredictable and unsafe behaviors when beginning to pull things off the wall after her
continually being a threat to safety. Client began sliding herself into the floor so staff
followed and continued with a floor restraint. 6:00pm-Personal Restraint End: Staff began to
let go of the client to see if she was going to be compliant and contract for safety. 6:01pm-
Personal Restraint: Client rolled on to her back and began attempting to self harm by biting
her hand and then began kicking staff near her legs and staff restarted the restraint. 6:11pm-
Personal Restraint End: Client began calming down and not resisting her restraint and
contracted for safety so staff began letting go and allowed the client to sit up in the floor to
further deescalate. Patient Debriefing date/time: 10/28/24 6:30pm: Client was still very
upset and was begging staff and her therapist to not make her go to acute. Client
continually repeated "please don't let them take me, I promise I'll be good." Nursing
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Assessment date/time: 10/28/24 6:30pm: Client required personal restraint due to self
harming. Upon my arrival, client was on the floor in active restraint, struggling with staff.
Client yelled out, continued to struggle with staff and look behind her frequently. Client was
partially released and she pulled her hair and/or bit on her own hand. Personal restraint was
restarted. Client eventually calmed down and was released from restraint. Client tearful,
pleaded with therapist no to go to acute. Client has no obvious new injury from this incident
and has no obvious injury noted. Alert and oriented, gait steady, full/active ROM all
extremities. Denies injury. Client left via MEMs around 6:30pm for acute. Guardian was
notified on 10/28/24 at 6:34pm Incident Report 2 date/time: 10/28/24 6:25pm Location of
Incident: Rose House Incident Description: Self Injury(Not Suicidal), Suicidal, Threat to
Safety Staff Involved: Michael Proveaux, Matthew Chrylser Events Leading: was
transported by MEMs to Rivendell Behavioral Health for acute hospitalization at 6:25pm.
has been making suicidal comments and has been self-harming for the past 6 days.
She required at least 3 personal restraint in the past 3 days in order to stop her from self-
harming, including this evening after being accepted for acute care. Guardian was notified
on 10/28/24 at 6:34pm. will be returning to Youth Home after her acute stay at
Rivendell. I
Interim Action Narrative: Resident was placed in personal restraints for safety and
transported to acute care via MEMS.
Maltreatment Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Program Coordinator requested documentation for this provider reported incident. Facility
provided documentation for this provider reported incident.


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

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: 024587
Date of Incident: 10/7/2024
Date Received: 10/8/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: PRTF Client/Chestnut House
Incident Date: 10/7/2024 @ 5:05 PM Incident Type: Acute Placement
Events Leading: Therapist talked with about his ongoing aggressive behaviors and the
safety concerns around this problem. He was informed that he would be going for acute
treatment at Rivendell Hospital. He as upset and cried on a heap of laundry on his bedroom
floor for a few minutes. After talking further with his therapist he calmed down and was able
to acknowledge the safety concerns. He was then willing to pack some changes of clothes.
He was able to be transported by MEMS without incident at 5:05pm Client was scheduled
to discharge on 10/8 and will not be returning to us from acute.
Interim Action Narrative: Resident was transported to acute care via MEMS.
Maltreatment Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Facility provided documentation for this incident. Resident will not return after acute care.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was transported to Arkansas Children’s Hospital and then to acute care after exhibiting aggressive and self-harming behaviors.

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: 024554
Date of Incident: 10/6/2024
Date Received: 10/7/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Client: Incident
Report Date: 10/6/24 7:45 PM PRTF Client at Mabee House on YH Campus Events
Leading: Client had spent much of this day upset, and was observed to punch walls and the
window of her bedroom when being held accountable for behaviors. Client ignored repeated
redirections to stop these behaviors, and refused to be seen/assessed by nursing staff. Client
was upset that another client was able to go to the outing today and she wasn't. She began
hitting the window and threw a chair several times causing a hole to be placed in the wall.
She then barricaded herself behind the door and continued to not respond to staff. Client
then refused meds from staff. MEMS was called to transport to Arkansas Children's
Hospital for potential acute placement. Client transferred Pinnacle Pointe Acute on 10/7/24
from ACH. Tentative Safety Plan upon return to Youth Home after discharge from acute:
will likely be on Close Observations and possibly Frozen until she restores with
others upon her return. Safety plan will be finalized closer to discharge from acute.
Interim Action Narrative: Resident was transported to acute care.
Maltreatment Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns
and inquired about the hole in the wall. Facility reported a request was made for repairs and
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

would update Licensing once completed. Licensing requested pictures once completed.
10/10/2024, facility provided pictures of before and after repairs. Facility also reported
resident is still in acute care.


summary: A resident was transported to the emergency room after accidently hitting his head on a dresser in his room.

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: 024495
Date of Incident: 10/3/2024
Date Received: 10/4/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: IR Date: 10/3/24 Time: 6:50 PM Events Leading: Patient states that he
was bending down and accidentally hit his head on the dresser/shelf in room. See IR
Nursing to see assessment. Patient taken to ER to rule out concussion. Nursing Assessment
10/3/24 Time 6:50 PM : Pt came to nurses station stating that he had hit head on dresser by
accident when he went to stand. Upon assessment, pt has superficial laceration about 1.5cm
in length to posterior L side of head, close to midline. Serosanguineous fluid present. Blood
able to clot appropriately after pressure applied to area. TAO applied. Pt c/o dizziness, h/a
@ 4/10, light sensitivity. Pt denies n/v, gait steady. Full ROM in all extremities. Eyes
PERRLA. Pt alert and oriented to self/situation. Vitals as follows: BP 124/79 HR 91, temp
97.6, rest even/unlabored. Pt given ibu x2 per MAR. After thirty minutes, pt c/o worsening
h/a @ 6/10, increased dizziness/light sensitivity and slight nausea w/o vomiting. Talked to
provider. Per provider, pt needs to have concussion r/o. Pt taken to ER at about 2050.
Attempted to notify guardian, 3 times prior to leaving voicemail. 10/3/24 @
9:31 PM, 9:35 PM and 9:42 PM Attempted to call guardian x3. Voicemail left w/o identifying
information, nurse cell number left in voicemail Psychiatrist notified 10/3/24 6:52 PM On
Call Therapist, Jori Burns, notified 10/3/24 8:18 PM Unit Manager on call, Beauty Moore
notified 10/3/24 @ 8:17 PM
Interim Action Narrative: Resident was assessed by the nurse and further evaluated at the
ER.
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Facility provided documentation and the resident's demographics. Licensing inquired
about guardianship. Per facility, resident raised up and bumped his head no sharp edges on
the dresser.


summary: A resident was transported to Urgent Care after reporting bloody stools.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 024383
Date of Incident: 9/27/2024
Date Received: 9/30/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
placement client in our PRTF program and resides in Rose House Incident Report
date/time: 09/27/24 5:40pm Location of Incident: Rose House Incident Description:
Medical Emergency(Trip to ER/Urgent Care) Staff Involved: Brayjana Pettigrew, Meredith
Reddin, Kantris Oliver Events Leading: Client used the restroom after school and expressed
to staff that she had blood coming out of her behind. Staff notified nursing and was told to
notify nursing again when she was able to attempt to poop again. Client notified staff and
staff sent a picture to nursing. Client was then sent out to Urgent Care and then to the ER.
Nursing Assessment date/time: 6:00pm: Pt taken to UC d/t bloody stool. Pt reports that she
has had 2 episodes today. Nurse assessed 1x episode at about 530pm. Stool is bright red,
BM is small/scant. UC told staff that pt should go to ER. Pt has been at ER since about
615pm. Guardian was notified on 09/27/24 at 6:50pm and again on 09/28/24 at 7:46am ER
paperwork was emailed to Kendra Slade on 09/27/24
Interim Action Narrative: Resident was assessed and evaluated at the ER.
Maltreatment Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Facility provided documentation for this incident.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was transported for acute care after exhibiting aggressive behaviors.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 024293
Date of Incident: 9/26/2024
Date Received: 9/27/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for DOB:
client in our PRTF program and resides in Chestnut House Incident Report date/time:
09/26/24 2:55pm Location of Incident: Chestnut House Incident Description: Aggressive to
Adults, Threat to Safety Staff Involved: Jonathan Pulliam, Keemon Otey, Anthony Mask,
Robert Page, Ashley Pankey, Barrett Harger, Valerie Alvarez, Joseph Davis Events Leading:
Staff heard loud noises and came out of his office. Pt was walking around the milieu as staff
tried talking with him. Pt began trying to break down the back door. 2:55pm Personal
Restraint: Pt began trying to break open the door by ramming it and was placed in a
personal restraint. Pt is screaming and threatening to kill staff. Pt is struggling and spitting
as staff are trying to talk to him. Another peer walks out of his area trying to help fight staff.
3:01pm Personal Restraint End: Pt has stopped struggling and and agrees that staff can
release him. Pt contracts to go to his area and is released from the personal restraint. 3:02pm
Other/None: Pt immediately begins walking around the milieu, not returning to his area as
he contracted to do. Pt goes over to the TV and begins pulling on the cord of the TV and is
told to stop. Pt does not. 3:04pm Personal Restraint: Pt is placed in a personal restraint due
to his aggressive behavior. Pt is struggling with staff. Staff are trying to talk with Pt but Pt
continues to yell and threaten staff. 3:07pm Chemical Restraint: Due to the PT's continued
aggression, Pt is given a chemical restraint by the nurse. 3:08 Personal Restraint: Pt
continues to struggle, trying to kick and head butt staff. Staff continue trying to talk to the
Pt. 3:20pm Personal Restraint: Pt has calmed somewhat and agrees to let the staff get off his
legs. Staff continue talking with him. 3:22pm Personal Restraint End: PT again contracts for
safety and to return to area. Staff release him at this time. Patient Debriefing date/time:
09/26/24 4:00pm: Pt was brought more comfort items and later approached staff and
apologized for his behavior. Staff told PT that they had to keep him and everyone safe.
Nursing Assessment date/time: 09/26/24 3:30pm: Client came home from school very
excited with peers. Client quickly turned angry and tried to barge out of the door. Client was
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

restrained for threat to safety. Client continued to struggle with staff to be released from
restraint. Client yelled out that we were racist. Client was released and placed in another
restraint shortly after. Client yelling and struggling with on the floor. Client was given IM
Thorazine 50mg right gluteus maximus. Client continued to struggle, said he will punch
me. Client began to calm down and was released from restraint. Client states that he is mad
and sad and anxious. Complains of pain to right forearm and right gluteal muscle.
Ibuprofen x 2 administered. Client was provided peapod to decrease anxiety. Client is alert
and oriented, has full/active ROM all extremities. Client is calm and cooperative at this
time. Client was easily awakened around 8:40pm, packed a bag and was taken to acute
around 9pm via agency staff and van. Guardian was notified on 09/26/24 at 4:26pm, 4:27pm,
and 4:30pm was transported to BridegeWay for an acute stay on 09/26/24 at 9:01pm.
Interim Action Narrative: Resident was placed in a restraint for safety, assessed by the
nurse, and transported to acute care.
Maltreatment Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
10/7/2024, Program Coordinator inquired about documentation for this incident. Facility
reported resident returned from acute care on 10/3/2024.


summary: Licensing reviewed camera footage of an incident after receiving a phone call from someone with concerns about a resident. No deficiencies cited.

raw_content:
521 Visit Compliance Report

Licensee: Youth Home, Inc.

Facility Number: 128

Licensee Address: 20400 COLONEL GLENN ROAD
LITTLE ROCK AR 72210

Licensing Specialist: Kendra Slade
Person In Charge: Mary Kelly
Record Visit Date: 9/23/2024
Home Visit Date: 9/23/2024

Purpose of Visit: Monitor Visit

Regulations Out of Compliance:

Regulations Needing Technical Assistance:

Regulation Not Applicable:

Regulations Not Correctable:

Narrative:

Time of Visit: 8:45 am to 11:15 am

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

S ARBRE AMBA FE
» DEPARTMENT OF

) \7 HUMAN
=a! SERVICES
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot $140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550

Page 1 of 3

Census:5

Program Coordinator received a phone call on 9/19/202 regarding some concerns that were mentioned
regarding a resident being placed on freeze at Chestnut House during camera review. Program Coordinator
reviewed camera footage with f the incident in question for 9/13/2024.

It was reported that the resident was placed on freeze for displaying unsafe behaviors. Camera footage was
reviewed from 10;21 am to 12:24 pm. The ratio was 2:1. Throughout the camera review, Program Coordinator
observed two (2) QBHPs and a nurse entering and leaving the area. Also, two (2) other residents were
observed entering and leaving the area.

Program Coordinator observed a female staff member sitting in a chair at the milieu and a male staff member
sitting in a chair by the doorway of the resident’s bedroom. Throughout the camera review, the resident could
be heard yelling, screaming, moaning, whining, and growling. The male staff member could be heard giving
the resident directives and providing countdowns.

The resident did not comply with the directives that were given and continued to yell and was heard using
racial slurs and cursing toward the male staff member. At 10:40 am, resident was observed standing in the
doorway with the male staff member sitting outside of the doorway. Resident was observed bumping his body
up against the door and making hand gestures at the staff member.

At 11:30 am, resident continued to whine and groan. Resident was observed pushing the chair that the staff
member wae in while ctanding in the danrwav Resident then started himning his hodv nn apainst the door

constantly stating, “Let me out.”

At 11:35 am, resident attempted to leave his bedroom. Staff member was observed blocking the resident with
is arm and guided the resident back into the bedroom. No aggression or force was observed by the staff
member. At 11:35 am, resident was observed knocking the staff member’s glasses off his face. The staff
member’s chair appeared to foll back on the outside of the resident’s bedroom doorway.

Resident was heard screaming and crying. Due to the resident being in his bedroom, Program Coordinator
could not observe why the resident was screaming or crying. The male staff member could be heard asking
the resident what was wrong. The female staff member was heard stating that the resident hit his hand.

Resident stopped screaming and could be heard banging on something in his room. A male staff member was
observed walking to the doorway of the resident’s bedroom with a piece of paper. It was reported it was the
resident’s classwork. The staff member handed the resident the paperwork and the resident threw the
paperwork out the door. The staff member picked up the paperwork and placed it on the bench outside the
resident’s bedroom door.

Resident started back yelling, screaming, and growling. At 11:56 am, resident was observed in the doorway
and started walking back and forth in his bedroom. At 12:03 pm, the nurse was observed talking with the staff
member before walking into the resident’s room.

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

The nurse could be heard asking why the staff member was sitting at the doorway and the staff member
explained to the nurse that the resident was on freeze. The nurse was observed entering the resident's
bedroom. The nurse could be heard talking to the resident.

The nurse indicated not observing any marks on the resident. When asked why he was on freeze, the resident
denied knowing the reason. Program Coordinator was informed of some expectations and safety concerns for
freeze below:

A resident’s expectation on freeze indicated:
Must stay in assigned area
If necessary, resident may need to remain at the house

Potential Safety Concerns:
Threat to safety
Physical aggression
Arguing/oppositional/complaining behaviors

It was reported that resident was placed on freeze due to using racial slurs towards staff and peers. Resident
was not placed in a restraint during the camera review and was observed going around the staff member when
he chose to. The staff member was observed making sure that resident completed his time while on freeze.

Provider Comments:

CCL Staff Signature : Date: 9/23/2024
may
Provider Signature Date: 9/23/2024

“teary: Th, FA

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


summary: A resident was transported to Urgent Care after injuring her hand by punching a wall.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 024058
Date of Incident: 9/17/2024
Date Received: 9/18/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Rose House Incident Report date/time:
09/17/24 4:34pm Location of Incident: Rose House Incident Description: Medical
Emergency(Trip to ER/Urgent Care), Patient Injury Staff Involved: Chastity Robinson,
Meredith Reddin, Brayjana Pettigrew Events Leading: After receiving a consequence after
being observed throwing up a gang sign with peer. Client returned to house and began to
punch the wall. Client was redirected by staff to stop and was able to accept the information.
Client was sent to Urgent Care for her injuries. Nursing Assessment date/time: 09/17/24
4:36pm: Pt punched wall in room d/t anger at information given. Upon assessment, R hand
red, swelling noted to pointer, ring, middle, pinky finger and knuckles. Pinky knuckle and
finger beginning to turn purple. Cap refill <2sec. Unable to flex or extend. Pt sent to UC for
further assessment of hand. Pt returned from UC at about 1900. Pt has cast to R hand. Per
provider, Pt is to keep cast on until reveal on 9/25/24 unless
showering. Pt given information, verbalized understanding. Pt told to continue RICE. Pt
given ibu w/ HS meds. Pt verbalized understanding. No further needs at this time.
Guardian was notified on 09/17/24 at 5:10pm Urgent Care paperwork will be emailed to
Kendra Slade once we receive it.
Interim Action Narrative: Resident was assessed and sent to urgent care for an evaluation.
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Facility will provide documentation for this incident once received. 9/19/2024, facility
provided documentation for this incident and it has been uploaded.


summary: A resident was transported for acute care after eloping from the facility following an altercation with a peer.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 024031
Date of Incident: 9/16/2024
Date Received: 9/17/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for DOB:
client in our PRTF program and resides in Chestnut House Incident Report date/time:
09/16/24 12:29pm Location of Incident: Siebert School Incident Description: Aggressive to
Peers, Aggressive to Adults, Threat to Safety, Property Destruction Staff Involved: Allison
DeMay, Robert Page, Rodney Ellis, Ben Malone, Caitlin Henthorne, Clytrell Daniel, Kara
Brooks, Valerie Alvarez, Taylor Tull, Charles Hoof, Samantha Henry, Melissa Price Events
Leading: While in class pt was struggling with a peer instigating him. Neither pt nor peer
would leave the class when asked to take a break. Pt's peer stood up and continued talking
to pt. Pt then stood up and approached peer, shoving staff in effort's to get to peer. Personal
restraint began at this time. 12:29pm-Personal Restraint: Patient charged at a peer, shoving
a teacher in his class. A personal restraint was initiated. Patient fought the restraint and his
feet tangled with staff's feet, causing all of them to fall to the floor. Patient attempted to bite
staff members while in the restraint. Patient cried and screamed. Patient was offered PRN
several times but declined. Staff attempted to provide verbal support to pt. 12:44pm-Personal
Restraint: Client started to calm down. Client stopped fighting staff. Nurse offered a
chemical by mouth. Client accepted. Nurse retrieved the chemical and administered. Staff
encouraged client to take a deep breath. He was given a tissue. 12:45pm-Chemical
Restraint: Client took chemical restraint by mouth. 12:46pm-Personal Restraint End: Client
was given water. Client contracted for safety. Personal restraint ended and client eloped
from the school. Client walked back to the house with staff and no further interventions.
Patient Debriefing date/time: 09/16/24 1:00pm: Client was asked if he was injured and he
initially said no, but then complained of pain in leg. Client also complained about the fall
that occurred in the restraint, but acknowledged that staff tripped over feet. Client expressed
concerns about potentially being placed on run risk, however client was only placed on
freeze PA. Client was able to accept information and discussed restoring with peer and
class. Verbalized that he did not have any other complaints or needs. He did not want any
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

fist bumps, but accepted a pat on the back from staff and verbalized feelings of sadness and
was tearful. Staff offered verbal support and explained that no one is angry with him and
they see him trying his best. Nursing Assessment date/time: 09/16/24 12:51pm: This nurse
attempted to process with following release of the restraint. He was tearful and crying
and made his way to the door of the classroom where he exited the classroom and eloped
from school. He jumped over the creek and stood there sobbing and crying while waiting on
team members. He voiced just needing to get out of the building. He walked back to
chestnut house amongst team members and endorsed being sad. Upon entering Chestnut
house, he initially denied any injuries. This nurse asked if he could remove his hoodie to
observe his arms. Erythema noted near/around posterior antecubital area. He also has a
healing scabbing sore one his (R) elbow that he reports his from his last restraint. He then
admits and c/o (R) leg pain below his calf area, rating pain 5/10. He complained about the
fall that occurred in the restraint, but acknowledged that staff tripped over feet. No physical
markings, erythema, bruising, abrasions, lacerations, or abnormalities noted. Gait is steady.
Active ROM to all extremities. Can bear weight without difficulty. PRN ibuprofen 400mg
administered. No further physical markings, erythema, bruising, abrasions, deformities,
protrusions, lacerations, or abnormalities noted. Of note: mild bruising and edema noted to
(R) hand, 5th carpal from patient punching the wall of some time recent. Capillary refill
brisk, less than 3 seconds, and WNL. AAOx4. Fairly clear and coherent speech. Sometimes
difficult to understand when he was crying and upset. No signs of respiratory distress. No
retractions, accessory muscle use, or nasal flaring. He agreed to a cold pack. he was
observed sitting on his bed, tearful, and appeared disappointed in self. He was looking
down and tearful. Denies any numbness, tingling, or weakness in extremities. This nurse
attempted to obtain vitals. remained upset, tearful, and tense. Discussed his vitals will
be obtained later when he feels better. 1315: MH, RN obtained vitals signs. BP: 126/74, HR
93. Temp. 97.2. SpO2 saturation 98%. Injuries to Staff or client: Pt stated he had no injuries
but did mention pain in his leg (possibly from staff and pt tripping, falling to the ground).
Staff were kicked and also suffered carpet burn. Follow-up to injuries: Pt was seen by the
nurse. Staff will self-care. Additional Comments: Concerns were made about the initiation of
the restraint, feeling as if the approach may have been too aggressive, furthering pt's
escalation. Video review shows that one team member may have been attempting to use
"team control" CPI hold but it was not communicated, making the initial restraint
ineffective. This will be further discussed/trained with team member. Guardian was notified
on 09/16/24 at 4:33pm, 4:34pm, 4:35pm was transported to acute at Rivendell on
09/16/24 at 6:50pm.
Interim Action Narrative: Staff used verbal de-escalation and presonal restraint. Resident
was assessed by the nurse and transported to acute care.
Maltreatment Narrative:

Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Program Coordinator will requsest nursing note and inquire about camera footage.
9/18/2024, Program Coordinator reviewed camera footage. Staff were not observed
preventing the resident from breathing. Resident was observed yelling and struggling to get
out of the resident. The resident was also observe displaying physical aggression towards
staff.


summary: A resident was transported for acute care due to exhibiting aggressive and self-harming behaviors.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 023941
Date of Incident: 9/11/2024
Date Received: 9/12/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Mabee House Incident Report
date/time: 09/11/24 2:59pm Location of Incident: Mabee House Incident Description: Self
Injury(Not Suicidal), Threat to Safety Staff Involved: Taylor Tull, Anthony White, Allison
DeMay, Ashley Pankey, Valerie Alvarez, Caitlin Henthorne, Ebony Galmore Events
Leading: Client received feedback from staffing that didn't include her being taken off extra
supervisory precautions, despite struggling with excessive hair pulling for two days prior.
Client dysregulated, and attempted to utilize the comfort room. She was observed hitting
the walls of this room with significant force. When staff attempted redirection, client
escalated, storming down the hall. Because she was on eyeball (line of sight) precaution,
staff followed, prompting of her intentions on going. Client ignored these prompts and
kicked a crate into staff's leg, nearly tripping staff. Due to her being escalated and her
unpredictability in this moment, and her increasingly unstable behaviors of the last couple
of days, client was restrained at this time. 2:59pm-Personal Restraint: Pt resisted against the
restraint and her momentum took the restraint to a seated floor position as she intentionally
dropped to her knees. Pt screamed loudly for several minutes, making it difficult to
understand her. Staff attempted to provide verbal support as she tried to thrash her body
forward and pull out her own hair. Pt's CT attempted verbal support as well. Pt asked that a
particular team member tag out of the restraint and this was granted. Pt screamed to be let
go and contiued trying to pull her, not allowing team members to help put her hair in a pony
tail. Pt rocked back and forth in restraint while continue to scream and cry loudly. Due to pt
remaining unsafe and showing no signs of calming, an order was given for a chemical
restraint. 3:13pm-Chemical Restraint: Staff adjusted position of pt and restraint to allow the
nurse access to administer chemical restraint via injection. Pt struggled against hold and
staff provided verbal support, encouraging pt to take deep breaths. 3:14pm-Personal
Restraint: Pt began dry heaving and retching, eventually producing mucus and saliva. Staff
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

quickly sat up pt to prevent choking. She continued to retch up saliva. Pt pretended to
"faint" and laid backwards multiple time in the restraint. Each time she laid still for
approximately 10 seconds before quickly lunging forward and struggling again. Nursing
and staff confirmed rising chest, breath sounds, etc. throughout. A small plastic tub was
placed in her lap and staff let her know she could spit or vomit in the tub as needed. Staff
attempted to wipe her face and pt began shredding the paper towels in her hands. Pt
screamed she couldn't feel anything. Staff asked pt if she could feel them holding her and
she again stated she couldn't feel anything anywhere. Pt bit her hand and continued to try
to pull her hair. She also began trying to pinch/claw her thighs and hands. 3:20pm-Personal
Restraint: Pt began screaming and crying "I can't see anything" over and over. Staff noted
her eyes were closed and hair was in front of her face. She continued yelling this and any
attempts at support pt were unsuccessful. Pt rocked back and forth in hold. Eventually pt
said something was stabbing her leg. Staff pointed out that was good that she could feel the
sensation in her legs while also ensuring nothing was jutting into her leg. Staff again
encouraged deep breathing. 3:24pm-Personal Restraint: Pt yelled for her dad. Pt continued
with "fainting" episodes and crying. Pt thrashed her arms about and slung the tub
containing mucus and her hair, into staff's face. Hold continued. 3:34pm-Personal Restraint
End: Staff offered pt water and she accepted. Pt spilt some water on herself and apologized.
Staff assured pt no apologies were necessary and continued to support her. Staff encouraged
deep breathing. Staff all began taking deep breaths and pt began to follow the lead. Pt was
released from the restraint and asked to call her father. Staff encouraged pt to wash her
hands and face and she did so. Pt asked to change her clothes as they were covered in
mucus. After this she called her father. Patient Debriefing date/time: 09/11/24 3:40pm:
Client denied injuries. Client expressed desire to clean herself up and change clothes. Client
also asked to call her father. She had questions about an acute placement. Client also
questioned how tissues ended up all over the milieu. Client allowed to clean herself up and
talk with her father. Nursing Assessment 1 date/time: 09/11/24 4:15pm: Upon arrival to
Mabee House, the nurse found the patient in personal restraint. According to staff, the
patient was agitated due to the staffing report she received earlier that day. At 15:13, a
chemical restraint was administered with approval from the MD. The patient remained in
personal restraint until 15:34, when she was calm and deemed safe for release. The patient
was provided time to compose herself before speaking with her father. Following the phone
call, the nurse conducted a face-to-face assessment at 16:15 with the following vital signs:
BP 108/88, HR 101, RR 21, T 98.2 F, SpO2 99% on room air. The nurse observed a bruise on
the patient's right arm, which the patient and staff stated was sustained at school on
9/10/24. The patient denied any other injuries and requested to rest due to fatigue. Staff
provided bedding, and the patient lay down calmly without any further issues. The UM and
CT were present during the incident. The attending physician was notified and provided
orders for the patient to be transferred to an acute care facility via MEMS. The patient's
father was informed of her behavior at 15:34 and provided consent for the transfer. No
additional issues or concerns were noted. Nursing Assessment 2 date/time: 09/11/24
5:19pm: MEMS arrived at Mabee House at 17:19 and received a report. The patient was
asleep in the milieu and was awakened by the MEMS personnel. Upon waking, the patient
requested to call her father, have dinner, pack her clothes, and take books. The UM, present

at the time of MEMS arrival, approved her request to take the books and dinner. The patient
was informed that she could speak with her father upon arrival at the acute facility. The
nurse observed that the patient displayed no signs of pain and voiced no concerns other
than her reluctance to leave. As the patient was assisted onto the cot, she remained calm.
The patient was placed into the MEMS vehicle and departed the facility at 17:40, en route to
Rivendell Behavioral Health Center. The UM was present during the patient's departure,
and the on-call CT was notified. Guardian was notified on 09/11/24 at 3:34pm
was transport via MEMS to Rivendell on 09/11/24 at 5:40pm Additional note regarding this
incident: CT notified guardian the we cannot accept client back into the program.
Interim Action Narrative: Resident was placed in a restraint for safety, assessed by the
nurse, and transported to acute care.
Maltreatment Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Per report, resident will not be returning to the facility. 9/19/2024, Program Coordinator
requested documentation for this incident. Facility reported resident was discharged on
9/16/2024 and provided documentation.


summary: Pulaski County Sheriff’s Office was contacted after a resident began hitting his peer in the head.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 023914
Date of Incident: 9/10/2024
Date Received: 9/11/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for DOB:
client in our PRTF program and resides in Sturgis House Incident Report date/time:
09/10/24 1:34pm Location of Incident: Siebert School Incident Description: Aggressive to
Peers, Law Violation, Threat to Safety Staff Involved: Melissa Price, Anthony White, Valerie
Alvarez, Marilyn Howell Events Leading: Staff was called out of the room for a situation in
another class. got up and started walking toward peer stating that he heard peer had
been talking about his mother. Staff asked peer to step out in the hall to get him out of the
classroom and away from went around staff and ran out into the hall and
started hitting peer in the head. PCSO was called to campus. Police report # P24-009852
Nursing Assessment date/time: 09/10/24 1:55pm Guardian was notified on 09/10/24 at
9:12p,m and 9:57pm Police report was emailed to Kendra Slade on 09/11/24
Interim Action Narrative: Staff intervened and the police were called.
Maltreatment Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Facility provided documentation for this incident. 9/17/2024, Program Coordinator inquired
if peer was assessed by nursing. 9/18/2024, per nursing note peer reported no complaints
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

and denied medical evaluation from MEMS. Peer was assessed by the nurse and nursing
note has been uploaded.


summary: Officer responded to Youth Home in reference to a disturbance. Upon arrival, the officer was advised that a resident punched another resident in the head multiple times.

raw_content:
Victim:
Case P24-009852 Page 2 of 2


summary: Officer responded to Youth Home in reference to a disturbance. Upon arrival, the officer made contact with a staff member who advised a resident in her class began interrupting the class and ignoring orders.

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

Printed on September 19, 2024

Approved
Report Type Patrol
Primary Officer Keon Leflore
Investigator None
Records Technician
Reported At 09/10/24 15:08
Incident Date 09/10/24 15:08
Incident Code DIST : DISTURBANCE
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
2
Southwest
None
Ereferral County None

Disposition P- PENDING
Disposition Date/Time 09/10/24 17:01
Disposition Comments

AM2737
Review for Gang Activity Not Applicable

Primary Narrative By Keon Leflore, 09/10/24 22:18

Disturbance

On September, 10, 2024 at approximately 1352 hours, |, Deputy K.LeFlore
received a call at 20400 Colonel Glenn Road in reference to a disturbance.

Upon my arrival, | met with Caroline Sipes, and she advised me of following:

Durina school hours, Sipes was teaching her class when one of her students,
was interrupting the class room by walking around talking in an

aggressive manner around the classroom. Sipes asked multiple time to be
seated at his desk. proceeded to walk around the classroom ignoring
orders. Once Sipes politely asked to be seated, quoted

“Bitch make me” and proceeded to aggressively push Sipes while she was
seated in her chair.

Secondary teachers, Rasheauna Lambert and Charles Hoof proceeded to
restrain and walk from out the classroom. While doing so, . __.__
turned around a proceeded to hit —_ classmate, Mon the side of his

Case P24-009854 Page 1 of 2

head with a closed fist. No injuries were reported from was
eventually escorted out the classroom into the hallway by Lambert and Hoof.

Once entering into the hallway, was very combative, fighting | way from
Lambert and Hoof. While doing so, managed to strike Lambert in the
middle of her chest 2x time with a closed first. Lambert advised she was not
injured nor did she need medical.

Upon speaking with , advised was upset and wanted to talk about
unknown problems. advised _ did not mean to harm anyone, but just
wanted to be heard of ~— unknownproblems that did not advise me of.

|, Deputy K.LeFLore contacted the intake Officer of Pulaski County Juvenile
Dentition Center, Martha Carter. Carter was given the details of the incident.
Carter advised me of the court date for which is October 2, 2024.

was Cited for Battery in the 3rd degree (5-13-203), and was given a court date.

Domestic violence sheets where submitted into evidence along with witness
statements. Videos of the incident where uploaded and submitted with the report.

Case P24-009854 Page 2 of 2


summary: Licensing reviewed two (2) personnel files. Both files reviewed complied with the 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: Youth Home, Inc.
Facility Number: 128
Licensee Address: 20400 COLONEL GLENN ROAD
LITTLE ROCK AR 72210
Licensing Specialist: Kendra Slade
Person In Charge: Renetta Cheathem
Record Visit Date: 9/10/2024
Home Visit Date: 9/10/2024
Purpose of Visit: Personnel Records
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Time of Visit: 10:30 am to 11:30 am
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Census: 55
Program Coordinator Kendra Slade reviewed two (2) personnel files.
(Qualified Behavioral Health Professional)
(Qualified Behavioral Health Professional)
Both files reviewed complied with the minimum licensing standards.
Provider Comments:
CCL Staff Signature : Date: 9/10/2024
Provider Signature : Date: 9/10/2024
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: Pulaski County Sheriff’s Department was called to the facility in response to a resident who was exhibiting aggressive behaviors and attacking staff.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 023916
Date of Incident: 9/10/2024
Date Received: 9/11/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Chestnut House Incident Report date/time:
09/10/24 1:30pm Location of Incident: Siebert School Incident Description: Aggressive to
Adults, Threat to Safety Staff Involved: Charles Hoof, Rasheauna Lambert, Rodney Ellis,
Taylor Tull, Anthony White, Barrett Harger, Ben Malone, Dejuan Williams, Caitlin
Henthorne, Kara Brooks, Joseph Davis Events Leading: Client was being a disruption and
not following directions in the classroom and d-zone staff was asked for assistance. He was
asked if he wouldn't mind sitting down and offered to take a walk, or talk things out, etc.
Client was offered a number of options, but client refused. Client proceeded to continue to
walk around in the room and threatened the teacher in the class and threatened to hit her
and cussed at her. He walked up into her face and pushed her out of her chair and D-zone
staff immediately escorted the client from the classroom after that. 1:30pm-Personal
Restraint: Client restrained at this time. Client was escorted out of the classroom and
towards the d-zone for safety. Client continued to fight back and try to get out of the hold.
While escorted towards the d-zone, he punched one staff member 2-3 times in the chest
after escaping one hand from the hold and was quickly continued to be escorted by staff
towards the d-zone. Once safe in the D-zone, he continued to struggle and kick staff and
was soon reversed to a hold on the ground for safety. While on the ground, pt continued to
curse and say, " let me go", and continued to struggle and try to get out of the hold ,
attempting to roll his body as staff made adjustments. Staff encouraged client to focus on
his breathing. He protested to be let go of the restraint in response. 1:41pm-Personal
Restraint End: Pt started to calm down and was released one at a time from the hold and
complied to sit in a chair. Staff sat with him and talked. 1:42pm-Personal Restraint: Pt
attempted to exit the d-zone area with unsafe behaviors and was put in a hold again. Pt
continued to kick and cuss at staff members. 1:44pm-Personal Restraint End: Pt soon
calmed down and complied to be safe and he was released from the restraint. Patient
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Debriefing date/time: 09/10/24 1:50pm: Pt was encouraged to go to his " safe places" when
mad or frustrated and talk to staff and request options or resources at his disposal when
needed. Pt said he had gotten mad because "everyone was talking too much" and "too
loud." Pt said that he didn't like the way staff were laying on his legs during the restraint. Pt
said that next time he would stay in his safe place for a longer period of time (pt had used
one of his safe spaces right before the incident, but only for a couple of minutes). Nursing
Assessment date/time: 09/10/24 1:55pm: Patient sitting on the floor in the dzone talking
with staff. Patient states that he has pain in his right arm. Upon assessment, patient has a
dime size area of skin abrasion. Patient also states that his fingers are sore on his right hand
from hitting the staff. He stated "this is my punching hand". Patient shows no signs of
distress. Breathing is unlabored, patient has FROM with his extremities. No signs of
redness, swelling, or discoloration of the right hand. Patient reported as he was waling out
of the dzone heading back to Chestnut house, that his left calf area was sore. He was unsure
of what happened to cause the soreness. Patient offered PRN pain medication and ice pack.
He declined both. Injuries to staff or client: No injuries to pt. Staff were shoved and
punched. Follow-up to injuries: Staff will self care. Additional Comments: PCSO was called
to the scene to allow staff to make a report/press charges. At this time I do not have the
police report #. The pt was cited and released, as well as given a court date. Police report
was emailed to Kendra Slade on 09/11/24
Interim Action Narrative: Resident placed in a restraint for safety and the police were called.
Maltreatment Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
9/19/2024, Program Coordinator inquired about doucmentation. Facility provided
documentation and it has been uploaded.