summary: Resident became non-compliant when prompted to get out of bed and later reported on a phone call to her parents that she was dragged out of her bed and beaten up by staff member. Resident reported she was dragged by her wrists and ankles, and her hair pulled to the point that strands broke off. A pin-point red area was noted to resident’s inner ankle and her knee. This 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
7/24/2023R
Notice of Serious Incident
Date of Incident: 7/22/2023
Date Received by DCCECE: 7/24/2023
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Dual
Report Description: AR Mandated Reporter Portal: During the morning shift, patient
became non-compliant
when prompted to get out of bed. Staff disengaged from the argument,
gives responsibility to another staff member and removed herself from interaction with
later reported on a phone call to her parents that she was dragged out of
bed and beaten up by staff member . This was reported to have happened
on 7/23/23. She reported that she was dragged by her wrists and ankles and her hair was
pulled to the point that some strands of hair broke off. Nursing assessment indicates that
there was no injury in the areas where stated that she was hit or harmed. Patient
pointed to a pin-point red area on her left inner ankle and one to inside lateral right knee.
The allegation was ACCEPTED for investigation by Reference ID:
was immediately placed on administrative leave, pending the results of the
investigation.
Interim Action Narrative: Staff was immediately placed on administrative
leave pending investigation.
Maltreatment Narrative: Ref# Allegation: ABUSE- AV stated that during the
morning shift that staff person dragged her out of the bed and beat her. It was noted that
staff dragged the AV by her wrists, ankles and her hair was pulled to the point that some
strands of her hair broke.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing received report from facility and Maltreatment notification
7/24/23 that client reported being physically assaulted by staff
on 7/23/23. Phone call made to Chris Butler of Millcreek 7/24/23 who
stated that video was available for the day in question, 7/23/23, but that client has since
stated that the incident of physical abuse happened a week, a couple weeks or maybe a
month ago. Phone call made 7/24/23 to Jennifer Harper of Ms. Harper scheduled
an appointment to meet licensing at Millcreek 7/26/23 at 9:30AM. Received email from
Chris Butler of Millcreek 7/24/23 that client is client roommate.
The staff member that overheard the allegation of abuse reported to parents on a phone call
was . Also indicated is that without a specific time or day (client has
changed her report and is unsure of when the event took place), it is not possible to pinpoint
staff that may have witnessed the event. Facility visited 7/26/23 in response to complaint
made by client that staff member physically harmed her. Licensing
attended interview by Investigator Jennifer Harper with client Client
reported that about "2 weeks ago...8AM in the morning in the hall between dayrooms,
mostly kids around, don't know their names, pulled my hair...then sat on my
bed and apologized". Client reported about "1 week after the first incident...asked for a 5-
minute time out...she came in there and grabbed my arm and my leg and dragged me off
my bed, mostly staff saw, and " ( adding that "
wrote a witness statement regarding the incident of her ( hair being pulled. Witness
statement of reviewed which did report that staff had pulled her hair
when attempting to pull jacket hood. Licensing interviewed staff
(" ") during facility visit 7/26/23. stated that she did not witness
on any day, get physical with client stated that on the day
believed to be in question, had asked to go into her room and
said no. Kids are kept out of their rooms in the day areas/hallways for the most
part during waking hours. At this point was sitting in the hallway and had cursed at
another client. stated that she, not , engaged client in
attempts to deescalate the situation. stated that she never witnessed
have any interaction with client after saying she could not enter her room.
added that she had never seen any staff at Millcreek be physically inappropriate
with any clients. Staff interviewed during facility visit 7/26/23.
stated that she was not aware nor witnessed any physical confrontation between client
and staff . stated she has never witnessed
be physically inappropriate with any clients. Licensing is not prepared to make a finding at
this time, 7/26/23. Received email 11/10/23 that maltreatment report was unfounded.

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: Millcreek of Arkansas PRTF
Facility Number: 233
Licensee Address: 1828 INDUSTRIAL DRIVE
FORDYCE AR 71742
Licensing Specialist: Clayton DeBoer
Person In Charge:
Record Visit Date: 7/26/2023
Home Visit Date: 7/26/2023
Purpose of Visit: Complaint Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Facility visited 7/26/23 in response to complaint made by client that staff member
physically harmed her.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Licensing attended interview by Investigator with client . Client reported
that about "2 weeks ago...8AM in the morning in the hall between dayrooms, mostly kids around, don't know
their names, pulled my hair...then sat on my bed and apologized". Client reported about "1 week
after the first incident...asked for a 5-minute time out...she came in there and grabbed my arm and my leg and
dragged me off my bed, mostly staff saw, and adding that " " wrote a
witness statement regarding the incident of her ( 's) hair being pulled. Witness statement of
reviewed which did report that staff had pulled her hair when attempting to pull 's
jacket hood.
Licensing interviewed staff during facility visit 7/26/23. stated that
she did not witness , on any day, get physical with client . stated that on the
day believed to be in question, had asked to go into her room and said no.
Kids are kept out of their rooms in the day areas/hallways for the most part during waking hours. At this point
was sitting in the hallway and had cursed at another client. stated that she, not ,
engaged client in attempts to deescalate the situation. stated that she never witnessed
have any interaction with client after saying she could not enter her room. added
that she had never seen any staff at Millcreek be physically inappropriate with any clients.
Staff interviewed during facility visit 7/26/23. stated that she was not aware nor
witnessed any physical confrontation between client and staff . stated she
has never witnessed be physically inappropriate with any clients.
Licensing is not prepared to make a finding at this time, 7/26/23.
Provider Comments:
CCL Staff Signature : Date: 8/22/2023
Provider Signature : Date: 8/22/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Millcreek of Arkansas PRTF
Facility Number: 233
Licensee Address: 1828 INDUSTRIAL DRIVE
FORDYCE AR 71742
Licensing Specialist: Clayton DeBoer
Person In Charge:
Record Visit Date: 11/20/2023
Home Visit Date: 11/20/2023
Purpose of Visit: Revisit Complaint
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
This is to document that licensing complaint Case#015194 involving A/V and A/O is
unfounded.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Provider Comments:
CCL Staff Signature : Date: 11/20/2023
Provider Signature : Date: 11/20/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


state: AR

facility_name: Millcreek Behavioral Health / Habilitation Center, Inc.

summary: A resident was sent to Dallas County Medical Center for assessment of a laceration 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: 7/13/2023
Date Received by DCCECE: 7/14/2023
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: DSS Custody, DOB: , was
sent to the Dallas County Medical Center for assessment following a physical confrontation
with a peer. She was punched in the face, receiving a small laceration above the left eye. The
laceration was treated with Dermabond and she was released to return to the facility.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: Licensing received incident report from facility 7/14/23 at 5:02PM
that on 7/13/23 client was sent to the Dallas County Medical Center for
assessment following a physical confrontation with a peer. She was punched in the face,
receiving a small laceration above the left eye. The laceration was treated with Dermabond,
and she was released to return to the facility. Email sent to facility 7/17/23 to inquire about
video footage of the altercation. Facility visited 7/18/23 and video reviewed of the
altercation involving from 7/13/23 which occurred in Penguin Hall. Hall video reviewed
which shows one staff standing and one sitting. One client aggressively enters a bedroom.
Within seconds staff present respond by following. The client who appears to be the
aggressor leaves the bedroom. The client who seems to have been attacked by the aggressor
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

exits her room aggressively as to retaliate. At this point 7 additional staff are present and
briefly restrain this client. All staff viewed in video seem to respond to this incident as fast as
possible.

doc_type: Notice of Incident


summary: A resident was sent to Dallas County Medical Center for x-rays after reporting hand pain from a physical confrontation 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: 7/11/2023
Date Received by DCCECE: 7/12/2023
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: (Kentucky, DHS custody, DOB: was sent to DCMC for
outpatient x-rays after reporting pain in his hand. The injury was a result of a physical
confrontation on 7/7/23. X-ray report has not been received at the time of this report. He
was released to return to the facility.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: Received report from facility that on 7/11/23 client was
sent to DCMC for outpatient x-rays after reporting pain in his hand. The injury was a result
of a physical confrontation on 7/7/23. X-ray report has not been received at the time of this
report. He was released to return to the facility. Received email from facility 7/13/23 that
client's is and there is no video footage of the confrontation. Also, X-ray
results indicate no fracture was found.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Licensing visited the facility to conduct an afterhours buildings and grounds walkthrough. The facility received technical assistance for 911.6 for a hole found in the laminate tile flooring.

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: Millcreek of Arkansas PRTF
Facility Number: 233
Licensee Address: 1828 INDUSTRIAL DRIVE
FORDYCE AR 71742
Licensing Specialist: Clayton DeBoer
Person In Charge:
Record Visit Date: 7/11/2023
Home Visit Date: 7/12/2023
Purpose of Visit: Monitor Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Number: 9. 911. 6
Regulation Description: All buildings and furnishings shall be safe, clean, and in good repair.
Findings Description: Bedroom 2 of Deerfield had 4"x4" hole in laminate tile. Maintenance order was put in to
have that piece of laminate tile replaced.
Action Due Date: 7/26/2023
Action Due Description: Piece of floor tile with hole replaced.
Comply Date:
Sub Regulation Description:
Regulation Not Applicable:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Regulations Not Correctable:
Narrative:
After hours Buildings & Grounds conducted for Deerfield from 5:45PM-6:45PM. Census: 12. Staff/client
ratio 2:12.
Living area and sleeping area clean, safe and in good repair except Bedroom 2 had 4"x4" hole in laminate tile.
Facility given T/A for 911.6: All buildings and furnishings shall be clean, safe and in good repair.
Maintenance order was put in to have that piece of laminate tile replaced. All other floor areas in Deerfield in
good condition. Bathrooms clean and sanitary with functioning sinks and toilets. Showers had hot water.
Grounds outside Deerfield clean and free of safety hazards.
MAR checked for:
BB 3/3/13
AC 9/26/11
AG 3/20/12
JL 12/25/10
JK 11/6/14
All initialed and up to date.
Provider Comments:
CCL Staff Signature : Date: 8/22/2023
Provider Signature : Date: 8/22/2023
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 Dallas County Medical Center for an x-ray after reporting hand pain following a game of 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: 7/10/2023
Date Received by DCCECE: 7/11/2023
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: , Parent Custody, DOB: ) was referred to
DCMC for outpatient x-ray after reporting pain in his hand following a recreational game of
basketball. No fracture was found, and he was released to return to the facility without
restriction.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: On 7/11/23 report received from facility that on 7/10/23 client
was referred to DCMC for outpatient x-ray after reporting pain in his hand following
a recreational game of basketball. No fracture was found, and he was released to return to
the facility without restriction. No licensing concerns noted from this incident.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Dallas County Medical Center for an x-ray after punching a wall.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 7/10/2023
Date Received by DCCECE: 7/11/2023
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: , Parent Custody, DOB: ) was referred to
DCMC for outpatient x-ray after reporting pain in his hand following an incident in which
he punched a wall. No fracture was found, and he was released to return to the facility
without restriction.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: Licensing received notification from facility on 7/11/23 that on
7/10/23 client was referred to DCMC for outpatient x-ray after reporting pain
in his hand following an incident in which he punched a wall. No fracture was found, and
he was released to return to the facility without restriction. No licensing concerns noted
from this incident.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Dallas County Medical Center for an x-ray of his hand after punching a wall.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 7/10/2023
Date Received by DCCECE: 7/11/2023
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: , DHHR Custody, DOB: ) was
referred to DCMC for outpatient x-ray after reporting pain in his hand following an incident
in which he punched a wall. No fracture was found, and he was released to return to the
facility without restriction.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: On 7/11/23 report received from facility that on 7/10/23 client
was referred to DCMC for outpatient x-ray after reporting pain in his
hand following an incident in which he punched a wall. No fracture was found, and he was
released to return to the facility without restriction. No licensing concerns noted from this
incident.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Dallas County Medical Center for an x-ray of her foot after 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: 7/7/2023
Date Received by DCCECE: 7/10/2023
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: reported foot pain after playing a game of kickball. After
seeing the medical director, she was referred to DCMC for outpatient x-ray. No fracture was
found. She was released to return to the facility without restriction.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: Licensing received incident report 7/10/23 that client
reported foot pain after playing a game of kickball. Phone call made to Chris Butler of
Millcreek to determine that first name is , DOB foster care.
After seeing the medical director, she was referred to DCMC for outpatient x-ray. No
fracture was found. She was released to return to the facility without restriction. No
licensing concerns noted from this incident.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Dallas County Medical Center for an x-ray of her wrist after slipping and trying to catch herself while falling.

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: 7/7/2023
Date Received by DCCECE: 7/10/2023
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: Custody, DOB: was sent to
DCMC for outpatient x-ray. She reported pain in her wrist after slipping in her bedroom
while changing clothes and trying to catch herself when falling. X-ray report indicates that
no fracture was found. She was returned to the facility without restriction.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: Licensing received report that client was sent to DCMC
for outpatient x-ray. She reported pain in her wrist after slipping in her bedroom while
changing clothes and trying to catch herself when falling. X-ray report indicates that no
fracture was found. She was returned to the facility without restriction. No licensing
concerns noted in complaint. Client remains at the facility.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Licensing visited the facility to conduct a buildings and grounds walkthrough. Technical assistance for 911.6 was provided for two showers not functioning in Zebra Hall.

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: Millcreek of Arkansas PRTF
Facility Number: 233
Licensee Address: 1828 INDUSTRIAL DRIVE
FORDYCE AR 71742
Licensing Specialist: Clayton DeBoer
Person In Charge: Joretha Bragg
Record Visit Date: 7/6/2023
Home Visit Date: 7/6/2023
Purpose of Visit: Monitor Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Number: 9. 911. 6
Regulation Description: All buildings and furnishings shall be safe, clean, and in good repair.
Findings Description: The flooring has been addressed on previous visits and is being replaced unit wide as
needed. The two showers not functioning in Zebra Hall will need to be fixed by visit to facility next week.
Action Due Date: 7/10/2023
Action Due Description: All 3 showers in Zebra Hall will need to be fully functional. Maintenance order has been
placed before today's visit.
Comply Date:
Sub Regulation Description:
Regulation Not Applicable:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 3

Regulations Not Correctable:
Narrative:
Buildings & Grounds conducted from 11AM-12AM. Census: 159.
Zebra and Flamingo Halls inspected. Zebra staff client ratio: 3:16. Flamingo staff/client ratio: 2:5 (some
clients on field trip).
All buildings and grounds clean, safe and in good repair other than previously addressed holes/tears in
laminate tiles which facility is replacing unit wide and two showers in Zebra Hall. Two showers in Zebra Hall
had, per staff, not been working for about two days and a maintenance order had been placed for this.
Sleeping areas furnished and in good repair. Bathrooms clean and sanitary. Day Room's clean, furnished and
in good repair. Clients present in Day Room areas were engaged in activities.
MAR checked for:
Facility given T/A for 911.6: All buildings and furnishings shall be clean, safe and in good repair. The
flooring has been addressed on previous visits and is being replaced unit wide as needed. The two showers not
functioning in Zebra Hall will need to be fixed by visit to facility next week.
Provider Comments:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 3

CCL Staff Signature : Date: 8/22/2023
Provider Signature : Date: 8/22/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 3 of 3

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: Millcreek of Arkansas PRTF
Facility Number: 233
Licensee Address: 1828 INDUSTRIAL DRIVE
FORDYCE AR 71742
Licensing Specialist: Clayton DeBoer
Person In Charge: Christie Aaron
Record Visit Date: 7/6/2023
Home Visit Date: 7/6/2023
Purpose of Visit: Monitor Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
This is to document that the following staff are not employed by Millcreek of Arkansas:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Provider Comments:
CCL Staff Signature : Date: 8/22/2023
Provider Signature : Date: 8/22/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident was sent to Dallas County Medical Center for an x-ray of his hand after he punched a wall.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 6/28/2023
Date Received by DCCECE: 6/28/2023
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: On 06.27.23, Parent Custody, DOB: ) was
referred to DCMC for outpatient x-ray of his right hand. His injury resulted from an incident
where he punched a wall on 06.25.23 after a phone call with his father. X-ray report received
on 06.28.23 indicates a fracture but is inconclusive on whether this injury is from the current
incident or a previously healed fracture. A follow up appointment with PCP is scheduled for
06.29.23.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: On 06.27.23, client was referred to DCMC for outpatient
x-ray of his right hand. His injury resulted from an incident where he punched a wall on
06.25.23 after a phone call with his father. X-ray report received on 06.28.23 indicates a
fracture but is inconclusive on whether this injury is from the current incident or a
previously healed fracture. A follow up appointment with PCP is scheduled for 06.29.23.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A former resident reported that while he was at Millcreek in 2022, his roommate raped him. The alleged victim stated that he told his therapist at Millcreek, but she did nothing about it and “blamed him”.

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
R
Notice of Serious Incident
Date of Incident: 6/26/2023
Date Received by DCCECE: Millcreek of Arkansas PRTF
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Dual
Report Description: Ref# Assigned Investigator with Contact Information: Gregoria
Garcia, Summary of the Incident(s): AV is . AO is a
former roommate at Mill Creek, yo unknown. communicated that while he was at
Mill Creek in 2022, his roommate raped him. He reports that he was in the Pebble Ranch
cabin, and it occurred after bed checks. It was prior to December of 2022. stated that
he told his therapist at Mill Creek, but she did nothing about it and ?blamed him?. He
stated that his roommate climbed into his bed after bed checks, pulled down his pants, and
raped him. He stated that his roommate was also older and biggen than him and was
?mixed?.
Interim Action Narrative:
Maltreatment Narrative: Ref# Assigned Investigator with Contact Information:
Gregoria Garcia, Summary of the Incident(s): AV is . AO
is a former roommate at Mill Creek, yo unknown. communicated that while he
was at Mill Creek in 2022, his roommate raped him. He reports that he was in the Pebble
Ranch cabin, and it occurred after bed checks. It was prior to December of 2022.
stated that he told his therapist at Mill Creek, but she did nothing about it and ?blamed
him?. He stated that his roommate climbed into his bed after bed checks, pulled down his
pants, and raped him. He stated that his roommate was also older and biggen than him and
was ?mixed?.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Received Maltreatment Complaint notification 6/26/23: Ref#
Assigned Investigator with Contact Information: Gregoria Garcia, . Summary
of the Incident(s): AV is . AO is a former roommate at Mill Creek, yo
unknown. communicated that while he was at Mill Creek in 2022, his roommate
raped him. He reports that he was in the Pebble Ranch cabin, and it occurred after bed
checks. It was prior to December of 2022. stated that he told his therapist at Mill
Creek, but she did nothing about it and ?blamed him?. He stated that his roommate
climbed into his bed after bed checks, pulled down his pants, and raped him. He stated that
his roommate was also older and biggen than him and was ?mixed?. Licensing was given
approval by Investigator via phone 6/26/23 to contact facility. Phone call made to facility
6/26/23 to confirm that was a Millcreek PRTF client and that his therapist
was . Visit scheduled for 6/27/23. Facility visited 6/27/23 in response to
complaint. All therapy notes reviewed for client Nothing in therapy notes is indicative
of subject matter in complaint. Licensing is not prepared to make a finding at this time.
was client last assigned therapist. Therapy notes reviewed included
notes from staff/therapists/therapist interns , , ,
and . 8/3/2023-Maltreatment investigation is still open and
pending at this time. 9/5/23-Case#014888 Maltreatment Complaint Unsubstantiated.
Facility visited and 521 findings issued.

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: Millcreek of Arkansas PRTF
Facility Number: 233
Licensee Address: 1828 INDUSTRIAL DRIVE
FORDYCE AR 71742
Licensing Specialist: Clayton DeBoer
Person In Charge:
Record Visit Date: 6/27/2023
Home Visit Date: 6/27/2023
Purpose of Visit: Complaint Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Facility visited 6/27/23 in response to complaint. All therapy notes reviewed for client Nothing in therapy notes is
indicative of subject matter in complaint. Licensing is not prepared to make a finding at this time.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Provider Comments:
CCL Staff Signature : Date: 6/27/2023
Provider Signature : Date: 6/27/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Millcreek of Arkansas PRTF
Facility Number: 233
Licensee Address: 1828 INDUSTRIAL DRIVE
FORDYCE AR 71742
Licensing Specialist: Clayton DeBoer
Person In Charge:
Record Visit Date: 9/5/2023
Home Visit Date: 9/5/2023
Purpose of Visit: Revisit Complaint
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
9/5/23-Facility visited. Case#014888 Maltreatment Report closed as Unsubstantiated.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Provider Comments:
CCL Staff Signature : Date: 9/5/2023
Provider Signature : Date: 9/5/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident was sent to Dallas County Medical Center for assessment of a laceration to the nose 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: 6/24/2023
Date Received by DCCECE: 6/26/2023
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: On 6/24/23, Parent Custody, DOB:
) was sent to Dallas County Medical Center for outpatient assessment following
his involvement in a physical confrontation. During the confrontation, he was punched in
the nose by a peer. On-site nursing referred him to DCMC for a laceration to the nose. The
laceration was closed using Dermabond. A CT scan of facial bones was performed out of
precaution. He was released to return to the facility. On 6/26/23 CT report received.
Revealed a slightly displaced left nasal bone fracture. Follow up with ENT is forthcoming.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: On 6/24/23, client was sent to Dallas County Medical
Center for outpatient assessment following his involvement in a physical confrontation.
During the confrontation, he was punched in the nose by a peer. On-site nursing referred
him to DCMC for a laceration to the nose. The laceration was closed using Dermabond. A
CT scan of facial bones was performed out of precaution. He was released to return to the
facility. On 6/26/23 CT report received. Revealed a slightly displaced left nasal bone
fracture. Follow up with ENT is forthcoming. Phone call made 6/26/23 to Chris Butler of
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Millcreek who stated there was video footage of this incident. Visit scheduled for 6/27/23.
Facility visited 6/27/23 and video reviewed of the incident which occurred at Pine Ridge on
6/24/23. Staff/client ratio visible in video 2:8. The fight itself appears to take place out of
video view, but the aggressor can be seen punching something (which later in the video is
revealed to be client ). As soon as the aggressor begins to punch two staff are seen
intervening. As soon as the staff intervene another altercation is seen at which point the
same two staff intervene in that altercation. Staff are seen using the phone and the nurse is
seen entering Pine Ridge a couple minutes later. Client then appears in video bleeding,
using a towel to wipe the blood. Both staff observed in video intervene seemingly as fast as
they possibly can in both altercations.


summary: Licensing visited the facility to review personnel files. 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: Millcreek of Arkansas PRTF
Facility Number: 233
Licensee Address: 1828 INDUSTRIAL DRIVE
FORDYCE AR 71742
Licensing Specialist: Clayton DeBoer
Person In Charge:
Record Visit Date: 6/21/2023
Home Visit Date: 6/21/2023
Purpose of Visit: Personnel Records
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Personnel Records Review conducted for staff:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

KH DOH: 5/22/23
NT DOH: 2/17/25
FW DOH: 11/3/08
TG DOH: 5/14/18
GJ DOH: 4/17/17
NL DOH: 4/5/04
LN DOH: 10/28/14
NT DOH: 4/18/17
MC DOH: 10/3/22
AT DOH: 1/11/10
All items per Minimum Licensing Standards accounted for.
Provider Comments:
CCL Staff Signature : Date: 8/22/2023
Provider Signature : Date: 8/22/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident was sent to Dallas County Medical Center for x-rays after hitting his thumb against the wall while horseplaying.

raw_content:
AR KAN S A S&S
DEPARTMENT OF

+4 HUMAN
<a¥ SERVICES

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot $140, Little Rock, AR 72203-1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550

Notice of Serious Incident

Date of Incident: 6/15/2023

Date Received by DCCECE: 6/16/2023

Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233

Incident Type: Licensing

Report Description: Ree > cBs Custody, DOB: a) was sent

to Dallas County Medical Center for outpatient x-rays. He reported pain in his thumb as a
result of him hitting it against the wall during a moment of horseplay. X-ray report reveals
no fracture. He was released to return to the facility.

Interim Action Narrative:

Maltreatment Narrative:

Licensing Narrative: Client 3 was sent to Dallas County Medical Center for
outpatient x-rays. He reported pain in his thumb as a result of him hitting it against the wall
during a moment of horseplay. X-ray report reveals no fracture. He was released to return to
the facility.

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humanservices.arkansas.gov


summary: A complaint received states: Resident has been at Millcreek since 2019 for mental health. Since December 2022 until now, there have been 6 or more phone calls from staff stating the resident has been injured due to an altercation. This past weekend, (6/10-6/11), a nurse reported the resident tried to run away, and a staff member tried stopping him. The staff member “accidentally” kneed the resident in the mouth. The caller believes that something more may be going on at the facility and doesn’t understand how a staff person’s knee could accidentally make its way to the child’s mouth. It is believed that the resident does have injuries, but the exact level of injury is unknown.

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
R
Notice of Serious Incident
Date of Incident: 6/13/2023
Date Received by DCCECE: Millcreek of Arkansas
Facility Name: Millcreek of Arkansas
Facility Number: 187
Incident Type: Dual
Report Description: AV is AO is Unknown Unknown-One (age
unknown), who is a staff member at Mill Creek Behavioral Health. has been at
Millcreek since 2019 for mental health. He has
. Since December 2022 until now, there have been 6 or more phone calls from staff
stating has been injured due to an altercation. This past weekend, (6/10 ? 6/11), a
nurse reported tried to run away, and the AO tried stopping him. AO "accidentally"
kneed in the mouth. The caller believes that something more may be going on at the
facility and doesn't understand how a staff person's knee could accidentally make it's way to
the child's mouth. It is believed that AV does have injuries but the exact level of injury is
unknown.
Interim Action Narrative:
Maltreatment Narrative: Ref# AV is AO is Unknown
Unknown-One (age unknown), who is a staff member at Mill Creek Behavioral Health.
Isaiah has been at Millcreek since 2019 for mental health. He has
. Since December 2022 until now, there have been 6 or more phone calls
from staff stating has been injured due to an altercation. This past weekend, (6/10 ?
6/11), a nurse reported tried to run away, and the AO tried stopping him. AO
"accidentally" kneed in the mouth. The caller believes that something more may be
going on at the facility and doesn't understand how a staff person's knee could accidentally
make it's way to the child's mouth. It is believed that AV does have injuries but the exact
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humanservices.arkansas.gov

level of injury is unknown. Received email 7/13/23 that Maltreatment Report was
unfounded.
Licensing Narrative: Recieved Maltreatment Complaint notification 6/13/23 as follows: AV
is AO is Unknown Unknown-One (age unknown), who is a staff
member at Mill Creek Behavioral Health. Isaiah has been at Millcreek since 2019 for mental
health. He has . Since December 2022 until
now, there have been 6 or more phone calls from staff stating has been injured due to
an altercation. This past weekend, (6/10 ? 6/11), a nurse reported tried to run away,
and the AO tried stopping him. AO "accidentally" kneed in the mouth. The caller
believes that something more may be going on at the facility and doesn't understand how a
staff person's knee could accidentally make it's way to the child's mouth. It is believed that
AV does have injuries but the exact level of injury is unknown. Phone call made by licensing
to facility 6/13/23 to confirm that client resides at Millcreek of Arkansas
Residential Oak Creek. Facility visited 6/14/23 in response to complaint that U/K staff had
injured client Licensing met Lasonya Goffin, , at Oak Creek
Residential House of Millcreek. was interviewed. When asked client reported that he
liked everything about Millcreek. reported that he had never been hit nor kicked by staff
at Millcreek. was asked about recent events, last weekend. was asked again if he was
hit or kicked "no". was asked what happened "I ran...I got mad...staff chased me...put
me back on unit...that's it...I told my Dad I had bad behavior". was asked again, and
denied ever being hit by staff. Gary Sneed, Millcreek ICF Program Director, consulted who
stated that at no time was unsupervised during this event. never made it off Oak
Creek property, making it to the trash cans at the end of the yard line. At no time during the
interview with today did indicate he successfully eloped from Oak Creek. Received
email 7/13/23 that Maltreatment Report was unfounded.


summary: A resident was sent to Dallas County Medical Center for a CT scan due to having blood-tinged sputum/stool.

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: 6/13/2023
Date Received by DCCECE: 6/14/2023
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: ( , Parent Custody, DOB ) Per Dr. Walley, the
patient was sent to Dallas Medical Center for a CT scan due to having blood-tinged
sputum/stool for a couple of days. returned from DCMC with orders not to eat or
drink after midnight just in case they need to do another CT scan with contrast. Follow-up
appointments will be scheduled as necessary.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: Client , per Dr. Walley, the patient was sent to Dallas
Medical Center for a CT scan due to having blood-tinged sputum/stool for a couple of days.
returned from DCMC with orders not to eat or drink after midnight just in case
they need to do another CT scan with contrast. Follow-up appointments will be scheduled
as necessary. Client remains at facility.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Dallas County Medical Center for an x-ray after injuring his right foot by tripping over something days before.

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: 6/8/2023
Date Received by DCCECE: 6/15/2023
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: DCFS Custody, DOB ) was sent
over to Dallas County Medical Center for X-ray due to him limping, patient stated he had
tripped over something a couple of days ago. On 6/15/23 X-ray report stated that due to the
right foot pain, there is a fracture to the distal third metatarsal neck.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: Client was sent over to Dallas County Medical Center
for X-ray due to him limping, patient stated he had tripped over something a couple of days
ago. On 6/15/23 X-ray report stated that due to the right foot pain, there is a fracture to the
distal third metatarsal neck. On 6/15/23 Licensing phoned Joretha Bragg, Risk Mgmt.
Coordinator for Millcreek, to confirm that the X-ray was completed on 6/14/23, not 6/8/23.
The incident that caused the client pain happened on 6/8/23.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Dallas County Medical Center for assessment following a physical altercation with a peer.

raw_content:
happened. stated that one staff was about "5 steps" from him when this happened.
stated that 5 other clients were with him from Tiger Hall when this happened. DW stated
that it took about "3 seconds" for staff to get to him after attacked him. stated that
afterwards he immediately went to the nurse's office then to the emergency room where he
got a "ring pop". stated that he received "staples". When asked stated that his
injury does not hurt today. stated that he felt comfortable telling staff at Millcreek if he
ever felt unsafe. interviewed. stated that he was with his group outside "playing".
stated that he was sitting on a bench, and that came and sat on top of him. He
stated that he told DW to get off of him and pushed him. He said that then threw a
stick at him. He said that then ran from him. stated that he punched in the eye
when he caught him. stated that staff broke it up "right away". stated that he felt
comfortable telling staff at Millcreek if he ever felt unsafe.


summary: A resident was sent to Dallas County Medical Center for assessment of his eye 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: 5/28/2023
Date Received by DCCECE: 5/30/2023
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Facility Type:
Incident Type: Licensing
Report Description: , DHHR Custody, DOB: 8) was sent to
Dallas County Medical Center for assessment. He was referred for swelling noted to his eye
following a physical confrontation that happened the previous day. He was assessed at
DCMC and released to return to the facility. The eye was irrigated only. If necessary, further
treatment could be provided by PCP.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: Clientr was sent to Dallas County Medical Center
for assessment. He was referred for swelling noted to his eye following a physical
confrontation that happened the previous day. He was assessed at DCMC and released to
return to the facility. The eye was irrigated only. If necessary, further treatment could be
provided by PCP. Phone call made to Chris Butler of Millcreek 5/31/23 who stated that
there is no video of the altercation. Facility visited 6/2/23 in response to self-report incident
of client being punched in the eye. Clients and interviewed. TS is who punched
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humanservices.arkansas.gov


summary:
During a camera review of a physical restraint of a patient, it was determined that two staff members did not perform the restraint in compliance of facility expectations. Staff hit the resident in the face as a response to being bitten on the arm. The other staff member can be seen pulling the resident’s shirt over their face.
The facility was cited 109.1.g and 905.4.g as a result of this incident. The staff members were terminated.

raw_content:
Licensing Narrative: During a camera review of a physical restraint of patient ,
it was determined that staff members and did not perform the
restraint in compliance of facility expectations. Staff hit in the face as a
response to being bitten on the arm. In an effort to stop Hannah from spitting on the staff
members, was seen to have pulled up 's shirt, covering 's mouth and
restricting her ability to freely breathe. No injuries were sustained by the patient. A report of
these findings was made to the Arkansas Mandated Reporter Portal. Reference ID:
Both staff members were placed on administrative leave, pending termination. Received
text message 5/25/23 from Chris Butler of Millcreek that Maltreatment Report was
accepted. Received email from Licensing 5/25/23 that Maltreatment Report was accepted.
Facility visited 5/25/23 and video reviewed of incident. Two staff are seen standing,
and . Client is sitting, staff reportedly asking client to take her
sweatshirt off for contraband search. Client is seen beginning to take her sweatshirt off.
While taking sweatshirt off, staff and grab both sleeves aggressively as to
remove shirt quicker. Client stands up and takes a swing at staff Anderson. The two staff
and an one additional staff take client to the ground. While on the ground, client is
seen biting staff on the arm. Staff Anderson is seen jabbing the face of client
with her right hand with a fist. Staff is then seen pushing her fist against client
's face. Two supervisors are then seen assisting, making total staff/client ratio 5:1. It
then appears that client spits at staff. Staff and are seen pulling client
s undershirt over her head as to prevent her from spitting. Supervisors seem to advise
staff and not to do this at which point client 's shirt is pulled off of her
face. The hold continues without further incident and client is released. Facility cited 109.1g
and 905.4g. As to document sub-regulation 109.1g) Engaging in behavior that could be
viewed as sexual, dangerous, exploitative, or physically harmful to children. Sub-regulation
905.4g) Physical injury or threat of bodily harm. Both staff and
have been suspended pending certain termination from employment by Millcreek. All
Millcreek staff will be retrained on Acadia Zero Tolerance for Abuse and Neglect.


summary: A resident was sent to Dallas County Medical Center for assessment after hitting his head while playing ball.

raw_content:
remains at the facility. Phone call made to Chris Butler of Millcreek to confirm that client's
DOB is .


summary: A resident reported that a peer was in his room being sexually inappropriate. In a family session with his therapist, the resident reported that he was raped by a peer. The facility was cited 110.9 for late reporting.

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
R
Notice of Serious Incident
Date of Incident: 5/21/2023
Date Received by DCCECE: Millcreek of Arkansas PRTF
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Dual
Report Description: On 5/21/23 at 1945
reported to the nurse that a peer was in his room being sexually
inappropriate. On 5/24/23 while in a family session with his therapist, reported
that he was rapped by a peer. was asked to explain by his therapist, and he
stated that the peer bent him over and stuck his penis in his butt. stated that the
peer asked him to be his bitch.
Interim Action Narrative: was moved to Tiger Hall. remained at
Magnolia Hall.
Maltreatment Narrative: Ref# FAX 6-12-23. AV is . AO is a
peer, . and are residents at Millcreek of Arkansas. On 5-
21-23, reported that was in his room being sexually inappropriate toward
staff by touching himself. has been bullying for the past couple of days as
well as touching his private area. At that time, nothing else had happened, according to
On 5-24-23, reported to his aunt that he had been raped.
states that bent him over and stuck his penis in his butt. asked to be
his bitch. Recieved email from 6/13/23 as follows: The AV is .
AO is a peer, . On 6/13/23, AV was interviewed, by Inv. Garcia,
and disclosed that 2 months ago he was raped by in the bedroom that they shared
together. When asked about that, disclosed that pulled down ?s
pants and underwear and put his penis in ?s butt twice on the same day.
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humanservices.arkansas.gov

advised that ?nutted? ( described this as being ?white?) and wiped it off
with a Nike grey jacket.
Licensing Narrative: On 5/21/23 at 1945
reported to the nurse that a peer was in his room being sexually
inappropriate. On 5/24/23 while in a family session with his therapist, reported
that he was rapped by a peer. was asked to explain by his therapist, and he
stated that the peer bent him over and stuck his penis in his butt. stated that the
peer asked him to be his bitch. Facility was phoned by licensing 6/13/23 to inquire about
when this incident was reported and when it was reported to licensing. Joretha Bragg, Risk
Mgmt. Asst., gave no reasonable explanation as to why was not called
until 6/9/23 for an incident that was reported 5/24/23. Ms. Bragg did state that the clients
were separated. was moved to Tiger Hall. remained at Magnolia Hall.
Chris Butler, Risk Mgmt. of Millcreek was phoned who was on vacation who could provide
no reasonable explanation as to why the was notified untimely.
Gregoria Garcia gave permission for licensing to visit facility 6/13/23. Visit was scheduled
for 6/14/23. Facility visited 6/14/23. and interviewed. Facility reports that the
camera footage of the unit has been deleted as it is only retained for 14 days. reported
that this incident happened "about a month ago...during the day...while staff were in the
dayroom...twice in one day". reported that this did not happen at any other time.
reported that each time took "about 15 minutes". reported that at no time during these
incidents did staff check on his room. When asked how often staff checked on him in his
room "not often". stated that he felt comfortable talking to staff if he ever felt unsafe.
interviewed. stated that he understood there was an "accusation" adding that he has
never done anything sexual with stated that he is not comfortable with talking about
anything sexual with or any other male peers. stated that staff checked on him and
in their room "about every 15 minutes". stated that he felt comfortable talking to
staff if he ever felt unsafe. Chris Butler of Millcreek reported that after client first
reported this to staff he was moved from Magnolia Hall to Tiger Hall. Client was placed
in a room by himself with precaution of having no roommates. Client was already and
remained on Close Observation and Elopement Precaution which were initiated 5/8/23 for
30 days. This incident was reported by client to Millcreek staff on 5/24/23. The
was notified of this incident by facility on 6/12/23. Facility cited 110.9: Any
owner, operator, employee, foster parent, or volunteer in a child welfare agency shall
immediately notify the Child Abuse Hotline if they have reasonable cause to suspect that a
child has been subjected to child maltreatment. 7/28/2023- Licensing received notification
that this case has been closed as TRUE. Millcreek was then contacted to determine if the
A/O was still residing at the facility. The facility confirmed the alleged offender is still at the
facility. The facility provided a safety plan for the resident and have plans to discharge him
due to the finding.

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: Millcreek of Arkansas PRTF
Facility Number: 233
Licensee Address: 1828 INDUSTRIAL DRIVE
FORDYCE AR 71742
Licensing Specialist: Clayton DeBoer
Person In Charge:
Record Visit Date: 6/14/2023
Home Visit Date: 6/14/2023
Purpose of Visit: Complaint Visit
Regulations Out of Compliance:
Regulation Number: 1. 110. 9
Regulation Description: Any owner/operator, employee, foster parent, or volunteer in a child welfare agency
shall immediately notify the Child Abuse Hotline if he or she has reasonable cause to suspect that a child has
been subjected to child maltreatment, died as a result of child maltreatment or if they observe a child being
subjected to conditions or circumstances that would reasonably result in child maltreatment.
Findings Description: This incident was reported by client to Millcreek staff on 5/24/23. Millcreek notified the
on 6/12/23.
Action Due Date: 8/21/2023
Action Due Description: All Millcreek staff will complete Arkansas Mandated Reporter Training by August 1st.
The link for the training was emailed to Ben Beasley and Chris Butler of Millcreek 6/14/23 at 10:26AM. A link to the
Mandated Reporter Portal was emailed as well.
Comply Date:
Sub Regulation Description:
Regulations Needing Technical Assistance:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 3

Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Facility visited 6/14/23 in response to a complaint on 5/24/23 that client was sexually assaulted by client and
interviewed.
reported that this incident happened "about a month ago...during the day...while staff were in the dayroom...twice in one
day". reported that this did not happen at any other time. reported that each time took "about 15 minutes".
reported that at no time during these incidents did staff check on his room. When asked how often staff checked on him in his
room "not often". stated that he felt comfortable talking to staff if he ever felt unsafe.
interviewed. stated that he understood there was an "accusation" adding that he has never done anything sexual with
stated that he is not comfortable with talking about anything sexual with or any other male peers. stated that
staff checked on him and in their room "about every 15 minutes". stated that he felt comfortable talking to staff if he
ever felt unsafe.
Chris Butler of Millcreek reported that after client first reported this to staff he was moved from Magnolia Hall to Tiger
Hall. Client was assigned a room by himself with precaution of no roommate.Client was already and remained on
Close Observation and Elopement Precaution which were initiated 5/8/23 for 30 days.
This incident was reported by client to Millcreek staff on 5/24/23. The was notified of this incident
by facility on 6/12/23. Facility cited 110.9: Any owner, operator, employee, foster parent, or volunteer in a child welfare
agency shall immediately notify the Child Abuse Hotline if they have reasonable cause to suspect that a child has been
subjected to child maltreatment.
Provider Comments:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 3

CCL Staff Signature : Date: 8/22/2023
Provider Signature : Date: 8/22/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 3 of 3

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: Millcreek of Arkansas PRTF
Facility Number: 233
Licensee Address: 1828 INDUSTRIAL DRIVE
FORDYCE AR 71742
Licensing Specialist: Clayton DeBoer
Person In Charge:
Record Visit Date: 8/2/2023
Home Visit Date: 8/2/2023
Purpose of Visit: Revisit Complaint
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Follow up visit conducted 8/2/23 of Magnolia Hall to verify client sleeping area. bedroom is Room
2 of Magnolia Hall. Three beds present, with only one furnished. Room appears as though one client occupies
it.
Provider Comments:
CCL Staff Signature : Date: 8/2/2023
Provider Signature : Date: 8/2/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident was sent to Dallas County Medical Center for assessment after a physical altercation with peers. After assessment at DCMC, he was referred to Arkansas Children’s Hospital.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 5/20/2023
Date Received by DCCECE: 5/22/2023
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Facility Type:
Incident Type: Licensing
Report Description: On 05.20.23 at approximately 8:30am, , Parent
Custody, DOB: ) was sent to Dallas County Medical Center for assessment after a
physical confrontation with peers. Nursing assessment reflected 10/10 mouth pain resulting
from being punched in the mouth. Assessment revealed that teeth were intact but displaced.
After assessment at DCMC, he was referred to Arkansas Children's Hospital. ACH
Diagnosis: Open fracture to tooth and displacement to tooth. He was ordered to receive the
care of a dentist ASAP. This visit is scheduled to occur on 05.22.23.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: On 05.20.23 at approximately 8:30am, client was sent
to Dallas County Medical Center for assessment after a physical confrontation with peers.
Nursing assessment reflected 10/10 mouth pain resulting from being punched in the mouth.
Assessment revealed that teeth were intact but displaced. After assessment at DCMC, he
was referred to Arkansas Children's Hospital. ACH Diagnosis:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

He was ordered to receive the care of a dentist ASAP. This visit is
scheduled to occur on 05.22.23. Phone call made 5/22/23 to Chris Butler of Millcreek who
stated there is video of the hallway but that the fight takes place in a client bedroom.
Facility visited 5/23/23 in response to self-reported incident of client being assaulted by
peers resulting in dental injury. Video reviewed of hallway of incident. Staff are seen in the
hallway then entering the dayroom entry way, seemingly to address something taking place
in the dayroom. No video of inside this dayroom available. 3 staff are seen in the video, 2
staff escorting client out of the dayroom. Another video review yields client
continuing being escorted by the two staff and being attended to by 2 nurses in the hallway.
Client was reassigned living quarters from Tiger Hall to Pebble Creek after this
incident. Client could not be interviewed during today's visit due to reported current,
ongoing, dysregulated behavior from client today. Per Risk Managment, Chris Butler,
several attempts have been made to assign client GF living quarters that will ensure his
safety.


summary: A resident was slapped on the left cheek by a staff member as he was picking up candy that had fallen to the floor. The staff member was terminated. The facility was cited 905.4.g and 109.1.g as a result of this incident.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 5/19/2023
Date Received by DCCECE: 5/22/2023
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Dual
Report Description: On 5.19.23 at 7:42pm, , WV Foster Care, was
slapped on the left cheek by staff member . A candy sucker had fallen to
the ground and attempted to pick it up. As he did, he was slapped by
. Nursing assessment reflected redness on the left cheek. The staff member was
immediately placed on administrative leave and removed from the living unit by supervisory
personnel. The incident was reported to the .
Reference number: No return correspondence has been received, reflecting if the
report was accepted for investigation. Based on the findings of the internal investigation,
Millcreek will terminate the employment of . Termination is scheduled for
05.22.23. As a follow-up, Zero Tolerance in-service training was conducted with employees
of the living unit.
Interim Action Narrative: The staff member was immediately placed on administrative leave
and removed from the living unit by supervisory personnel.
Maltreatment Narrative: The AV is . The AO is who is a
staff member at Millcreek where the AV is currently housed. I reviewed video on 5/23/23 in
which I saw Millcreek staff member slap client . Ref#
Received notification 7/24/23 that ref# was unsubstantiated.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: On 5.19.23 at 7:42pm, client was slapped on the left
cheek by staff member . A candy sucker had fallen to the ground and
attempted to pick it up. As he did, he was slapped by . Nursing
assessment reflected redness on the left cheek. The staff member was immediately placed
on administrative leave and removed from the living unit by supervisory personnel. The
incident was reported to the . Reference number:
No return correspondence has been received, reflecting if the report was accepted
for investigation. Based on the findings of the internal investigation, Millcreek will
terminate the employment of . Termination is scheduled for 05.22.23. As a
follow-up, Zero Tolerance in-service training was conducted with employees of the living
unit. Phone call made 5/22/23 to Chris Butler of Millcreek who stated there is video of this
incident. Facility visited 5/23/23. Video reviewed of when incident took place. Client is
seen standing against a wall with staff sitting in chair against the wall a
few feet from client Client appears to bend over to pick it up something that had
fallen on the floor. Staff is seen attempting to pick the item up at the same time. A
brief struggle of who will retain the item seems to take place at which time staff
slaps client in the face with her left hand. Other peers and staff in the hall seem to react
as if something out of the ordinary had just happened. Facility cited 109.1g and 905.4g.
Received notification 5/22/23 that the first call for this incident was
screened out. This incident was re-reported to the 5/23/23 by
Licensing Specialist Clayton DeBoer, ref# . Received confirmation 5/24/23 that
call was accepted. Received notification 7/24/23 that ref# was
unsubstantiated.


summary:
The following non-compliance areas have been cited during the past 3 months:
109.1.g (Unprofessional Conduct) – Facility received a citation on 03/03/23 regarding the inappropriate discipline given to a resident based on their age, development, and history.
905.3 (Behavior Management) – Facility received a citation on 03/13/23 regarding the inappropriate discipline given to a resident based on their age, development, and history.
905.4.f (Behavior Management) – Facility received a citation on 03/13/23 regarding inappropriate behavior management.
905.4.g (Behavior Management) – Facility received a citation on 03/17/23 regarding inappropriate behavior management.
907.2 (Ratio & Supervision) – Facility received citations on 01/03/23, 01/17/23, 03/03/23, and 03/13/23 regarding the failure of staff to provide adequate supervision to residents.
The facility is required to complete the following:
Present an intent training for all facility staff regarding the Minimum Licensing Standards sections 109, 110, and all of 900.
Conduct a minimum of once per week camera reviews of 3 separate locations in facility to ensure staff are appropriately supervising residents.
If a discovery is made of staff failing to supervise or participating in inappropriate behavior management, the facility will report it to the Licensing Unit by the next business day.
Retrain all child caring staff on behavior management policy.
Continue daily leadership rounding program to ensure all doors required to be locked are secured, looking for safety concerns, and any environment of care issues.
Proceed with training all direct care staff on the topics of Nurtured Heart Approach, Improving the Milieu, De-escalation with Highly Aggressive Patients, and Processing with our Clients.

raw_content:
ARKANSAS
DEPARTMENT OF

ay —=a¥ SERVICES
Division of Child Care & Early Childhood Education

P.O. Box 1437, Slot $140, Little Rock, AR 72203-1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550

Corrective Action Agreement

Date: 5/18/2023

To: Ben Beasley

Owner Name: Habilitation Center, Inc.
Facility Name: Millcreek of Arkansas PRTF
License #: 233

Mr. Beasley,

This document constitutes a formal Corrective Action Agreement (CAA) agreed upon by
Millcreek of Arkansas PRTF and the Department of Human Services, Division of Child Care and
Early Childhood Education, Placement and Residential Licensing Unit. This CAA will be in effect
for a period of six months from the date of signing by both parties, This agreement may be
extended beyond six months should DHS determine any non-compliance with the CAA during
the stated corrective action period.

The purpose of this agreement is to gain and maintain a high degree of compliance with
licensing requirements. The following non-compliance areas have been cited during the past
three months:

Minimum Licensing Standards {Residential}: Section 109-Unprofessional Conduct

109.1.g Unprofessional conduct in the practice of child welfare activities shall include without
limitation: (g) Engaging in behavior that could be viewed as sexual, dangerous, exploitative,
or physically harmful to children.

¢ Millcreek of Arkansas PRTF received a citation on the following date regarding the
inappropriate discipline given to a resident based on their age, development, and
history.

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

© 03/03/2023- Staff pushed residents several times during the outbreak of
multiple resident altercations on the unit.

" Review of camera footage revealed that a male staff on the unit had
pushed residents aggressively multiple times during several altercations
that occurred between the residents. A resident can be seen being
pushed into a table, another one into a corner, and a third being pushed
over the back of a couch and landing on the other side.

Minimum Licensing Standards (Residential): Section 905-Behavior Management

905.3 Discipline shall be appropriate to the child's age, development, and history.

e Millcreek of Arkansas PRTF received a citation on the following date regarding the
inappropriate discipline given to a resident based on their age, development, and
history.

oO 03/13/2023- A ten-year-old resident was disciplined by standing in the corner
of the dayroom in the evening for approximately two hours and twenty-five
minutes.

* Camera review of the incident revealed that the resident was directed
into the corner by the staff supervisor at approximately 7:15pm. The
resident then stayed in the corner with staff siting at a table in front of
the corner. The resident did come out of the corner 2-3 times for a
bathroom break and to quickly complete his nighttime chore, but then
would immediately return to the corner. At one point staff makes the
resident turn his head around and face the corner with his nose against
the wall for almost an hour.

905.4.f The following disciplinary actions shall not be used: (f} Restriction to a dark room or
area.

¢ Millcreek of Arkansas PRTF received a citation on the following date regarding
inappropriate behavior management.

© 03/13/2023- Camera review of the incident revealed that the resident was
directed into the corner by the staff supervisor for approximately two hours
and twenty-five minutes.

" The resident can be seen directed to the corner at approximately
7:15pm. The resident then stayed in the corner with staff siting at a table
in front of the corner. The resident did come out of the corner 2-3 times
for a bathroom break and to quickly complete his nighttime chore, but

then would immediately return to the corner. At one point staff makes
the resident turn his head around and face the corner with his nose
against the wall for almost an hour

905.4.g The following disciplinary actions shall not be used: (g) Physical injury or threat of
bodily harm.

¢ Millcreek of Arkansas PRTF received a citation on the following date regarding
inappropriate behavior management.

© 03/17/2023- Camera review of an incident revealed that a staff member had
aggressively walked towards a resident in a threatening manner and bumped
him with her stomach knocking him off balance as she directed him back to the
corner, he had been standing in for over two hours.

«The resident can be seen being allowed to leave the corner he had been
standing in for a significant amount of time by a male staff. The resident
walks to the doorway of his bedroom hall then can be seen turning
around and saying something to the female staff on the unit. The female
staff can be seen pointing towards the corner and begins to walk quickly
towards the resident with a broom in her hand. The resident looks
towards the ground and turns sideways as the staff begins bumping into
him with her stomach, knocking him off balance, and directing him back
inte the corner. The resident then stands back in the corner for
approximately another hour before being allowed to go to bed.

907.2 Child caring staff shall be responsible for providing the level of supervision, care, and

treatment necessary to ensure the safety and well-being of each child at the facility, taking

into account the child’s age, individual differences and abilities, surrounding circumstances,
hazards and risk.

° Millcreek of Arkansas PRTF received citations on the following date regarding the
failure of staff to provide adequate supervision to residents.

o 01/03/2023- Camera review revealed that a resident was able to enter an
unlocked staff office and return to her room with contraband.

* While in the bedroom with the contraband the resident used the
contraband, scissors, to self-harm. Approximately eleven minutes after
obtaining the scissors the resident was seen by staff, but then the
resident returned to her room and was not discovered by her peers until

twenty-nine minutes later. The peers notified staff of the situation and
they sought immediate medical attention for the resident.
o 01/17/2023- Review of an incident submitted to the licensing unit revealed
that a resident had ingested Pine-sol cleaner.

* After the resident’s peer had just completed his nightly chore he left
Pine-Sol cleaner openly accessible on the table of the dayroom. No staff
were supervising the cleaning chemicals left on the table, so the resident
approached the table and swallowed an estimated two ounces of the
chemical.

© 03/03/2023- Review of camera footage revealed that staff failed to provide
adequate supervision of residents to ensure their safety and well-being during a
multiple resident altercation.

" The staff viewed on camera during the several altercations that took
place on the unit, can be seen being slow to intervene, failing to de-
escalate, and they did not remove the remaining residents from the
situation to avoid an escalation.

© 03/13/2023- Staff failed to ensure the safety and well-being of residents when
they left a staff office door unlocked.

" Review of the camera footage of a separate issue, it was seen that staff
were sitting at a day room table and leaving their doer to their office
open. Resident’s can be seen entering and leaving the office multiple
times without any supervision from staff.

The agency is required to complete the following:

* The Licensing Unit wiil present an intent training for all facility staff regarding the
Minimum Licensing Standards sections 109, 110, and all of 900. All staff that is
unavailable during the meeting shall be trained by management using the slideshow
provided by the Licensing Unit and documentation of all staff trained shall be provided
to the Licensing Unit.

© The facility shall conduct a minimum of once per week camera reviews of three separate
locations on the facility to ensure that staff are appropriately supervising residents.
Documentation of date, time, area viewed, and a brief description of what was reviewed
shall be logged by the reviewer. The documentation of weekly checks shall be provided
to the Licensing Specialist monthly for review.

e If at any time during the course of this corrective action agreement, a discovery is made
of a staff failing to supervise or participating in inappropriate behavior management, the
facility will report it to the Licensing Unit by the next business day. The report shall
include the incident date, incident time, name of staff/residents involved, brief
description of the incident, date it was discovered by facility management and any
corrective measures taken to correct the issues.

e The facility shall retrain all child caring staff on their behavior management policy
including topics surrounding acceptable forms of discipline by 6/30/2023 and provide
sign in sheets of all staff trained to the Licensing Specialist.

¢ The facility management shall continue their daily leadership rounding program to
ensure all doors required to be locked are secured, looking for safety concerns, and any
environment of care issues. These walkthroughs shall be documented, noting any
concerns, retained, and available to the licensing specialist upon request.

e The facility shail proceed with training all direct care staff on the topics of Nurtured
Heart Approach, Improving the Milieu, De-escalation with Highly Aggressive Patients,
and Processing with our Clients. The facility shall notify the licensing unit when all direct
care staff have completed the above courses.

This document is intended to clarify any outstanding issues and to reduce the risk of
misunderstanding or miscommunication.

Please be advised that any serious non-compliance cited during this corrective action period
may result in a recommendation for adverse action on the license, Any serious violation of
this corrective action plan will result in recommendation for adverse action on the license.

Please do not hesitate to contact the Placement and Residential Licensing Unit if you have any
questions or concerns regarding ongoing compliance with this agreement or any other licensing

requirement.

The signature of the licensee constitutes full acceptance of the provisions of this agreement.

78;
Owner/ Administrator/Agency Representative Date
Licensing Specialist Date

Sylgpoaas

Licensing Supervisor

doc_type: Corrective Action Agreement


summary: Licensing met with facility leadership to discuss the Corrective Action Agreement put in place between Millcreek and the Placement and Residential Licensing Unit.

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: Millcreek of Arkansas PRTF
Facility Number: 233
Licensee Address: 1828 INDUSTRIAL DRIVE
FORDYCE AR 71742
Licensing Specialist: Chelsea Vardell
Person In Charge: Ben Beasley
Record Visit Date: 5/18/2023
Home Visit Date: 5/18/2023
Purpose of Visit: Corrective Action Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Program Coordinator met with CEO Ben Beasley and Regional CEO Matt Wiltshire to discuss the Corrective
Action Agreement put in place between Millcreek of Arkansas PRTF and the Placement and Residential
Licensing Unit. The plan was discussed, agreed upon, and signed by all parties.
The Program Coordinator informed the facility that, while it is not required, their attendance at the CWARB
meetings over the period of the Corrective Action Agreement is encouraged so they may discuss their
progress towards the goals for correcting areas of non-compliance.
CEO Beasley will provide the Program Coordinator with dates and times that would be good for the agency to
conduct an intent training with the Licensing Unit.
Provider Comments:
CCL Staff Signature : Date: 6/15/2023
Provider Signature : Date: 6/15/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident was sent to Dallas County Medical Center for x-rays after reporting ankle pain from a recreational injury.

raw_content:
AR KAN S A S&S
DEPARTMENT OF

+4 HUMAN
<a¥ SERVICES

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot $140, Little Rock, AR 72203-1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550

Notice of Serious Incident

Date of Incident: 5/16/2023

Date Received by DCCECE: 5/17/2023

Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233

Facility Type:

Incident Type: Licensing

Report Description {i ii i i i iii State Custody, DOB: a) was

referred to Dallas County Medical Center for outpatient x-rays as she reported pain in her
ankle from a recreational injury. No fracture was found. She was returned to the facility
without treatment.

Interim Action Narrative:

Maltreatment Narrative:

Licensing Narrative: Client was referred to Dallas County Medical Center for
outpatient x-rays as she reported pain in her ankle from a recreational injury. No fracture
was found. She was returned to the facility without treatment.

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


summary: A resident was sent to Dallas County Medical Center for x-rays after punching a wall.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 5/16/2023
Date Received by DCCECE: 5/17/2023
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Facility Type:
Incident Type: Licensing
Report Description: Parent Custody, DOB: ) was sent to Dallas
County Medical Center for outpatient x-rays following an episode of self-injurious behavior
where he punched a wall. X-ray results indicate that no fracture was present. He was
returned to the facility without treatment.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: Client was sent to Dallas County Medical Center for
outpatient x-rays following an episode of self-injurious behavior where he punched a wall.
X-ray results indicate that no fracture was present. He was returned to the facility without
treatment.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Licensing visited the facility to conduct a buildings and grounds walkthrough. The facility was cited 908.8 and received technical assistance for 911.6 for issues identified during the review.

raw_content:
ARKANSAS
) DEPARTMENT OF

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

521 Visit Compliance Report

Licensee: Millcreek of Arkansas PRTF

Facility Number: 233

Licensee Address: 1828 INDUSTRIAL DRIVE
FORDYCE AR 71742

Licensing Specialist: Clayton DeBoer
Person In Charge: Ben Beasley
Record Visit Date: 5/16/2023

Home Visit Date: 5/16/2023

Purpose of Visit: Monitor Visit

Regulations Out of Compliance:

Regulation Number: 9. 908. 8

Regulation Description: The administering of all medications, including over-the-counter, shall be logged at the
time the medication is given, by the person administering the medication.

Findings Description: Client ik AM medication not initialed for 5/16/23.

Action Due Date: 5/16/2023

Action Due Description: Nurse indicated that client had been given this medication and initialed it during today's
visit.

Comply Date:

Sub Regulation Description:
Regulations Needing Technical Assistance:

Regulation Number: 9. 911. 6

Regulation Description: All buildings and furnishings shall be safe, clean, and in good repair.

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

Findings Description: Kangaroo and Eagle Hall had holes/tears in wooden flooring.
Action Due Date: 11/16/2023

Action Due Description: CEO Ben Beasley indicated during today's visit that all damaged flooring facility wide
was being addressed, waiting on contractor to fix.

Comply Date:

Sub Regulation Description:

Regulation Not Applicable:

Regulations Not Correctable:

Narrative:

Buildings & Grounds conducted from 9:45AM-11:00AM. Census: 160

Kangaroo Hall and Eagle Hall observed to be clean, safe and in good repair except for wooden flooring had
tears/holes in them. CEO Ben Beasley indicated during this visit that floors were being repaired facility wide,
and that the flooring contractor was to replace these floors in the near future. Bathrooms observed to be clean
and sanitary with functioning showers, sinks, toilets. No clients present today in either hall.

Outdoor basketball court observed to be free of safety hazards. Staff/client ratio 1:6.

MAR checked for:

All initialed and up to date except one of clen AM medication was not initialed for 5/16/23. Nurse
consulted who stated that all AM medications were given to this client but that this one had been overlooked,
not initialed.

Facility given T/A for 911.6: All buildings and furnishings shall be safe, clean and in good repair. Holes/tears
in floors have been addressed and are waiting on contractor to fix. Facility cited 908.8: The administering of
all medications, including over the counter, shall be logged by the person administering the medication at the
time the medication is given. One of client [Js AM medications was not initialed for 5/16/23.

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

Provider Comments:

CCL Staff Signature :

4

ry)

Provider Signature :

a ff

www.arkansas.gov/dhs

Serving more than one million Arkansans each year

Date: 6/15/2023

Date: 6/15/2023

Page 3 of 3


summary: A resident was sent to Dallas County Medical Center for assessment following a physical confrontation 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: 5/13/2023
Date Received by DCCECE: 5/15/2023
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Facility Type:
Incident Type: Licensing
Report Description: Parent Custody, DOB: 0 was sent to the
Dallas County Medical Center for assessment following a physical confrontation with a
peer. He was punched in the face and received a superficial laceration above his left eye.
Dermabond was applied to the wound, and he was returned to the facility. No further
treatment was necessary.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: Client was sent to the Dallas County Medical Center for
assessment following a physical confrontation with a peer. He was punched in the face and
received a superficial laceration above his left eye. Dermabond was applied to the wound,
and he was returned to the facility. No further treatment was necessary. Facility visited
5/16/23 and video reviewed of this incident. Visible staff/client ratio in video 2:11. Client
sits in a chair that client appears to disapprove of. Client punches client .
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Client punches back. Staff immediately intervene. Client is taken to the nurse's
station. Nurse's note reviewed.


summary: A resident was sent to Dallas County Medical Center for x-rays of his arm after falling during a recreational game.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 5/9/2023
Date Received by DCCECE: 5/10/2023
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Facility Type:
Incident Type: Licensing
Report Description: , MD DHR Custody, DOB: )
reported to the medical director that he had pain in his right arm from when he fell during a
recreational game. previously fractured his right arm on 01.18.23. Out of precaution,
he was referred to Dallas County Medical Center for outpatient x-rays. The x-ray report
indicates that there is no fracture.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: Client reported to the medical director that he had
pain in his right arm from when he fell during a recreational game. previously
fractured his right arm on 01.18.23. Out of precaution, he was referred to Dallas County
Medical Center for outpatient x-rays. The x-ray report indicates that there is no fracture.
Client remains at facility.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Dallas County Medical Center for assessment of a head injury after striking the back of his head on the floor when he was dropped by a peer.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 5/9/2023
Date Received by DCCECE: 5/9/2023
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Facility Type:
Incident Type: Licensing
Report Description: , Parent Placement, DOB: ) was
sent to the Dallas County Medical Center for assessment of a head injury. He was picked up
and dropped by a peer while standing in line to leave the living unit. When he was dropped
to the floor, he struck the back of his head on the floor. On-site nursing assessed and
referred to DCMC as a precautionary measure and for further assessment. DCMC
determined that no treatment was necessary. He was released to return to the facility.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: Client was sent to the Dallas County Medical Center for
assessment of a head injury. He was picked up and dropped by a peer while standing in line
to leave the living unit. When he was dropped to the floor, he struck the back of his head on
the floor. On-site nursing assessed and referred to DCMC as a precautionary measure and
for further assessment. DCMC determined that no treatment was necessary. He was
released to return to the facility. Facility visited 5/10/23 and video reviewed of this incident.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

The incident occurred in Pine Ridge. 15 clients are seen lined up against the wall seemingly
waiting to exit Pine Ridge. Two staff members seen initially. Third staff is outside of the
doorway, seen later entering Pine Ridge after incident. Towards the back of the line, a peer
is seen attempting to pick up and lift client This does not appear to be aggressive. It
appears that is too heavy for peer to pick up. Peer seems to successfully elevate in the
air then drops him. This appears to be accidental. landed on his back and his head hits
the wall. grabs the back of his head. 3 staff immediately tend to . goes to the
bathroom and is given paper towel for bleeding. 's back of head is seen in video bloody. A
nurse is seen entering Pine Ridge 4 minutes later. Nurse escorts out of Pine Ridge.


summary: A resident was sent to Dallas County Medical Center for x-rays 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: 4/28/2023
Date Received by DCCECE: 5/1/2023
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Facility Type:
Incident Type: Licensing
Report Description: , State Custody, DOB: 0 ) was sent to Dallas
County Medical Center for outpatient x-rays. He received an on-site nursing assessment
following a physical confrontation with a peer where he was kicked in the face. X-ray report
indicates an acute comminuted and displaced nasal bone fracture, greater on the right. The
doctor determined no follow up treatment is necessary. He was released to return to the
facility.
Interim Action Narrative: Resident was moved to the Tiger Hall.
Maltreatment Narrative:
Licensing Narrative: Client was sent to Dallas County Medical Center for
outpatient x-rays. He received an on-site nursing assessment following a physical
confrontation with a peer where he was kicked in the face. X-ray report indicates an acute
comminuted and displaced nasal bone fracture, greater on the right. The doctor determined
no follow up treatment is necessary. He was released to return to the facility. Facility
contacted 5/1/23 and noted that there was no video footage of incident as it occurred
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humanservices.arkansas.gov


summary: A resident reported that Millcreek staff members performed a personal body search on her while they were looking for contraband. During the search, an unnamed staff member rubbed her hand against the resident’s breast. Four staff were present during the search, and all staff present were interviewed. All staff corroborate the same story. The resident was asked to remove some clothes for the search, but staff never asked the resident to remove their undergarments.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 4/27/2023
Date Received by DCCECE: 4/27/2023
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Facility Type:
Incident Type: Dual
Report Description: CACD investigator Jennifer Harper informed Millcreek of an open
investigation reported by an external entity. , Guardian
Custody, DOB: ) reported that Millcreek staff members performed a personal
body search on her while they were looking for contraband. During the search, an unnamed
staff member rubbed her hand against breast. The external investigation is
ongoing. No determination has been made at the time of this report.
Interim Action Narrative:
Maltreatment Narrative: On 4/27/23 CACD investigator Jennifer Harper informed
Millcreek of an open investigation reported by an external entity. Client reported that
Millcreek staff members performed a personal body search on her while they were looking
for contraband. During
Licensing Narrative: On 4/27/23, CACD investigator Jennifer Harper informed Millcreek
of an open investigation reported by an external entity. Client reported that
Millcreek staff members performed a personal body search on her while they were looking
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

for contraband. During the search, an unnamed staff member rubbed her hand against 's
breast. Facility reports 4/27/23 that the external investigation is ongoing, and no
determination has been made at the time of this report. Phone call made 4/27/23 to Chris
Butler of Millcreek. CACD Investigator Jennifer Harper had visited the facility today. A/V
disclosed that it was all female staff who performed the search. A/V did not provide a name
of the A/O. Email sent to Jennifer Harper 4/27/23 who granted permission for licensing to
visit the facility and provided snapshot and ref# of complaint. Licensing phoned Jennifer
Harper 4/27/23. Ms. Harper stated that the A/V stated that nothing sexual took place
during the search, but that she (A/V) did not agree with the search. Ms. Harper stated that
an A/O could not be named as A/V stated that no one person searched her (A/V) more
than any of the others present. Facility visited 5/1/23. 4 staff were present during the search,
Nurse Dana Stephens and direct care staff Sheena Hampton, Mona Heard and Katakawia
Lowe. Ms. Stephens was not working during today's visit. The other staff were all present
and interviewed today. stated that 4 female staff were present during search. stated
that she was searched. She stated that staff were looking for a "vape pen". stated that
she had removed all of her clothing but her shirt and bra. stated that she was "definitely
exposed" from the waist down. stated that she did not feel staff had done anything
inappropriate during the search. Staff Katakawia Lowe interviewed. Ms. L stated that
had a shirt on that extended down to just above her knee. Ms. L stated that was not
asked to pull down her panties, just her pants, but pulled down her panties with her pants.
Staff Mona Heard interviewed. Ms. H stated that had on a shirt that covered her
privates, and that was never exposed. Ms. H stated that was not asked to pull down
her panties, just her pants, but pulled down her panties with her pants. Sheena Hampton
interviewed. Ms. H stated that GR had a shirt on which covered just above her knees. Ms. H
stated that at no time was exposed. Ms. H stated that GR was not asked to pull down
her panties, just her pants, but pulled down her panties with her pants. Facility Risk Mgmt.
Chris Butler consulted who stated that is not facility policy that undergarments be removed
during searched. No persons interviewed today indicated that was asked to remove her
panties. Campus wide in-service training on client search procedures initiated and ongoing
at this time as a precautionary measure. Licensing is not prepared to make a finding as of
5/1/23. Received notification 6/6/23 that maltreatment complaint was unfounded. 521
unfounded notification sent to Millcreek 6/6/23.


summary: A resident was sent to Dallas County Medical Center for assessment of injuries 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: 4/26/2023
Date Received by DCCECE: 4/27/2023
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Facility Type:
Incident Type: Licensing
Report Description: , State Custody, DOB: 0 ) was sent to Dallas
County Medical Center ER for assessment of injuries following a physical confrontation that
involved him being punched by a peer. He was assessed and released back to the facility
without signs of distress. ER report indicated minimal swelling on the right side of his nose.
No further injury noted.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: On 4/26/23, client
a physical confrontation that involved him
being punched by a peer. He was assessed and released back to the facility without signs of
distress. ER report indicated minimal swelling on the right side of his nose. No further
injury noted. Facility visited 5/1/23 and video reviewed of incident 4/26/23 at Pebble
Creek. Video showed initial staff/client ratio to be 1:4. Later 3 additional staff arrive with
several clients from outside, staying within required licensing staff/client ratio. Seconds
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humanservices.arkansas.gov

before 3 staff and additional clients are seen entering Pebble Creek, a peer is seen punching
at Off camera it appears as though succeeds in punching It does not appear
that any staff witness this. Client does not appear to immediately ask for help from staff.
He is seen seconds afterwards putting his arm around another peer and remains in the day
room. does not appear to be in distress. Per video, this incident occurred at 2:04PM.
Staff incident report was filled out regarding this incident at 2:19PM. Nursing note indicates
that was seen by nurse at 2:28PM.


summary: A resident was sent to Dallas County Medical Center for an x-ray after punching a wall.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 4/17/2023
Date Received by DCCECE: 4/18/2023
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Facility Type:
Incident Type: Licensing
Report Description: , (Arkansas, Grandmother Custody, DOB:
0) was sent to the Dallas County Medical Center Emergency Room for x-ray of her
right hand. Medical Director instructed her to be sent for assessment following the patient
punching a wall. X-ray report indicates normal alignment with no displacement seen. No
fracture or deformity indicated. She was released to return to the facility.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: Client was sent to the Dallas County Medical
Center Emergency Room for x-ray of her right hand. Medical Director instructed her to be
sent for assessment following the patient punching a wall. X-ray report indicates normal
alignment with no displacement seen. No fracture or deformity indicated. She was released
to return to the facility. Continue to monitor.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov