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

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 3/15/2023
Date Received by DCCECE: 3/16/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Facility Type: Residential
Incident Type: Licensing
Report Description: Residents Name/DOB: / Date/Time of
incident: 3/15/2023/ 6:50pm Please describe the incident: Per staff report the resident was
brought to the nurse?s station complaining Rt side hip pain. The resident stated it started
hurting after playing basketball and only hurts with movement. Actions Taken: The resident
was assessed by nursing and APRN. During assessment, the resident was referred to FCMC
for further evaluation and a X-ray. The resident returned from FCMC with the diagnosis of:
No acute fracture or dislocation. The right femoral acetabular joint intact. Lucency through
the S1 segment of the sacrum is probably a growth plate. Nursing will continue to monitor
the residents' progress while in school and the milieu. Guardianship: Private Placement
Interim Action Narrative: Resident was assessed by nursing and APRN. He was referred to
FCMC for further evaluation and x-ray.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed provider reported incident. No licensing
concerns noted.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


state: AR

facility_name: Perimeter Behavioral of Forrest City

summary: Officers were dispatched in response to a report of a runaway resident.

raw_content:
CFS - Command Log Printed on March 28, 2023

CFS# CFS2308607
Call Taker ALLISON LAWS
Location 1521 ALBERT ST, FORREST CITY, AR 72335 (Woodridge Behavioral Center)
Location Details
Primary Incident Code RUNAWAY : Runaway
Mod Report Needed
Priority 1
Use Caution No
Primary Disposition Handled By Officer / Deputy
Beat
Zone Forrest City Police Department
Call Time 03/15/23 08:48:08
Completed Time 03/15/23 09:00:30
Reporters

Unknown (Initial Reporter)

Sex

DOB

Address

Report Time 03/15/23 08:48:08
How Reported

From Phone

Contact Phone

Comments

Other Names
Vehicles

Responders
543 (Primary) 543 - MITLEFF, DALTON FCPD (Primary)

_ Response Times

Assigned 03/15/23 08:51:49 *
Enroute 03/15/23 08:51:49 *
Arrived 03/15/23 08:51:49
Leaving

Arrived At

Completed 03/15/23 09:00:30

IR / External Agency Numbers
FCPD202301998

Officer Addenda

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

03/15/23 08:48:08 | LAWS, ALLISON | New CFS
03/15/23 08:51:49 | HOWTON, KILEY | 543 | On Scene
03/15/23 08:52:00 | HOWTON, KILEY | OUT WITH SUBJECT ON KITTLE ROAD

Page 1 of 2

03/15/23 08:53:00 | HOWTON, KILEY | 10-19 14308 BEG MIL

03/15/23 08:53:11 | LAWS, ALLISON | B/M WEARING BLACK HOODIE, RIPPED JEANS AND WHITE CROCS
03/15/23 08:54:02 | HOWTON, KILEY | 10-97

03/15/23 09:00:30 | HOWTON, KILEY | 543 | Complete

CLQ
Requested At
Sent To
Status
Received At

Location
Accuracy

Page 2 of 2

doc_type: Police Report


summary: Licensing attended SAMA training at the facility to ensure that staff members are being trained according to the facility’s policy on physical restraints.

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: Perimeter Behavioral of Forrest City
Facility Number: 142
Licensee Address: 603 KITTLE ROAD
FORREST CITY AR 72335
Licensing Specialist: Kendra Rice
Person In Charge: Helena Coplin
Record Visit Date: 3/7/2023
Home Visit Date: 3/7/2023
Purpose of Visit: Special Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Time of Visit: 10:00 am to 11:15 am
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Census: 58
Licensing Specialist attended SAMA training at the facility to ensure that staff members are being trained
according to the facility’s policy on physical restraints. Also, to ensure that the facility’s policy on physical
restraints complies with the minimum licensing standards.
Provider Comments:
CCL Staff Signature : Date: 3/7/2023
Provider Signature : Date: 3/7/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2

doc_type: Compliance Report


summary: A resident was sent to Forrest City Medical Center for evaluation after complaining of feeling dizzy, fuzzy and being sleepy.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 3/3/2023
Date Received by DCCECE: 3/6/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Facility Type: Residential
Incident Type: Licensing
Report Description: Residents Name/DOB: Date/Time of incident:
3/3/2023/ 7:25am Please describe the incident: Per staff report the resident was brought to
the nurse's station complaining of feeling dizziness, feeling fuzzy, and being sleepy. Actions
Taken: The resident was assessed by nursing and APRN. During assessment the resident
was referred to FCMC for further evaluation due to a possible adverse medication reaction.
The resident returned from FCMC with the diagnosis of
The resident's medication was discontinued by the psychiatrist 3.3.23 The
resident did not return with new orders or prescriptions. Nursing will continue to monitor
the residents' progress while in school and the milieu. Guardianship: Private Placement
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative:Licensing Specialist reviewed provider reported incident. No licensing
concerns noted.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

doc_type: Notice of Incident


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

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 3/3/2023
Date Received by DCCECE: 3/6/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Facility Type: Residential
Incident Type: Licensing
Report Description: Residents Name/DOB: Date/Time of
incident: 3/3/2023/ 11:50am Please describe the incident: Per staff report the resident was
brought to the nurse?s station complaining of a hurt Rt hand 5th digit. The resident stated
he jammed his finger playing basketball. Actions Taken: The resident was assessed by
nursing and APRN. During assessment the resident was referred to FCMC for further
evaluation due to a possible adverse medication reaction. The resident returned from FCMC
with the diagnosis of:
. .
.
. Nursing will continue to monitor the residents' progress
while in school and the milieu. Guardianship: Private Placement
Interim Action Narrative:
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative:Licensing Specialist reviewed provider reported incident. No licensing
concerns noted.


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

raw_content:
521 Visit Compliance Report

Licensee: Perimeter Behavioral of Forrest City

Facility Number: 142

Licensee Address: 603 KITTLE ROAD
FORREST CITY AR 72335

Licensing Specialist: Kendra Rice
Person In Charge: Helena Coplin
Record Visit Date: 2/27/2023
Home Visit Date: 2/27/2023

Purpose of Visit: Child Record Review Visit

Regulations Out of Compliance:

Regulations Needing Technical Assistance:

Regulation Not Applicable:

Regulations Not Correctable:

Narrative:

Time of Visit: 12:45 pm to 1:45 pm

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

_ ARKANSAS
) DEPARTMENT OF

«| SERVICES

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

Page 1 of 2

Census: 58

Licensing Specialist reviewed four (4) children files:

All children files reviewed complied with the minimum licensing standards.

Provider Comments:

CCL Staff Signature : Date: 2/27/2023
ike
Provider Signature : Date: 2/27/2023

/ h
yf} / I\y
UNA Pe

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

521 Visit Compliance Report

Licensee: Perimeter Behavioral of Forrest City

Facility Number: 142

Licensee Address: 603 KITTLE ROAD
FORREST CITY AR 72335

Licensing Specialist: Kendra Rice
Person In Charge: Helena Coplin
Record Visit Date: 2/27/2023
Home Visit Date: 2/27/2023

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: 12:00 pm to 12:45 pm

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

_ ARKANSAS
) DEPARTMENT OF

«| SERVICES

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

Page 1 of 2

Census: 58

Licensing Specialist reviewed four (4) personnel files:
A. Mattison — PRN Registered Nurse

R. Fields — Dietary Aide

N. Booker — Mental Health Technician

L. Austion — PRN Therapist

All personnel files reviewed complied with the minimum licensing standards.

Provider Comments:

CCL Staff Signature : Date: 2/27/2023

Provider Signature : Date: 2/27/2023

fay .. |
MIT NY

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


summary: A resident was sent to Forrest City Medical Center for evaluation after swallowing staples he found in the school.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 2/17/2023
Date Received by DCCECE: 2/20/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Facility Type: Residential
Incident Type: Licensing
Report Description: Residents Name/DOB: Date/Time of incident:
2.17.2023/ 10:15am Please describe the incident: Per the staff reported, he was chewing on
some staples found in the school. While chewing them the resident stated he accidentally
swallowed them. Actions Taken: Resident was assessed by nursing and APRN then sent out
to FCMC for further evaluation. The resident returned to the facility with a diagnosis:
. Continued follow-up is recommended. There is no
free air or evidence of obstruction. The resident will continue follow up X-rays until the
staples have exited the body. The staples have descended from the body as of 2/18/2023.
The resident was placed on line of sight precautions while in the milieu and school. The
resident will remain on line of sight until deemed safe by his assigned therapist.
Guardianship:
Interim Action Narrative: Resident was assessed by nursing and sent to FCMC for further
evaluation. He was placed on line of sight precautions. Staples descended from resident's
body on 2/18/2023.
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative:Licensing Specialist reviewed provider reported incident and will
follow-up with facility. Licensing Specialist informed that resident found the staples in the
wall. Resident removed the staples from art work that was hanging inside of the classroom.
Licensing Specialist also informed that teachers have been instructed to use alternative
items for hanging art work in the school. Licensing Specialist will schedule a walk through
of the school. 2/27/2023, Licensing Specialist completed walkthrough of the classrooms.


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

raw_content:
521 Visit Compliance Report

Licensee: Perimeter Behavioral of Forrest City

Facility Number: 142

Licensee Address: 603 KITTLE ROAD
FORREST CITY AR 72335

Licensing Specialist: Kendra Rice
Person In Charge: Helena Coplin
Record Visit Date: 2/15/2023
Home Visit Date: 2/15/2023

Purpose of Visit: Subsequent Building and Grounds

Regulations Out of Compliance:

Regulations Needing Technical Assistance:

Regulation Not Applicable:

Regulations Not Correctable:

Narrative:

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

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

ARKANSAS
) DEPARTMENT OF

y HUMAN
»” "at SERVICES
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437

P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550

y

Page 1 of 2

Census: 54

Licensing Specialist completed a buildings and grounds walkthrough. Licensing Specialist was escorted by
Mr. Williams, Program Director and Mr. Jackson, Clinical Director. Licensing Specialist observed the
following areas: courtyard and SRU (200 Hall).

Licensing Specialist observed basketballs, footballs, and kickballs on the courtyard. Licensing Specialist
observed the window seals by the courtyard and gym. No debris was observed around the window seals by the
gym. The grounds were wet due to the rain the day before.

Licensing Specialist observed the SRU Hall (200 Hall). There were no residents on the hall, residents were in
the gym. Licensing Specialist observed all bedrooms, dayroom, and bathroom. The bedrooms were organized
with one bedroom being empty. Dayroom was organized and free of debris. Bathroom had toilet paper on the
floor. Mr. Williams had housekeeping to correct while Licensing Specialist walked the building.

MARs were checked on the following residents:

All initialed and up to date.

Licensing Specialist received the roster for Conscious Discipline. All staff members have completed this
training.

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


summary: A resident was sent to Forrest City Medical Center for evaluation after complaining of stomach pains and vomiting.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 2/13/2023
Date Received by DCCECE: 2/14/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Facility Type: Residential
Incident Type: Licensing
Report Description: Residents Name/DOB: Date/Time of
incident: 2.13.2023/ 8:32pm Please describe the incident: Per the staff report, the came to
the nurse's station complaining of stabbing stomach pains and vomiting Actions Taken:
Resident was assessed by nursing and APRN then sent out to FCMC for further evaluation.
The resident returned to the facility with a diagnosis of .
The resident was placed on a 24-hour quarantine to prevent spreading throughout the
facility. Staff will continue to monitor the residents progress while in quarantine.
Guardianship: Private Placement
Interim Action Narrative: Resident was assessed by nursing. APRN ordered for resident to
be evaluated at FCMC. Diagnosis: . Resident was placed on 24 hour
quarantine to prevent spreading.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed provider reported incident. No licensing
concerns noted.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Officers were dispatched to the facility in response to a report that a resident had escaped.

raw_content:
CFS - Unit Response Times

Printed on March 15,

CFS # CFS2304854
Call Taker KILEY HOWTON
Location 1521 ALBERT ST, FORREST CITY, AR 72335 (Woodridge Behavioral Center)

Location Details
Primary Incident Code ESCAPE : Escape

Mod In Progress
Priority 1
Use Caution No
Primary Disposition Handled By Officer / Deputy
Beat
Zone Forrest City Police Department
Call Time 02/11/23 12:53:56
Completed Time 02/11/23 13:01:08
Reporters
Unknown (Initial Reporter)
Sex
DOB
Address
Report Time 02/11/23 12:53:56
How Reported
From Phone
Contact Phone (870) 970-4500
Comments

Other Names

Vehicles
Responders
540 540 - THOMAS, MICHAEL FCPD (Primary)
542 542 - HAWKINS, FCPD (Primary)
NATHANIEL
544 (Primary) 544 - DIXON, CORBIN FCPD (Primary)

Response Times

Assigned 02/11/23 12:57:03 *
Enroute 02/11/23 12:57:03 *
Arrived 02/11/23 12:57:03
Leaving

Arrived At

Completed 02/11/23 13:01:08

IR / External Agency Numbers
FCPD202301121

Officer Addenda

Unit Response Times

Page 1 of 2

Non Unit Specific Times
02/11/23 12:53:56 | New CFS |
02/11/23 12:55:24 | WORKER AT BEHAVIORAL CENTER ADVISED HAD ONE ESCAPE. NAME IS

ILL BE IN BLACK PANTS AND BURGUNDY SHIRT/GRAY HOODIE. WENT TOWARDS NURSING
HOME

02/11/23 13:01:02 | 544 ADVISED 10-22 SUBJECT BACK AT BAHAVIORAL CENTER
02/11/23 13:14:03 | Complete

540
02/11/23 12:57:14 | On Scene

540, 542, 544

02/11/23 13:01:08 | Complete

542
02/11/23 12:57:20 | On Scene

544
02/11/23 12:57:03 | On Scene

Page 2\of 2

CFS - Command Log Printed on March 15, 2023

CFS # CFS2304854
Call Taker KILEY HOWTON
Location 1521 ALBERT ST, FORREST CITY, AR 72335 (Woodridge Behavioral Center)

Location Details
Primary Incident Code ESCAPE : Escape

Mod In Progress
Priority 1
Use Caution No
Primary Disposition Handled By Officer / Deputy
Beat
Zone Forrest City Police Department
Call Time 02/11/23 12:53:56
Completed Time 02/11/23 13:01:08
Reporters
Unknown (Initial Reporter)
Sex
DOB
Address
Report Time 02/11/23 12:53:56
How Reported
From Phone
Contact Phone (870) 970-4500
Comments

Other Names

Vehicles
Responders
540 540 - THOMAS, MICHAEL —-FCPD (Primary)
542 542 - HAWKINS, FCPD (Primary)
NATHANIEL
544 (Primary) 544 - DIXON, CORBIN FCPD (Primary)

Response Times

Assigned 02/11/23 12:57:03 *
Enroute 02/11/23 12:57:03 *
Arrived 02/11/23 12:57:03
Leaving

Arrived At

Completed 02/11/23 13:01:08

IR / External Agency Numbers
FCPD202301121

Officer Addenda

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

a
Page Uof 2

02/11/23 12:53:56 | HOWTON, KILEY | New CFS

02/11/23 12:55:24 HOWTON, KILEY | WORKER AT BEHAVIORAL CENTER ADVISED HAD ONE ESCAPE. NAME
IS WILL BE IN BLACK PANTS AND BURGUNDY SHIRT/GRAY HOODIE. WENT TOWARDS
NURSING HOME

02/11/23 12:57:03 | HOWTON, KILEY | 544 | On Scene

02/11/23 12:57:14 | HOWTON, KILEY | 540 | On Scene

02/11/23 12:57:20 | HOWTON, KILEY | 542 | On Scene

02/11/23 13:01:02 | HOWTON, KILEY | 544 ADVISED 10-22 SUBJECT BACK AT BAHAVIORAL CENTER
02/11/23 13:01:08 | HOWTON, KILEY | 540, 542, 544 | Complete

02/11/23 13:14:03 | HOWTON, KILEY | Complete

CLQ

Requested At
Sent To

Status
Received At
Location '
Accuracy

Page 2 of 2


summary: Officers were dispatched to the facility in response to a report that a resident ran away from the property.

raw_content:
CFS - Unit Response Times Printed on March 15, 3

CFS # CFS2304841
Call Taker KILEY HOWTON
Location 1521 ALBERT ST, FORREST CITY, AR 72335 (Woodridge Behavioral Center)

Location Details
Primary Incident Code ALRF : Fire Alarm

Mod Emergency Fire/Medical
Priority 5
Use Caution No
Primary Disposition Handled By Officer / Deputy
Beat
Zone Forrest City Police Department
Call Time 02/11/23 08:17:43
Completed Time 02/11/23 08:38:01

Reporters
OLD ARKANSAS ALARM (Initial Reporter)
Sex -
DOB
Address

Report Time 02/11/23 08:17:43
How Reported Phone

From Phone

Contact Phone (866) 588-8950
Comments

Other Names

Vehicles
‘1 eee
Responders
CALL1 FCFD (Primary)
FCE1 (Primary) FCFD, Engine CO 1 FCFD (Primary)
544 (Primary) 544 - DIXON, CORBIN FCPD

Response Times

Assigned 02/11/23 08:20:05
Enroute 02/11/23 08:26:06 *
Arrived 02/11/23 08:26:06
Leaving

Arrived At

Completed 02/11/23 08:38:01

IR / External Agency Numbers
FCFD 202300189

Officer Addenda

Unit Response Times

Non Unit Specific Times

Page 1 of 2

02/11/23 08:17:43 | New CFS
02/11/23 08:20:32 | SPOKE TO KEYHOLDER WHO ADVISED CHILD HAS PULLED THE FIRE ALARM NEEDS FIRE
TO TURN ALARM OFF.

02/11/23 08:25:25 | BAHAVIOR HEALTH CALLED BACK ADVISING THERE WAS A B/M THAT HAS RAN OFF
FROM PROPERTY IN GRAY SHIRT AND BLACK/GRAY PAJAMA PANTS

02/11/23 08:25:47 | 544 OUT WITH MALE ON LINDAUER

02/11/23 08:26:27

02/11/23 08:28:51

02/11/23 08:30:20 | GIVING JUV RIDE BEG MIL 16290

02/11/23 08:31:21 | 544 10-97

02/11/23 08:37:51 | BACK IN SERVICE

544

02/11/23 08:28:00 | On Scene

544, CALL1, FCE1
02/11/23 08:38:01 | Complete

CALL1

02/11/23 08:20:05 | Assign

FCE1

02/11/23 08:26:06 | On Scene

Page 2 of 2

CFS - Command Log Printed on March 15, 7023

|

CFS # CFS2304841
Call Taker KILEY HOWTON
Location 1521 ALBERT ST, FORREST CITY, AR 72335 (Woodridge Behavioral Center)

Location Details
Primary Incident Code ALRF : Fire Alarm

Mod Emergency Fire/Medical
Priority 5
Use Caution No
Primary Disposition Handled By Officer / Deputy
Beat
Zone Forrest City Police Department
Call Time 02/11/23 08:17:43
Completed Time 02/11/23 08:38:01

Reporters
OLD ARKANSAS ALARM (Initial Reporter) |
Sex
DOB
Address

Report Time 02/11/23 08:17:43
How Reported Phone

From Phone

Contact Phone (866) 588-8950
Comments

Other Names

Vehicles

Responders
CALL1 FCFD (Primary)
FCE1 (Primary) FCFD, Engine CO 1 FCFD (Primary)
544 (Primary) 544 - DIXON, CORBIN FCPD

Response Times

Assigned 02/11/23 08:20:05
Enroute 02/11/23 08:26:06 *
Arrived 02/11/23 08:26:06
Leaving

Arrived At

Completed 02/11/23 08:38:01

IR / External Agency Numbers
FCFD 202300189 ti

Officer Addenda

Command Log Filter: All Commands | Details: Hidden | Units: All Units | Revised Entries: Shown
02/11/23 08:17:43 | HOWTON, KILEY | New CFS

a eS
Page lLiof 2

02/11/23 08:20:05 | HOWTON, KILEY | CALL1 | Assign
02/11/23 08:20:32 | HOWTON, KILEY | SPOKE TO KEYHOLDER WHO ADVISED CHILD HAS PULLED THE FIRE
ALARM NEEDS FIRE TO TURN ALARM OFF.
02/11/23 08:25:25 | HOWTON, KILEY | BAHAVIOR HEALTH CALLED BACK ADVISING THERE WAS A B/M THAT
HAS RAN OFF FROM PROPERTY IN GRAY SHIRT AND BLACK/GRAY PAJAMA PANTS
02/11/23 08:25:47 | HOWTON, KILEY | 544 OUT WITH MALE ON LINDAUER

02/11/23 08:26:06 | HOWTON, KILEY | FCE1 | On Scene

02/11/23 08:26:27 | HOWTON, KILEY | 543 OUT WITH 544

02/11/23 08:28:00 | HOWTON, KILEY | 544 | On

02/11/23 08:28:51 | HOWTON, KILEY |

02/11/23 08:30:20 | HOWTON, KILEY | GIVING JUV RIDE BEG MIL 16290

02/11/23 08:31:21 | HOWTON, KILEY | 544 10-97

02/11/23 08:37:51 | MORGAN, SYDNEY | BACK IN SERVICE

02/11/23 08:38:01 | MORGAN, SYDNEY | 544, CALL1, FCE1 | Complete

CLQ

Requested At
Sent To
Status
Received At
Location
Accuracy

Page 2 of 2


summary: Officers were dispatched to the facility in response to a report that a resident had swallowed glass.

raw_content:
CFS - Command Log Printed on March 15, g 023
|

CFS # CFS2304788
Call Taker HALEY MILLS
Location 1521 ALBERT ST, FORREST CITY, AR 72335 (Woodridge Behavioral Center)

Location Details
Primary Incident Code MED : MEDICAL CALL

Mod

Priority 1

Use Caution No

Primary Disposition Handled By Officer / Deputy

Beat

Zone Forrest City Police Department

Call Time 02/10/23 18:59:50

Completed Time 02/10/23 19:53:07
Reporters

CNA AT BEHAVIORIAL HEALTH (Initial Reporter)

Sex

DOB

Address

Report Time —_ 02/10/23 18:59:50

How Reported

From Phone

Contact Phone (870) 970-3500

Comments

Other Names

Vehicles
Responders
511 511 - TODD, ADRIAN FCPD rd]
512 512-MANSEL, STEVEN FCPD
513 (Primary) 513 - POWERS, JAKE FCPD
613 (Primary) 613 - HALLMARK, DAVID _SFSD (Primary)

Response Times

Assigned 02/10/23 19:18:15 *
Enroute 02/10/23 19:18:15
Arrived 02/10/23 19:23:44
Leaving

Arrived At

Completed 02/10/23 19:53:07

IR / External Agency Numbers

Officer Addenda

Command Log Filter: All Commands | Details: Hidden | Units: All Units | Revised Entries: Shown
02/10/23 18:59:50 | MILLS, HALEY | New CFS

Page 1 f 2

02/10/23 19:01:14 | MILLS, HALEY | CALLER ADVISED THAT THERE IS A BOY THAT SWALLOWED GLASS, 117YO
MALE

02/10/23 19:01:55 | MILLS, HALEY | GO INTO THE DOOR ON THE SIDE CLOSEST TO NURSING HOME
02/10/23 19:02:27 | MILLS, HALEY | EMS EN ROUTE

02/10/23 19:09:49 | MILLS, HALEY | EMS ON SCENE

02/10/23 19:17:27 | MILLS, HALEY | EMS REQUESTING AN OFFICER

02/10/23 19:18:15 | MILLS, HALEY | 613 | Enroute

02/10/23 19:18:28 | MILLS, HALEY | 613 | Available

02/10/23 19:18:33 | MILLS, HALEY | 513 | Enroute

02/10/23 19:19:09 | MILLS, HALEY | 613 WAS NEVER EN ROUTE, ACCIDENTALLY PUT IN

02/10/23 19:19:25 | MILLS, HALEY | 512 | Enroute
02/10/23 19:20:56 | MILLS, HALEY | EMS ADVISED THEY ARE HAVING TO WRESTLE GLASS AWAY FROM THE
JUVENILE

02/10/23 19:21:08 | MILLS, HALEY | SAME JUVENILE THAT 513 DEALT WITH EARLIER
02/10/23 19:23:44 | MILLS, HALEY | 513 | On Scene

02/10/23 19:24:37 | MILLS, HALEY | 512 | On Scene

02/10/23 19:25:26 | MILLS, HALEY | 511 | Enroute
02/10/23 19:26:31 | MILLS, HALEY | 511 | On Scene
02/10/23 19:27:02 | MILLS, HALEY | 512 AND 513 FOLLOWING EMS TO HOSPITAL
02/10/23 19:27:07 | MILLS, HALEY | EMS TRANSPORTING ONE
02/10/23 19:28:56 | MILLS, HALEY | 513 | Clear Alarms

02/10/23 19:29:45 | MILLS, HALEY | 512 | Clear Alarms

02/10/23 19:31:43 | MILLS, HALEY | 511 | Clear Alarms

02/10/23 19:32:20 | MILLS, HALEY | 512 AND 513 AT ER
02/10/23 19:53:07 | MILLS, HALEY | 511, 512, 513 | Complete

CLQ

Requested At
Sent To
Status
Received At
Location
Accuracy

Page 2 of 2

CES - Unit Response Times Printed on March 15, 2023
|

CFS # CFS2304788 |
Call Taker HALEY MILLS
Location 1521 ALBERT ST, FORREST CITY, AR 72335 (Woodridge Behavioral Center)

Location Details
Primary Incident Code MED : MEDICAL CALL

Mod
Priority 1
Use Caution No
Primary Disposition Handled By Officer / Deputy
Beat
Zone Forrest City Police Department
Call Time 02/10/23 18:59:50
Completed Time 02/10/23 19:53:07
Reporters |
CNA AT BEHAVIORIAL HEALTH (Initial Reporter) |
Sex
DOB
Address
Report Time 02/10/23 18:59:50
How Reported
From Phone
Contact Phone (870) 970-3500
Comments

Other Names

Vehicles
Responders
511 511 - TODD, ADRIAN FCPD
512 512 - MANSEL, STEVEN FCPD
513 (Primary) 513 - POWERS, JAKE FCPD
613 (Primary) 613 - HALLMARK, DAVID —__SFSD (Primary)

Response Times

Assigned 02/10/23 19:18:15 * |
Enroute 02/10/23 19:18:15
Arrived 02/10/23 19:23:44
Leaving

Arrived At

Completed 02/10/23 19:53:07

IR / External Agency Numbers

Officer Addenda

Unit Response Times

1}

Non Unit Specific Times
Page 1 Cr 2

02/10/23 18:59:50 | New CFS

02/10/23 19:01:14 | CALLER ADVISED THAT THERE IS A BOY THAT SWALLOWED GLASS, 17YO MALE
02/10/23 19:01:55 | GO INTO THE DOOR ON THE SIDE CLOSEST TO NURSING HOME

02/10/23 19:02:27 | EMS EN ROUTE

02/10/23 19:09:49 | EMS ON SCENE

02/10/23 19:17:27 | EMS REQUESTING AN OFFICER

02/10/23 19:19:09 | 613 WAS NEVER EN ROUTE, ACCIDENTALLY PUT IN

02/10/23 19:20:56 | EMS ADVISED THEY ARE HAVING TO WRESTLE GLASS AWAY FROM THE JUVENILE
02/10/23 19:21:08 | SAME JUVENILE THAT 513 DEALT WITH EARLIER

02/10/23 19:27:02 | 512 AND 513 FOLLOWING EMS TO HOSPITAL

02/10/23 19:27:07 | EMS TRANSPORTING ONE

02/10/23 19:32:20 | 512 AND 513 AT ER

511
02/10/23 19:25:26 | Enroute |

02/10/23 19:26:31 | On Scene
02/10/23 19:31:43 | Clear Alarms

511, 512, 513
02/10/23 19:53:07 | Complete

512 |
02/10/23 19:19:25 | Enroute |

02/10/23 19:24:37 | On Scene
02/10/23 19:29:45 | Clear Alarms

513 R
02/10/23 19:18:33 | Enroute

02/10/23 19:23:44 | On Scene
02/10/23 19:28:56 | Clear Alarms

613
02/10/23 19:18:15 | Enroute |

02/10/23 19:18:28 | Available

Page 2)of 2


summary: A resident was sent to Forrest City Medical Center for evaluation after complaining of abdominal pain and coughing up blood.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 2/10/2023
Date Received by DCCECE: 2/13/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Facility Type: Residential
Incident Type: Licensing
Report Description: Residents Name/DOB: Date/Time of
incident: 2.10.2023/ 8:00pm Please describe the incident: Per the staff report, the resident
came to the nurse's station complaining of abdominal pain and stated he coughed up blood,
when nursing asked to see it, the resident stated he had already flushed the toilet. Actions
Taken: Resident was assessed by nursing and APRN then sent out to FCMC for further
evaluation. The resident returned to the facility with a diagnosis of:
Staff will continue to monitor the residents' progress
while in the milieu and in school. Guardianship: Private Placement
Interim Action Narrative: Resident assessed by nursing and sent to FCMC for further
evaluation. Diagnosis: .
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed provider reported incident. No licensing
concerns noted.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for evaluation after he was bitten by a peer during a physical altercation.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 2/10/2023
Date Received by DCCECE: 2/13/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Facility Type: Residential
Incident Type: Licensing
Report Description: Residents Name/DOB: Date/Time of incident:
2.10.2023/ 11:40am Please describe the incident: Per the staff report, the resident became
was in a physical altercation with a peer. During the physical altercation the resident was
bitten on his Rt thumb. Actions Taken: Resident was assessed by nursing and the ARPN
then sent out to FCMC for further evaluation. The resident returned to the facility with a
diagnosis of: . The resident was placed on peer
restriction and assault precautions. Precautions will be reassessed within 72 hours for safety.
Staff will continue to monitor the residents' progress while in the milieu and in school.
Guardianship: Private Placement
Interim Action Narrative: Resident was assessed by nursing and sent to FCMC for further
evaluation. Diagnosis: . Resident placed on peer
restriction and assault precautions.
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing Specialist reviewed provider reported incident. Licensing
Specialist will inquire about the resident's injury and if peer involved was placed on any
precautions. Licensing Specialist was informed that resident's skin was not intact and he
was sent to FCMC due to his complaints of pain. The peer involved in the altercation was
placed on the same precautions, peer restrictions and assault precautions. No licensing
concerns noted.


summary: A resident was sent to Forrest City Medical Center for evaluation after he swallowed a piece of glass he found in the courtyard.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 2/10/2023
Date Received by DCCECE: 2/13/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Facility Type: Residential
Incident Type: Licensing
Report Description: Residents Name/DOB: Date/Time of incident:
2.10.2023/ 5:50pm Please describe the incident: Per the staff report, while in the gym the
resident became upset and went out of the area. While in the gym courtyard the resident
stated he found a small piece of glass and swallowed it. Actions Taken: Resident was
assessed by nursing and APRN then sent out to FCMC for further evaluation. The resident
returned to the facility with a diagnosis of: Suicidal ideation; foreign body in mouth, initial
encounter. The resident returned to the facility, and it was noted that the resident never
swallowed the glass. The resident was placed on suicide precautions and line of sight
precautions for safety. Precautions are reassessed every 24 hours until the resident is
deemed safe. The resident stated that he is having these ideations due to his upcoming
discharge. He stated he does not want to leave the facility because he?s afraid he will mess
up while at home. On-call maintenance staff came to the facility on 2/10/23 at 8pm to
vacuum all outside window seals to ensure no more plexi glass particles were left from the
previous window fix. Staff will continue to monitor the residents' progress while in the
milieu and in school. Guardianship: OH Foster Care
Interim Action Narrative: Resident was assessed by nursing and APRN ordered for resident
to be evaluated at FCMC. Diagnosis:
. Resident placed on suicide precautions and line of sight for safety. On-call
maintenance staff
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed provider reported incident. Licensing
Specialist will schedule a buildings and grounds. 2/15/2023, Licensing Specialist completed
a buildings and grounds walkthrough.

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: Perimeter Behavioral of Forrest City
Facility Number: 142
Licensee Address: 603 KITTLE ROAD
FORREST CITY AR 72335
Licensing Specialist: Kendra Rice
Person In Charge: Helena Coplin
Record Visit Date: 2/15/2023
Home Visit Date: 2/15/2023
Purpose of Visit: Self Report Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Time of Visit: 11:15 am to 12:45 pm
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Census: 54
Licensing Specialist informed that there is no camera footage of the provider reported incident. The camera
outside the gym is not working but the camera is scheduled to be repaired.
Licensing Specialist spoke with staff member, Mr. Williams (Program Manager). Mr. Williams is the staff
member that followed resident when resident went outside the gym. Mr. Williams informed Licensing
Specialist that resident gestured that he swallowed something. Mr. Williams reported that the resident held the
object in his mouth but never swallowed it. Mr. Williams informed Licensing Specialist that the resident was
taken to FCMC for further evaluation because it could not be determined if resident swallowed anything.
Licensing Specialist, Ms. Lockhart, and Mr. Williams discussed the incident. Ms. Lockhart informed
Licensing Specialist that the camera on the courtyard is scheduled to be repaired. Licensing Specialist was
informed that resident is still on precautions.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: Officers were dispatched to the facility for an assault report. Upon arrival, a staff member reported that a resident struck her in the chest and head with a closed fist after she attempted to stop him from escaping the facility.

raw_content:
FORREST CITY Page
POLICE DEPARTMENT

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

Crime / Incident (Primary, Secondary, Tertiary
5-13-203 BATTERY 3RD DEGREE

Incident

meet 9302100008

to foanonoza |__| | Fn _|
Oo

Ou

Location of Incident 1512 ALBERT ST, FORREST CITY, AR
Cross Street 1512 ALBERT ST

Dispo 'V" = Victim “RP" = Reporting Party "W" = Witness "S" = Suspect "O" = Other
Last, First, Middle (Firm if Business) Race | Sex | Age HT WT Hair | Eyes | tigie Phone |
| Yarrn verona nama | |r| [er] ™ aix [ro
— lll =

City, State, Zip Code SSN Local ID # State # FBI# Cell Phone
FORREST CITY AR 72335 0

Address
City, State, Zip Code ~ TSSN Local ID # State # FBI¢ Cell Phone
FORREST CITY AR 72335 0
Home Phone

a nie “ ee ee ee
DOB DL Number State | Work Phone

te
City, State, Zip Code SSN Local ID # State # FBI# Cel] Phone

j
im ot “ -

Address DOB DL Number State | Work Phone

” “ i “= Z _ ee ee bl

Synopsis

Continuation PropertyList
Press Domestic Violence

en. 4b
Gang Related N Hate Crime CL] Victim Senior Citizen {i
Foote [|
Solvability County |
a
Report Complete/Ready for Review CADICFS Event # 2302100008

Assigned To Date

OficerID Officer Jake Powers 519 Pil. Adrian Todd 02/13/2023

ZZ22222222222

Printed By/On: 412 / 03/14/2023 13:16:17

CrimeStar® Law Enforcement Records Management System
Licensed to: FORREST CITY AR POLICE DEPARTMENT

FORREST CITY ree 82 incident conta

Incident #
POLICE DEPARTMENT Narrative ' 2302100008
Crime / Incident (Primary) Attempt | Type Seq
5-13-203 BATTERY 3RD DEGREE CJ 1
On Friday, Febuary 10 2023 I Officer Powers was dispatched to Pinnacle Behavior

facility for a assault report. Upon arrival contact was made with Ms. Victoria
Britt.

Ms. Britt stated that a residents of the building

ee --<-.-
i d tried to escape the facility. Ms. Britt stated when she went to| stop
a struck her in the chest and head with a closed fist.

Ms. Britt was advised of the affidavit process and stated she would be in) at a
later time.

Reviewed By Approved at
OfficerID Officer Jake Powers

Pt. Adrian Todd Yl 4/13/2023
Printed By/On: 412 / 03/14/2023 13:16:18

n: AR P. rt =D, > ay WM WN OANA lit)
Licensed to; FORREST CITY AL IC ARTMEN’

519


summary: Licensing visited the facility to perform a Buildings and Grounds walkthrough. No deficiencies cited.

raw_content:
521 Visit Compliance Report

Licensee: Perimeter Behavioral of Forrest City

Facility Number: 142

Licensee Address: 603 KITTLE ROAD
FORREST CITY AR 72335

Licensing Specialist: Kendra Rice
Person In Charge: Helena Coplin
Record Visit Date: 2/6/2023
Home Visit Date: 2/6/2023

Purpose of Visit: Subsequent Building and Grounds

Regulations Out of Compliance:

Regulations Needing Technical Assistance:

Regulation Not Applicable:

Regulations Not Correctable:

Narrative:

Time of visit: 2:15 pm to 4:00 pm

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

ARKANSAS
) DEPARTMENT OF

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

P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550

Page 1 of 2

Census: 56

Licensing Specialist completed a buildings and grounds walkthrough. Licensing Specialist was escorted by
Ms. Helena, Director of Quality and Risk Management. Licensing Specialist observed the following areas:
courtyard, cafeteria, 200 and 300 Halls.

Licensing Specialist requested to see the decorations that the residents completed on their halls. Licensing
Specialist observed black history and valentine decorations. Licensing Specialist did not observe any licensing
concerns on the courtyard or the 300 Hall. Housekeeping was cleaning the cafeteria and the 200 Hall.

MARs were checked on the following residents:

All initialed and up to date.

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


summary: Fire alarm. False alarm.

raw_content:
CFS - Unit Response Times Printed on March 15, 2023
]

CFS # CFS2304194
Call Taker ANN GRAVES
Location 1521 ALBERT ST, FORREST CITY, AR 72335 (Woodridge Behavioral Center)

Location Details
Primary Incident Code FUNK : Fire Unknown

Mod Emergency Fire/Medical
Priority 1
Use Caution No
Primary Disposition Handled By Officer / Deputy
Beat
Zone Forrest City Police Department
Call Time 02/05/23 10:36:27
Completed Time 02/05/23 10:55:24

Reporters
AR ALARMS (Initial Reporter) |
Sex
DOB
Address

Report Time 02/05/23 10:36:27
How Reported

From Phone

Contact Phone (866) 858-8950
Comments

Other Names

Vehicles |
Responders

CALL1 FCFD (Primary)

FCE1 (Primary) FCFD, Engine CO 1 FCFD (Primary)

FCE2 FCFD, Engine Co 2 FCFD (Primary)

532 (Primary) 532 - MARLOW, JOHN FCPD

Response Times

Assigned 02/05/23 10:36:40
Enroute 02/05/23 10:38:04
Arrived 02/05/23 10:41:34
Leaving

Arrived At

Completed 02/05/23 10:55:24

IR / External Agency Numbers

FCFD 202300148
FCPD202300950

Officer Addenda

Unit Response Times
a |

Page 1 of 2

Non Unit Specific Times |
02/05/23 10:36:27 | New CFS
02/05/23 10:39:43 | RECEIVING A FIRE ALARM COMING FROM ZONE 581 THE GYM STORAGE UPSTAIRS AND
ZONE 583 FOR GYM LIGHT SMOKE

02/05/23 10:41:19 | THE ALARM COMPANY CALLED BACK AND STATED THAT THEY MADE CONTACT
8706333220 AND THEY SAID SHE HAD MAINTANCE THERE CHECKING IT OUT BUT IM GOING TO LET THE
FIRE DEPARTMENT CHECK IT OUT TO MAKE SURE

02/05/23 10:43:14 | NOTHING SHOWING AT THIS TIME
02/05/23 10:55:11 | EVERYTHING IS GOING TO BE 10-4

532
02/05/23 10:39:50 | Assign

02/05/23 10:39:53 | Enroute
02/05/23 10:41:34 | On Scene
02/05/23 10:53:22 | Available

CALL1 |
02/05/23 10:36:40 | Assign

CALL1, FCE1, FCE2

02/05/23 10:55:24 | Complete

FCE1 |
02/05/23 10:38:04 | Enroute

FCE2 |
02/05/23 10:39:36 | Enroute |

02/05/23 10:44:36 | On Scene |

Page 2 of 2

CFS - Command Log Printed on March 15, 2023

CFS # CFS2304194
Call Taker ANN GRAVES
Location 1521 ALBERT ST, FORREST CITY, AR 72335 (Woodridge Behavioral Center)

Location Details
Primary Incident Code FUNK : Fire Unknown

Mod Emergency Fire/Medical

Priority 1

Use Caution No

Primary Disposition Handled By Officer / Deputy

Beat

Zone Forrest City Police Department

Call Time 02/05/23 10:36:27

Completed Time 02/05/23 10:55:24
Reporters

AR ALARMS (Initial Reporter)

Sex

DOB

Address

Report Time 02/05/23 10:36:27

How Reported

From Phone

Contact Phone (866) 858-8950

Comments

Other Names

Vehicles

Responders
CALL1 FCFD (Primary)
FCE1 (Primary) FCFD, Engine CO 1 FCFD (Primary)
FCE2 FCFD, Engine Co 2 FCFD (Primary)
532 (Primary) 532 - MARLOW, JOHN FCPD

Response Times

Assigned 02/05/23 10:36:40
Enroute 02/05/23 10:38:04
Arrived 02/05/23 10:41:34
Leaving

Arrived At

Completed 02/05/23 10:55:24

IR / External Agency Numbers

FCFD 202300148
FCPD202300950

Officer Addenda

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

Page 1jof 2

02/05/23 10:36:27 | GRAVES, ANN | New CFS
02/05/23 10:36:40 | GRAVES, ANN | CALL1 | Assign

02/05/23 10:38:04 | FCFD, Engine CO 1| FCE1 | Enroute
02/05/23 10:39:36 | FCFD, Engine Co 2 | FCE2 | Enroute

02/05/23 10:39:43 | GRAVES, ANN | RECEIVING A FIRE ALARM COMING FROM ZONE 581 THE GYM STORAGE

UPSTAIRS AND ZONE 583 FOR GYM LIGHT SMOKE
02/05/23 10:39:50 | GRAVES, ANN | 532 | Assign

02/05/23 10:39:53 | GRAVES, ANN | 532 | Enroute |
02/05/23 10:41:19 | GRAVES, ANN | THE ALARM COMPANY CALLED BACK AND STATED THAT THEY MADE

CONTACT 8706333220 AND THEY SAID SHE HAD MAINTANCE THERE CHECKING IT OUT BUT IM GOING TO

LET THE FIRE DEPARTMENT CHECK IT OUT TO MAKE SURE

02/05/23 10:41:34 | GRAVES, ANN | 532 | On Scene

02/05/23 10:43:14 | GRAVES, ANN | NOTHING SHOWING AT THIS TIME
02/05/23 10:44:36 | FCFD, Engine Co 2 | FCE2 | On Scene

02/05/23 10:53:22 | GRAVES, ANN | 532 | Available

02/05/23 10:55:11 | GRAVES, ANN | EVERYTHING IS GOING TO BE 10-4
02/05/23 10:55:24 | GRAVES, ANN | CALL1, FCE1, FCE2 | Complete

cLQ

Requested At
Sent To

Status
Received At
Location ‘
Accuracy

of 2


summary: A resident was sent to Forrest City Medical Center for evaluation after complaining of pain, redness, and swelling to the eye, head, and knee following a physical altercation with a peer.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 2/3/2023
Date Received by DCCECE: 2/6/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Facility Type: Residential
Incident Type: Licensing
Report Description: Residents Name/DOB: Date/Time of
incident: 2.3.2023/ 1:00pm Please describe the incident: Per the staff report, the resident was
involved in a physical altercation in the gym. After the altercation, the resident complained
of swelling, redness, and pain of Rt eye; pain of head, redness, and pain of Lt knee skin
intact and redness of chest Actions Taken: Resident was sent out to FCMC for further
evaluation. The resident returned to the facility with a diagnosis of:
. The resident was placed on peer restriction from the resident he
was in a physical altercation with. The resident was also placed on assault precautions for
initiating the fight. Staff and nursing will continue to monitor the residents progress while in
the milieu and school. Guardianship: Private Placement
Interim Action Narrative: Resident was sent to FCMC for further evaluation. Diagnosis:
. Resident was placed on peer restriction
and assault precaution.
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing Specialist viewed camera footage of incident. 2/7/2023,
Licensing Specialist reviewed provider reported incident. 2/8/2023, Licensing Specialist
confirmed that resident was assessed by the nurse before being evaluated at FCMC.
Licensing Specialist will inquire about nursing notes.

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: Perimeter Behavioral of Forrest City
Facility Number: 142
Licensee Address: 603 KITTLE ROAD
FORREST CITY AR 72335
Licensing Specialist: Kendra Rice
Person In Charge: Helena Coplin
Record Visit Date: 2/8/2023
Home Visit Date: 2/8/2023
Purpose of Visit: Self Report Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Time of Visit: 2:15 pm to 4:00 pm
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Census: 56
Licensing Specialist reviewed camera footage on 2/6/2023 for provider reported incident that happened on
2/3/2023. Ratio was 3:14.
Licensing Specialist observed some residents playing basketball with staff. Licensing Specialist observed
some residents sitting on the bench, a staff member standing by a bench, and another staff member at the
doorway of the gym.
Licensing Specialist observed resident, and a peer go up for what appeared to be a layup and there was a slight
tussle over the basketball. It appeared that words were exchanged, and resident shoved peer. Licensing
Specialist observed staff going toward the basketball goal where the two residents were being physical with
each other. Licensing Specialist observed staff pointing toward the doorway of the gym. The residents were
separated by staff and the peer walked out the doorway of the gym.
Licensing Specialist then observed resident attempting to be physical with his peers that remained in the gym.
Staff intervened and the resident was separated from his peers. Licensing Specialist observed the peer from
the first incident enter back into the gym. Staff was observed blocking peer from getting to the resident.
Licensing Specialist observed resident being assessed by a female staff member and escorted out the gym.
Staff intervened to the physical altercation and other attempts.
Licensing Specialist and Ms. Coplin discussed the incident. Due to resident initiating the physical altercation
he was placed on assault precaution and peer restriction.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident was sent to Forrest City Medical Center for evaluation after punching a window.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 2/3/2023
Date Received by DCCECE: 2/6/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Facility Type: Residential
Incident Type: Licensing
Report Description: Residents Name/DOB: Date/Time of incident:
2.3.2023/ 1:00pm Please describe the incident: Per the staff report, the resident became
upset with a peer while in the gym. The resident walked out of area and punched a window
shattering the glass in the gym courtyard. Actions Taken: Resident was sent out to FCMC
for further evaluation. The resident returned to the facility with a diagnosis of: No acute
fracture of dislocation. The proximal and distal carpal rows are adequately aligned. The soft
tissues are grossly remarkable. The resident was also placed on self-harm precautions and
will be assessed in 72 hours (about 3 days) for safety. Staff and nursing will continue to
monitor the residents' progress while in the milieu and school. The glass was cleaned up by
maintenance and window replaced on the 2.3.2023. Guardianship: Private Placement
Interim Action Narrative: Resident was sent to FCMC for further evaluation. Diagnosis:
. The soft tissues are grossly remarkable. Resident was placed o
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing Specialist reviewed provider reported incident. Licensing
Specialist will follow-up with facility on type of glass that was replaced. 2/8/2023, Licensing
Specialist confirmed that resident was assessed by the nurse before being evaluated at
FCMC. Licensing Specialist informed that the shattered window was replaced with
plexiglass. Licensing Specialist informed that resident has been released from self-harm
precautions.


summary: A resident was sent to Forrest City Medical Center for evaluation after complaining of a sore throat and not being able to yawn.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 2/2/2023
Date Received by DCCECE: 2/6/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Facility Type: Residential
Incident Type: Licensing
Report Description: Residents Name/DOB: Date/Time of
incident: 2.2.2023/ 7:30pm Please describe the incident: Per the nurses report, the resident
was complaining of sore throat and not being able to yawn. Actions Taken: Resident was
sent out to FCMC for further evaluation. The resident returned to the facility with a
diagnosis of: . The resident was placed on a 24-hour quarantine
and started a new antibiotic to assist with illness. Nursing and staff will continue to monitor
the residents' progress in the milieu and while in school. Guardianship: AR Foster Care
Interim Action Narrative: Resident was sent to FCMC for further evaluation. Diagnosis:
and was prescribed a new . Resident was placed on a
24-hour quarantine.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed provider reported incident. No licensing
concerns noted. 2/8/2023, Licensing Specialist confirmed that resident was assessed by the
nurse before being evaluated at FCMC.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Officers were dispatched to the facility in response to a resident walking away from the facility.

raw_content:
CES - Unit Response Times Printed on March 15, 2023

49

CFS # CFS2303838
Call Taker SYDNEY MORGAN
Location 1521 ALBERT ST, FORREST CITY, AR 72335 (Woodridge Behavioral Center)

Location Details
Primary Incident Code ESCAPE : Escape

Mod In Progress

Priority 1

Use Caution No

Primary Disposition Handled By Officer / Deputy

Beat

Zone Forrest City Police Department

Call Time 02/02/23 13:27:39

Compieted Time 02/02/23 13:47:09
Reporters

PERIMETER HEALTH CARE (Initial Reporter)

Sex

DOB

Address 1521 ALBERT ST

FORREST CITY, AR 72335
Report Time 02/02/23 13:27:39
How Reported
From Phone
Contact Phone (870) 970-3475
Comments

Other Names
Vehicles

Responders
581 (Primary) 581 - CALLAHAN, STEVEN FCPD (Primary)

Response Times

Assigned 02/02/23 13:27:39
Enroute 02/02/23 13:47:09 *
Arrived 02/02/23 13:47:09 *
Leaving

Arrived At

Completed 02/02/23 13:47:09

IR / External Agency Numbers
Officer Addenda

Unit Response Times

Non Unit Specific Times
02/02/23 13:32:13 | WALKED OFF FROM FACILITY HE WILL BE WEARING A GREEN
| |

JACKET TYE DYE GREEN AND BEIGE PANTS 5'7 120LBS

Page 1 of 2

02/02/23 13:33:30 | 542 IN THE AREA WITH 581
02/02/23 13:45:17 | 581 OUT AT THE FACILITY
02/02/23 13:46:59 | 581 ADVISED MALE SUBJECT BACK AT FACILITY

581

02/02/23 13:27:39 | New CFS

02/02/23 13:47:09 | Complete

Page 2 of 2

CFS - Command Log Printed on March 15, #023

CFS # CFS2303838
Call Taker SYDNEY MORGAN
Location 1521 ALBERT ST, FORREST CITY, AR 72335 (Woodridge Behavioral Center)

Location Details
Primary Incident Code ESCAPE : Escape

Mod In Progress

Priority 1

Use Caution No

Primary Disposition Handled By Officer / Deputy

Beat

Zone Forrest City Police Department

Call Time 02/02/23 13:27:39

Completed Time 02/02/23 13:47:09
Reporters

PERIMETER HEALTH CARE (Initial Reporter)

Sex

DOB

Address 1521 ALBERT ST

FORREST CITY, AR 72335
Report Time 02/02/23 13:27:39
How Reported
From Phone
Contact Phone (870) 970-3475
Comments

Other Names
Vehicles

Responders
581 (Primary) 581 - CALLAHAN, STEVEN FCPD (Primary)

Response Times

Assigned 02/02/23 13:27:39
Enroute 02/02/23 13:47:09 *
Arrived 02/02/23 13:47:09 *
Leaving

Arrived At

Completed 02/02/23 13:47:09

IR / External Agency Numbers

Officer Addenda

Command Log Filter: All Commands | Details: Hidden | Units: All Units | Revised Entries: Shown
02/02/23 13:27:39 | MORGAN, SYDNEY | 581 | New CF |
02/02/23 13:32:13 | MORGAN, SYDNEY WALKED OFF FROM FACILITY HE WILL BE
WEARING A GREEN JACKET TYE DYE AND BEIGE PANTS 5'7 120LBS

Page lof 2

02/02/23 13:33:30 | MORGAN, SYDNEY | 542 IN THE AREA WITH 581
02/02/23 13:45:17 | MORGAN, SYDNEY | 581 OUT AT THE FACILITY

02/02/23 13:46:59 | MORGAN, SYDNEY | 581 ADVISED MALE SUBJECT BACK AT FACILITY
02/02/23 13:47:09 | MORGAN, SYDNEY | 581 | Complete

CLQ

Requested At
Sent To

Status
Received At
Location ‘
Accuracy

Page 2

of 2


summary: Fire alarm. False alarm.

raw_content:
CES - Command Log Printed on March 15, 2023

CFS # CFS2303235
Call Taker KILEY HOWTON
Location 1521 ALBERT ST, FORREST CITY, AR 72335 (Woodridge Behavioral Center)

Location Details
Primary Incident Code ALRF : Fire Alarm

Mod Emergency Fire/Medical

Priority 5

Use Caution No

Primary Disposition Handled By Officer / Deputy

Beat

Zone Madison Police Department

Call Time 01/28/23 09:30:15

Completed Time 01/28/23 09:43:05
Reporters

OLD ARKANSAS ALARMS (Initial Reporter)

Sex |

DOB

Address

Report Time 01/28/23 09:30:15
How Reported Phone

From Phone

Contact Phone (866) 858-8950
Comments

Other Names

Vehicles

Responders
CALL1 FCFD (Primary)
FCBAT1 FCFD, Battalion Chief FCFD (Primary)
FCE1 FCFD, Engine CO 1 FCFD (Primary)
FCE2 (Primary) FCFD, Engine Co 2 FCFD (Primary)
543 (Primary) 543 - MITLEFF, DALTON FCPD

Response Times

Assigned 01/28/23 09:31:46
Enroute 01/28/23 09:32:40
Arrived 01/28/23 09:34:19
Leaving

Arrived At

Completed 01/28/23 09:43:05

IR / External Agency Numbers
FCFD 202300100

Officer Addenda

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

Page 1 of 2

01/28/23 09:30:15 | HOWTON, KILEY | New CFS

01/28/23 09:31:46 | HOWTON, KILEY | CALL1 | Assign
01/28/23 09:32:02 | HOWTON, KILEY | 543 | Assign

01/28/23 09:32:40 | FCFD, Engine Co 2 | FCE2 | Enroute
01/28/23 09:33:20 | FCFD, Battalion Chief | FCBAT1 | Enroute
01/28/23 09:33:25 | HOWTON, KILEY | MOTION IS ROOM 301 SMOKE DETECTOR
01/28/23 09:34:19 | LAWS, ALLISON | 543 | On Scene

01/28/23 09:36:33 | FCFD, Battalion Chief | FCBAT1 | On Scene

01/28/23 09:37:12 | FCFD, Engine CO 1| FCE1 | On Scene

01/28/23 09:37:41 | FCFD, Engine Co 2 | FCE2 | Available

01/28/23 09:42:06 | HOWTON, KILEY | 543 | Available - ADVISED EVERYTHING 104-
01/28/23 09:42:14 | HOWTON, KILEY | 10-4

01/28/23 09:42:28 | FCFD, Battalion Chief | FCBAT1 | Message - smoke detector is broken, maintenance is on scene

to get it repaired or call alarm company if its beyond their skill.
01/28/23 09:42:39 | FCFD, Battalion Chief | FCBAT1 | Available
01/28/23 09:43:05 | HOWTON, KILEY | CALL1, FCE1 | Complete

CLQ

Requested At
Sent To

Status
Received At
Location ‘
Accuracy

of 2

CFS - Unit Response Times Printed on March 15, 2023

CFS # CFS2303235
Call Taker KILEY HOWTON
Location 1521 ALBERT ST, FORREST CITY, AR 72335 (Woodridge Behavioral Center)

Location Details
Primary Incident Code ALREF : Fire Alarm

Mod Emergency Fire/Medical

Priority 5

Use Caution No

Primary Disposition Handled By Officer / Deputy

Beat

Zone Madison Police Department

Call Time 01/28/23 09:30:15

Completed Time 01/28/23 09:43:05
Reporters

OLD ARKANSAS ALARMS (Initial Reporter) |

Sex

DOB

Address

Report Time 01/28/23 09:30:15
How Reported Phone

From Phone

Contact Phone (866) 858-8950
Comments

Other Names

Vehicles

Responders
CALL1 FCFD (Primary)
FCBAT1 FCFD, Battalion Chief FCFD (Primary)
FCE1 FCFD, Engine CO 1 FCFD (Primary)
FCE2 (Primary) FCFD, Engine Co 2 FCFD (Primary)
543 (Primary) 543 - MITLEFF, DALTON FCPD

Response Times

Assigned 01/28/23 09:31:46
Enroute 01/28/23 09:32:40
Arrived 01/28/23 09:34:19
Leaving

Arrived At

Completed 01/28/23 09:43:05

IR / External Agency Numbers
FCFD 202300100

Officer Addenda

Unit Response Times |
aS || ee
Page 1 of 2

Non Unit Specific Times

01/28/23 09:30:15 | New CFS

01/28/23 09:33:25 | MOTION IS ROOM 301 SMOKE DETECTOR
01/28/23 09:42:14 | 10-4

543
01/28/23 09:32:02 | Assign
01/28/23 09:34:19 | On Scene

01/28/23 09:42:06 | Available - ADVISED EVERYTHING 104-

CALL1

01/28/23 09:31:46 | Assign

CALL1, FCE1

01/28/23 09:43:05 | Complete

FCBAT1 |
01/28/23 09:33:20 | Enroute

01/28/23 09:36:33 | On Scene |
01/28/23 09:42:28 | Message - smoke detector is broken, maintenance is on scene to get it repaired or call alarm
company if its beyond their skill.
01/28/23 09:42:39 | Available

FCE1 |
01/28/23 09:37:12 | On Scene

FCE2
01/28/23 09:32:40 | Enroute

01/28/23 09:37:41 | Available |

Page 2 of 2


summary: A resident was sent to Forrest City Medical Center for evaluation after complaining of ankle pain and swelling from playing basketball.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 1/26/2023
Date Received by DCCECE: 1/27/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Facility Type: Residential
Incident Type: Licensing
Report Description: Residents Name/DOB: Date/Time of
incident: 1/24/2023 unknown/Reported 1/26/2023 5:00pm Please describe the incident: Per
the staff report, the resident complained of pain and swelling in his Lt ankle due to playing
basketball in the gym. The residents had a 5 on 5 basketball tournament competing for a
residential hall party. Actions Taken: Resident was assessed by nursing. The APRN was
contacted and requested the resident be sent out to FCMC for further evaluation. The
resident was diagnosed with the following: . Mild
hammertoe deformity of the third through fifth digit. Nursing will continue to monitor the
residents' progress while in school and on the milieu. Guardianship: AR Foster Care
Interim Action Narrative: Resident was assessed by nursing and sent to FCMC for further
evaluation. Nursing will continue to monitor resident's progress.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed provider reported incident. No licensing
concerns noted.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for evaluation after complaining of pain and swelling in his thumb due to playing basketball.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 1/26/2023
Date Received by DCCECE: 1/27/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Facility Type: Residential
Incident Type: Licensing
Report Description: Residents Name/DOB: Date/Time of incident:
1/24/2023 unknown/Reported 1/26/2023 5:00pm Please describe the incident: Per the staff
report, the resident complained of pain and swelling in his Rt thumb due to playing
basketball in the gym. The residents had a 5 on 5 basketball tournament competing for a
residential hall party. Actions Taken: Resident was assessed by nursing. The APRN was
contacted and requested the resident be sent out to FCMC for further evaluation. The
resident was diagnosed with the following: . The proximal
and distal carpal rows are adequately aligned. The soft tissues are grossly remarkable.
Nursing will continue to monitor the residents' progress while in school and on the milieu.
Guardianship: Private Placement
Interim Action Narrative: Resident was assessed by nursing and the APRN was contacted.
APRN ordered for resident to be further evaluated at FCMC.
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing Specialist reviewed provider reported incident. No licensing
concerns noted.


summary: A complaint alleged that a staff member pushed a resident into his bedroom. The complaint was UNFOUNDED by Licensing.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 1/20/2023
Date Received by DCCECE: 1/30/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Facility Type: Residential
Incident Type: Maltreatment
Report Description: Residents Name/DOB: Date/Time of
incident: 1/19/2023 unknown/Reported 1/30/2023 1:45pm Please describe the incident: Per
DHS investigator an allegation was made on 1/19/2023 against a staff member
, it was alleged the staff member pushed the resident into his bedroom on 1/19/2023.
Actions Taken: Resident will be assessed by nursing and any findings will be documented
on an incident report. Camera review was conducted with the DHS investigator on
1/30/2023 at 1:48pm. Per camera review, did not interact with the resident on
the day of the allegation. was assigned to a different group of residents and
worked the hours of 7:00am-4:00pm. has been placed on an Interim Corrective
Action plan pending this investigation's findings. Staff and nursing will continue to monitor
the residents' progress while in school and on the milieu. Guardianship: Private Placement
Interim Action Narrative: Staff ( ) was placed on an ICA that has been approved. Staff
will not have any direct contact with the residents until investigation is completed. Resident
was assessed by nursing.
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing Specialist reviewed complaint. and inquired about an ICA
for the alleged staff member involved. Licensing Specialist emailed Investigator Byles.
1/31/2023, Licensing Specialist requested nursing notes. 2/2/2023, Licensing Specialist
received an email from Keri Worley, DCFS inquiring about what licensing had put in place.
Ms. Worley informed Licensing Specialist she plans to follow-up with the family. 1/6/2023,
Licensing Specialist reviewed camera footage and interviewed resident. 2/15/2023,
Licensing Specialist emailed Investigator Worley.


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

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Perimeter Behavioral of Forrest City
Facility Number: 142
Licensee Address: 603 KITTLE ROAD
FORREST CITY AR 72335
Licensing Specialist: Kendra Rice
Person In Charge: Helena Coplin
Record Visit Date: 1/20/2023
Home Visit Date: 1/20/2023
Purpose of Visit: Child Record Review Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulations Not Correctable:
Narrative:
Time of Visit: 9:15 am to 1:30 pm
Census: 57
Licensing Specialist reviewed five (5) children’s files:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year
Page 1 of 2

All children’s files reviewed complied with the minimum licensing standards.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year
Page 2 of 2


summary: A resident was sent to Forrest City Medical Center for evaluation after complaints of abdominal pain, nausea, and vomiting.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 1/19/2023
Date Received by DCCECE: 1/20/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Facility Type: Residential
Incident Type: Licensing
Report Description: Residents Name/DOB: Date/Time of incident:
1/19/2023 12:59pm Please describe the incident: Per the staff report, the resident
complained of abdominal pain, nausea, and vomiting. Actions Taken: Resident was
assessed by nursing. The APRN was contacted and requested the resident be sent out to
FCMC for further evaluation. The resident was diagnosed with the following:
. Nursing will continue to monitor the residents' progress while in
school and on the milieu. Guardianship: AR Foster Care
Interim Action Narrative: Resident assessed by nursing and APRN contacted. Resident
referred to FCMC for further evaluation.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed Provider Reported Incident. No
licensing concerns noted.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for evaluation after he was kicked in the face by a peer during a physical altercation.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 1/19/2023
Date Received by DCCECE: 1/20/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Facility Type: Residential
Incident Type: Licensing
Report Description: Residents Name/DOB: Date/Time of incident:
1/19/2023 11:30am Please describe the incident: Per the staff report, the resident was in a
physical altercation with a peer. During the altercation the resident was kicked in the face
by his peer. The resident complained that his nose may be broken. Actions Taken: Resident
was assessed by nursing. The APRN was contacted and requested the resident be sent out
to FCMC for further evaluation. The resident was diagnosed with the following:
. The resident and his peer were both placed on peer restriction and
assault precautions. Precautions will be re-evaluated in the next 72 hours. Guardianship: AR
Foster Care
Interim Action Narrative: Resident was assessed by nursing and APRN contacted. Further
evaluation completed at FCMC. Both residents were placed on peer restriction and assault
precautions.
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing Specialist will inquire about location of altercation.
1/23/2023, Licensing Specialist informed there is camera footage but no witness statements.
Licensing Specialist will schedule day and time to review camera footage. 1/26/2023,
Licensing Specialist reviewed camera footage and nursing notes.

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: Perimeter Behavioral of Forrest City
Facility Number: 142
Licensee Address: 603 KITTLE ROAD
FORREST CITY AR 72335
Licensing Specialist: Kendra Rice
Person In Charge: Charlotte Lockhart
Record Visit Date: 1/26/2023
Home Visit Date: 1/26/2023
Purpose of Visit: Self Report Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulations Not Correctable:
Narrative:
Time of Visit: 11:15 am to 12:30 pm
Census: 56
Licensing Specialist reviewed camera footage on 1/26/2023 for provider reported incident on 1/19/2023.
Licensing Specialist received and reviewed nursing notes.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year
Page 1 of 2

Licensing Specialist observed resident standing at the nurse’s station and it appeared having a verbal
altercation with a peer. Resident was observed throwing a cup at his peer. The peer was observed
attacking the resident. Staff was observed quickly separating the two residents. Licensing Specialist observed
the peer taken to the side by staff and the resident was placed inside the nurse’s station.
The other residents were escorted off the hall. The peer was taken down the hall by a staff member and once
the other residents were off the hall, he was escorted off the hall as well. Resident was observed coming
out of the nurse’s station. The other residents were observed coming back by the nurse’s station for their
medication. There was a total of three (3) staff members and a nurse during this time.
When the other residents arrived on the hall, staff was observed keeping the peer and resident separated.
Resident ( ) was observed trying to get to his peer. Resident was placed in a restraint, ratio (1:1). Staff
stood around the peer to prevent contact with the resident. Peer kept trying to go around staff and was able to
kick the resident while he was in a restraint.
Peer was placed in a restraint, ratio (2:1). Other staff members were observed on the hall to assist with the
residents. Resident was observed by the nurse and Licensing Specialist observe the nurse on her cell phone
after she assessed the resident. Resident was released from his restraint to receive medical attention. Peer was
released from his restraint once he had calmed down.
Licensing Specialist and Ms. Lockhart (CEO) discussed the incident. Licensing Specialist was informed that
support staff were called to assist with incident. Staff responded quickly and were able to separate the
residents. Licensing Specialist did not observe any licensing concerns reviewing camera footage.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year
Page 2 of 2


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

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 1/16/2023
Date Received by DCCECE: 1/17/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Facility Type: Residential
Incident Type: Licensing
Report Description: Residents Name/DOB: Date/Time of
incident: 1/16/2023 12:54pm Please describe the incident: Per the staff report, the resident
complained of pain in his Rt ankle from playing basketball Actions Taken: Resident was
assessed by nursing. The APRN was contacted and requested the resident be sent out to
FCMC for further evaluation. The resident was diagnosed with the following:
The ankle mortis is intact. Soft tissues are grossly unremarkable.
Nursing will continue to monitor the residents' progress in the milieu and school.
Guardianship: TX Foster Care
Interim Action Narrative: Resident was assessed by nursing and had further evaluation at
FCMC.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed provider reported incident. No licensing
concerns noted.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for evaluation after complaining of sore throat, nausea, and a consistent cough.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 1/15/2023
Date Received by DCCECE: 1/16/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Facility Type: Residential
Incident Type: Licensing
Report Description: Residents Name/DOB: Date/Time of incident:
1/15/2023 8:20am Please describe the incident: Per the staff report, the resident complained
of sore throat, nausea, and a consistent cough. Actions Taken: Resident was assessed by
nursing. The APRN was contacted and requested the resident be sent out to FCMC for
further evaluation. The resident was diagnosed with the following: Encounter for screening,
unspecified. Nursing will continue to monitor the residents' progress in the milieu and
school. Guardianship: Private Placement
Interim Action Narrative: Resident assessed by nursing and seen at FCMC for further
evaluation.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed Provider Reported Incident. No
licensing concerns noted.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for evaluation after complaining of feeling cold, loss of appetite, sore throat, nausea, and a consistent cough.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 1/15/2023
Date Received by DCCECE: 1/16/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Facility Type: Residential
Incident Type: Licensing
Report Description: Residents Name/DOB: Date/Time of incident:
1/15/2023 8:20am Please describe the incident: Per the staff report, the resident complained
of feeling cold, loss of appetite, sore throat, nausea, and a consistent cough. Actions Taken:
Resident was assessed by nursing. The APRN was contacted and requested the resident be
sent out to FCMC for further evaluation. The resident was diagnosed with the following:
. Nursing will continue to monitor the residents' progress in the milieu and school.
Guardianship: Private Placement
Interim Action Narrative: Resident was assessed by nursing and further evaluation at
FCMC.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed Provided Reported Incident. No
licensing concerns noted.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for evaluation after complaining of abdominal pain and nausea.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 1/14/2023
Date Received by DCCECE: 1/16/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Facility Type: Residential
Incident Type: Licensing
Report Description: Residents Name/DOB: Date/Time of
incident: 1/14/2023 6:00pm Please describe the incident: Per the staff report, the resident
complained of abdominal pain and nausea. Actions Taken: Resident was assessed by
nursing. The APRN was contacted and requested the resident be sent out to FCMC for
further evaluation. The resident was diagnosed with the following: . Nursing
will continue to monitor the residents' progress in the milieu and school. Guardianship: AR
Foster Care
Interim Action Narrative: Resident was assessed by nursing and sent to FCMC for further
evaluation.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed Provided Reported Incident. No
licensing concerns noted.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for evaluation after complaining of ankle pain and swelling from playing kickball.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 1/13/2023
Date Received by DCCECE: 1/16/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Facility Type: Residential
Incident Type: Licensing
Report Description: Residents Name/DOB: Date/Time of
incident: 1/13/2023 4:18pm Please describe the incident: Per the staff report, the resident
complained of pain and swelling in his Rt ankle from playing kick ball outside. Actions
Taken: Resident was assessed by nursing. The APRN was contacted and requested the
resident be sent out to FCMC for further evaluation. The resident was diagnosed with the
following: The proximal and distal carpal rows are
adequately aligned. The soft tissues are grossly unremarkable. Guardianship: Private
Placement
Interim Action Narrative: Resident was assessed by nursing and further evaluation at
FCMC per request of APRN.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed Provider Reported Incident. No
licensing concerns noted.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for evaluation after complaining of pain and swelling in his hand from playing basketball.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 1/13/2023
Date Received by DCCECE: 1/16/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Facility Type: Residential
Incident Type: Licensing
Report Description: Residents Name/DOB: Date/Time of
incident: 1/13/2023 4:26pm Please describe the incident: Per the staff report, the resident
complained of pain and swelling in his Rt hand from playing basketball in the gym. Actions
Taken: Resident was assessed by nursing. The APRN was contacted and requested the
resident be sent out to FCMC for further evaluation. The resident was diagnosed with the
following: . The proximal and distal carpal rows are
adequately aligned. The soft tissues are grossly unremarkable. Guardianship: Private
Placement
Interim Action Narrative: Resident assessed by nursing and further evaluation at FCMC.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed Provider Reported Incident. No
licensing concerns noted.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for evaluation of a laceration after horseplaying with a peer.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 1/13/2023
Date Received by DCCECE: 1/16/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Facility Type: Residential
Incident Type: Licensing
Report Description: Residents Name/DOB: Date/Time of
incident: 1/13/2023 4:05pm Please describe the incident: Per staff report, the resident
reported to the nurse that he was horseplaying with a peer and obtained a laceration to the
Rt eyebrow. Actions Taken: Resident was assessed by nursing. The APRN was contacted
and requested the resident be sent out to FCMC for further evaluation. The resident was
diagnosed with the following:
The resident has been placed on assault precautions and peer
restrictions from the resident he was horseplaying with. Guardianship: Private Placement
Interim Action Narrative: Resident was assessed by nursing and further evaluation at
FCMC. Resident placed on assault precautions and peer restrictions.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist will inquire if peer involved received any
precautions. Licensing Specialist was informed, both residents involved were placed on peer
restrictions and assault precautions. 1/19/2022, Licensing Specialist followed-up with
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facility. Licensing Specialist was informed that the incident occurred in the resident's
bedroom. 1/20/2023, Licensing Specialist interviewed resident.

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: Perimeter Behavioral of Forrest City
Facility Number: 142
Licensee Address: 603 KITTLE ROAD
FORREST CITY AR 72335
Licensing Specialist: Kendra Rice
Person In Charge: Helena Coplin
Record Visit Date: 1/20/2023
Home Visit Date: 1/20/2023
Purpose of Visit: Self Report Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulations Not Correctable:
Narrative:
Time of Visit: 1:30 pm to 1:45 pm
Census: 57
Licensing Specialist interviewed resident regarding his injury to his eyebrow.. Resident informed Licensing
Specialist that he injured his right eyebrow on the television while horse playing in the dayroom. Resident
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informed Licensing Specialist that staff redirected him to stop horse playing but he did not stop until he inured
his eyebrow.
Resident informed Licensing Specialist that he has learned his lesson about horse playing. Licensing
Specialist ended the interview.
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summary: A resident reported to his mother that a peer forced him to perform oral sex on him. The complaint was UNFOUNDED by Licensing.

raw_content:
Licensing Narrative: Licensing Specialist emailed Investigator Harris. Licensing Specialist
received permission to communicate with facility. 1/6/2023, Licensing Specialist received
witness statements. Licensing Specialist inquired about the sexual safety plan for the
residents. Licensing Specialist will review the witness statements. 1/9/2023 Licensing
Specialist followed up with Investigator Harris. Case is still pending. 2/3/2023, Licensing
Specialist emailed investigator for an update. Licensing Specialist informed case is still
pending.

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: Perimeter Behavioral of Forrest City
Facility Number: 142
Licensee Address: 603 KITTLE ROAD
FORREST CITY AR 72335
Licensing Specialist: Kendra Rice
Person In Charge: Helena Coplin
Record Visit Date: 1/6/2023
Home Visit Date: 1/6/2023
Purpose of Visit: Complaint Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulations Not Correctable:
Narrative:
Time of Visit: 12:00 pm to 3:30 pm
Census: 58
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Licensing Specialist received a complaint on 1/4/2023. A resident told his mother that his roommate was
hitting him with a stuff animal on a phone call. He also told his mother that his peer pulled down his pants and
allegedly forced him to perform oral sex in their bedroom.
There was no camera footage to view due to this incident taking place in the resident’s bedroom. Licensing
Specialist received witness statements from both residents. Licensing Specialist inquired about the sexual
safety plan. Licensing Specialist was informed the sexual safety plan consists of peer restriction, single room
placement, and interaction with other residents is observed until investigation is completed.
Licensing Specialist is not prepared to leave a finding at this time.
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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: Perimeter Behavioral of Forrest City
Facility Number: 142
Licensee Address: 603 KITTLE ROAD
FORREST CITY AR 72335
Licensing Specialist: Kendra Rice
Person In Charge: Helena Coplin
Record Visit Date: 2/17/2023
Home Visit Date: 2/17/2023
Purpose of Visit: Complaint Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
No in-person licensing visit completed on 2/17/2023.
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Licensing Specialist received a complaint on 1/4/2023. Licensing Specialist reviewed witness statements on
1/6/2023.
Licensing Specialist informed by Investigator Harris case closed.
Licensing complaint is unfounded.
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summary: A resident was sent to Forrest City Medical Center for an x-ray after complaining of pain from punching his mattress.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 1/3/2023
Date Received by DCCECE: 1/4/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Facility Type: Residential
Incident Type: Licensing
Report Description: Residents Name/DOB : Date/Time of
incident: 1/3/2022 3:20pm Please describe the incident: Per staff report, the resident was in
his room punching his mattress against. He stated that he was using his coping skills. The
resident complained of pain in the RT 4th digit with mild swelling. Actions Taken: The
nurse evaluated the resident and contacted the APRN. The resident was sent out to FCMC
for an X-Ray. The resident?s X-Ray presented the following findings: No acute fracture or
dislocation. The proximal and distal carpal rows are adequately aligned. The soft tissues are
grossly unremarkable. The resident has been placed on self-harm precautions and will be
re-evaluated in 72 hours (about 3 days) and staff will continue to monitor the residents'
progress in the milieu and school. Guardianship: Private Placement
Interim Action Narrative: Resident was evaluated by the nurse and transferred to FCMC for
x-ray, no acute fraction or dislocation. Resident placed on self-harm precautions.
Maltreatment Narrative: Outcome:
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humanservices.arkansas.gov

Licensing Narrative: Licensing Specialist will inquire about self-harm precautions.
Licensing Specialist was informed that resident was placed on self-harm precautions due to
taking his mattress off the bed, placing the mattress on the wall to punch, and causing a
self-inflicted injury. No licensing concerns noted.


summary: A resident was sent to Forrest City Medical Center for an x-ray after reporting that he swallowed 2 staples.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 1/3/2023
Date Received by DCCECE: 1/4/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Facility Type: Residential
Incident Type: Licensing
Report Description: Residents Name/DOB : Date/Time of incident:
1/3/2022 5:20pm Please describe the incident: Per staff report, the resident walked to the
nursing station and reported to the nurse that he found 2 stables in the quiet room and
swallowed them. Actions Taken: The nurse evaluated the resident and contacted the APRN.
The resident was sent out to FCMC for an X-Ray. The resident?s X-Ray presented the
following findings: The visualized bowel gas pattern is unremarkable. Mild constipation
noted. No foreign bodies. There is no free air or evidence of obstruction. No pathologic
appearing calcification are identified projecting over the kidneys or usual course of the
ureters. The osseous structure are intact. The resident has been placed on line of sight and
staff will continue to monitor the residents progress in the milieu and school. Guardianship:
Private Placement
Interim Action Narrative: Resident evaluated by the nurse and sent to FCMC for x-ray.
Resident placed on line of sight.
Maltreatment Narrative: Outcome:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing Specialist will inquire about the staples and prevention.
Licensing Specialist informed that resident did not swallow the staples. X-ray revealed not
foreign bodies. Daily maintenance walk throughs are conducted by Maintenance Supervisor
and Directory of Quality and Risk Management. 1/6/2023, Licensing Specialist and
Director of Quality and Risk Management discussed the prevention plan for when residents
are in the classrooms.

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: Perimeter Behavioral of Forrest City
Facility Number: 142
Licensee Address: 603 KITTLE ROAD
FORREST CITY AR 72335
Licensing Specialist: Kendra Rice
Person In Charge: Helena Coplin
Record Visit Date: 1/6/2023
Home Visit Date: 1/6/2023
Purpose of Visit: Self Report Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulations Not Correctable:
Narrative:
Time of Visit: 12:00 pm to 3:30 pm
Census: 58
Licensing Specialist spoke with Ms. Coplin, Director of Quality and Risk Management regarding staple
incidents. Resident reported to staff that he swallowed two staples. X-ray revealed foreign body of alimentary
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track. Another resident reported to staff he found two staples and swallowed them. X-ray revealed no foreign
bodies.
Licensing Specialist was informed that teachers have been made aware for staples to be kept out of view of
the residents. Licensing Specialist was also informed that residents are not allowed behind or around the
teachers’ desk.
Little Boys’ Classroom ratio 3:14. Big Boys’ Classroom ratio 3:13
Licensing Specialist and Ms. Coplin discussed how her and the Maintenance Lead complete daily
walk-throughs of the facility. Licensing Specialist was informed that Education has black tape on the floor to
mark how close residents are allowed to the teacher’s desk. Licensing Specialist will follow-up with facility
on 1/13/2023 to make sure that each classroom is marked.
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summary: A resident was sent to Forrest City Medical Center for evaluation due to complaining of wrist pain after a physical altercation with a peer.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 1/2/2023
Date Received by DCCECE: 1/3/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Facility Type: Residential
Incident Type: Licensing
Report Description: Residents Name/DOB : Date/Time of
incident: 1/2/2022 9:32pmm Please describe the incident: Per staff report, the resident was
involved in a physical altercation with a peer. The resident complained of Rt wrist pain.
Actions Taken: The nurse evaluated the resident. The resident was sent out to FCMC for
further evaluation; he was diagnosed with the following: ,
resident was placed on assault Precautions and peer restrictions to ensure little to no contact
precautions will be reassessed in 72 hours. Nursing and staff will continue to monitor the
residents' progress while in the milieu. Guardianship: Private Placement
Interim Action Narrative: Resident was evaluated by the nurse. He was sent to FCMC for
further evaluation. Diagnosis: Resident was placed on
assault precautions and peer restrictions to ensure little to no contact.
Maltreatment Narrative: Outcome:
Licensing Narrative: Resident was assessed by the nurse and evaluated at FCMC.
Diagnosis: . No licensing concerns noted.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident reported that he and his peer engaged in sexual contact when he snuck into his peer’s room.

raw_content:
Interim Action Narrative: and screened out. All residents and staff were
interviewed and statements collected. Resident is in a single room assignment.
Residents are peer restricted to ensure little to no contact, both have been placed on line of
sight precauti
Maltreatment Narrative: Outcome:
Licensing Narrative: Licensing Specialist will inquire about the assign investigator. No
investigator due to being screened out. Licensing will inquire about late reporting.
Licensing Specialist informed that resident did not report incident to staff until 1/5/2023.
1/6/2023, Licensing Specialist viewed camera footage of reported incident on 1/2/2023 and
received witness statements from residents and staff members. Licensing Specialist will
review witness statements. 1/9/2023, Licensing Specialist reviewed witness statements.
is the staff member that was informed of the incident by the resident. Licensing Specialist
will verify what staff member were present that night of the incident. Licensing Specialist
informed that staff member was not present the night of the incident. Staff members
and were the staff members that Licensing Specialist observed on the camera footage.

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Perimeter Behavioral of Forrest City
Facility Number: 142
Licensee Address: 603 KITTLE ROAD
FORREST CITY AR 72335
Licensing Specialist: Kendra Rice
Person In Charge:
Record Visit Date: 1/6/2023
Home Visit Date: 1/6/2023
Purpose of Visit: Self Report Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulations Not Correctable:
Narrative:
Time of Visit: 12:00 pm to 3:30 pm
Census: 58
Licensing Specialist reviewed camera footage on 1/5/2023 for reported incident on 1/2/2023. It was reported
that a resident snuck in his peer’s room and got behind the door and kissed him. Resident reported that his
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peer grabbed the back of his head and pulled it in front of his private area and told him to “suck it.” Resident
confirmed that he performed oral sex on his peer. Resident did not inform staff of this incident until 1/5/2023.
Licensing Specialist observed a staff member at each end of the hallway. At one end of the hallway was a
staff member and two residents what appeared to be a huddle. The other staff member was at the end of the
hallway alone. Licensing Specialist observed resident walking down the hallway and standing in the doorway
of a bedroom. Resident entered the bedroom, and another resident was observed standing in the door. The first
resident who entered the bedroom quickly left the bedroom and walked down the hall.
Licensing Specialist received witness statements from the staff and residents. It was reported that the
timeframe of this incident was before bedtime. Licensing Specialist was informed that bedtime is 8:30 pm.
Licensing Specialist is not prepared to leave a finding at this time.
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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: Perimeter Behavioral of Forrest City
Facility Number: 142
Licensee Address: 603 KITTLE ROAD
FORREST CITY AR 72335
Licensing Specialist: Kendra Rice
Person In Charge: Helena Coplin
Record Visit Date: 1/25/2023
Home Visit Date: 1/25/2023
Purpose of Visit: Self Report Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulations Not Correctable:
Narrative:
Time of Visit: 11:00 am to 11:30 am
Census: 58
Licensing Specialist reviewed camera footage on 1/5/2023 for provider reported incident on 1/2/2023.
Licensing Specialist have reviewed provided witness statements.
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After review of camera footage and witness statements, Licensing Specialist did not observe any licensing
concerns regarding this provider reported incident.
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