summary: An x-ray was ordered after a resident jammed 3 fingers while playing basketball.

raw_content:
Division of Provider Services & Quality Assurance
Office of Long-Term Care
P.O. Box 8059, Slot S404, Little Rock, AR 72203-1437
R
Notice of Serious Incident
Case Number: 032072
Date of Incident: 06/16/2025
Date Received: 08/13/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Incident Type: DPSQA - Complaint
Case Status: Not Submitted
DPSQA - Complaint
Report Description: Client was playing basketball with peers and jammed his 3 fingers on
his left hand during recreational therapy, client was seen by the nurse and a x-ray was given
to the client . The results came back with no findings.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


state: AR

facility_name: United Methodist Children's Home - Little Rock

summary: An x-ray was ordered after a resident tripped and fell while playing basketball.

raw_content:
R
Notice of Incident
Case Number: 030545
Date of Incident: 6/15/2025
Date Received: 6/17/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Report Description: on 6/15/25 Client
. Client was playing basketball with his peers in the gym when he tripped and
fell. He complained about some discomfort on Monday the 16th and an x-ray was ordered.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

doc_type: Notice of Incident


summary: A resident was transported for acute care after she was found in her room with clothing tied around her neck.

raw_content:
R
Notice of Incident
Case Number: 030429
Date of Incident: 6/11/2025
Date Received: 6/11/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Report Description: On 6/11 Client
Client was in her bedroom due to having pink eye and being contagious, another
client was on the unit acting out and causing chaos, staff went and checked on client around 5:22pm
and client was barely responding, staff tried to open the door all the way, but client put her mattress
in the door to prevent staff from coming in, client was laying on the floor with four shirts/pants tied
around her neck. Staff went in the bedroom to remove the items from around her neck due to the
clients face being purple and her lips being purple. Once staff removed the items from her neck, her
color resumed normal. Client was able to sit up and stand up and walk out of the bedroom and sit
on the floor in the hallway to talk with staff. Client later was transported by
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: An x-ray was ordered after a resident injured her finger by punching a door.

raw_content:
R
Notice of Incident
Case Number: 030398
Date of Incident: 6/9/2025
Date Received: 6/10/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Report Description: On 6/9/25 client
got upset at another peer. Walked out of the dayroom, towards the end of the hall
and punched a door. Lead and consultant spoke to resident and resident reported discomfort in
her right-hand 3rd finger. She was assessed by nurse and an X-ray was ordered.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: An x-ray was ordered after a resident injured his foot while jumping over a couch.

raw_content:
R
Notice of Incident
Case Number: 030355
Date of Incident: 6/7/2025
Date Received: 6/9/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Report Description: On Saturday /25 Client
received an x-ray after client jumped over a couch and complained
of right foot pain. Results are as follows:
No
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident who is 5 years older, punched an 11-year-old peer in the face. The residents are being monitored by staff to ensure they stay away from each other.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 030134
Date of Incident: 5/29/2025
Date Received: 5/30/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: on 5/29/25 a
retaliated by
punching an 11 year old in the face. The other client is younger and a 5 years age difference.
referral number is and is being "reviewed by specialist" The clients are being
monitored by staff to make sure they stay away from each other.
Interim Action Narrative: and residents were separated.
Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Licensing inquired if there was camera footage of this provider reported incident. Facility
informed licensing that there is camera fooage of this provider reported incident. Licensing
requested for camera footage to be saved for licensing to review. 06/04/2025 Licensing
Specialist visited facility and viewed camera footage.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident complained of pain after being hit in the face and hand by a peer. An x-ray was ordered.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 030121
Date of Incident: 5/29/2025
Date Received: 5/29/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: on 5/29/25 client
was antagonizing his peers and one of his peers got upset. His peer
hit him in the face and his hand. was screaming and yelling afterwards of pain. An
x-ray was ordered for face and hand:
Interim Action Narrative:
Narrative:
Licensing Narrative: 05/29/2025 Licensing Specialist inquired of the facility nurse's note
and if the residents were placed on any safety precautions. Facility reported to Licensing
that the other resident was transported via so they won?t be around each
other. Facility reported nursing notes, documentations uploaded.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident complained of pain to the foot after repeatedly kicking doors. An x-ray was ordered.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 030133
Date of Incident: 5/29/2025
Date Received: 5/30/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: on 5/29/25 client
client got up and went to maglock doors on D-Hall bedroom hallway
and began screaming and kicking/banging on the doors. This didn't appear to be provoked
and there was no incident that occurred prior to him doing this. He refused to be redirected
for approx. 10-15 minutes, and then reported to nurse that the top of his left foot was hurting
and it hurt to put his left foot on the ground. No swelling, bruising, gross deformities, or
abnormalities noted on exam besides tenderness to touch on the top of his left foot. Client
was given and ice pack, but initially refused an xray was ordered and results are as
followed.
. The nurse
practitioner said that we will treat his inflammation with by mouth
twice daily for 21 days. She said that this is ultimately something that will outgrow
with time as he gets older (growing pains). We will continue to monitor for any changes or
worsening of his symptoms. His guardian has been notified and did give consent for the
Interim Action Narrative: Resident was assessed by nursing and an x-ray was completed.
Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Licensing requested nurse's note from the facility. Nurse's notes provided, reviewed, and
uploaded.


summary: Complaint #AR00036799, #AR00037333, and #AR00036298 were found in compliance during the Complaint Investigation Survey performed at the facility.

raw_content:
Division of Provider Services
& Quality Assurance
P.O. Box 8059, Slot S404
Little Rock, AR 72203-8059
June 2, 2025
Craig Gammon, Administrator
United Methodist Childrens Home
2002 S Fillmore St
Little Rock, AR 72214-4848
Dear Mr. Gammon:
A Complaint Investigation Survey was conducted on May 22, 2025. We are pleased to inform you
that no deficiencies were cited during the survey and that your facility was in compliance with the
requirements of 42 CFR Part 483, Subpart G, Requirements for Psychiatric Residential Treatment
Facilities. Your certification remains in effect unless terminated due to non-compliance with program
requirements or voluntary withdrawal from the program.
We have enclosed form CMS 2567, “Statement of Deficiencies and Plan of Correction” for the May 22,
2025 Complaint Investigation Survey conducted at your facility for participation in the Medicaid
program. CMS 2567 is enclosed, indicating your facility's compliance status. Please sign and date
the 2567 and email to jordyn.brown4@dhs.arkansas.gov.
If you have any questions please contact your reviewer, Jordyn Brown, at 501-320-6547.
Sincerely,
for Jeff Rosenbaum
Jordyn Brown, RN QA Reviewer
DPSQA/Office of Long Term Care
Survey and Certification Section
jb
cc: DRA
Craig Gammon - United Methodist Childrens Home - 06/02/2025- (AOLTC - PRTF No Def) Page 1]

PRINTED: 06/02/2025
DEPARTMENT OF HEALTH AND HUMAN SERVICES FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING ______________________
C
04L106 B. WING _____________________________ 05/22/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
2002 S FILLMORE ST
UNITED METHODIST CHILDRENS HOME
LITTLE ROCK, AR 72214
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETION
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
N 000 Initial Comments N 000
Note: The CMS-2567 (Statement of Deficiencies)
is an official, legal document. All information must
remain unchanged except for entering the plan of
correction, correction dates, and the signature
space. Any discrepancy in the original deficiency
citation(s) will be reported to the Dallas Regional
Office (RO) for referral to the Office of the
Inspector General (OIG) for possible fraud. If
information is inadvertently changed by the
provider/supplier, the State Survey Agency (SA)
should be notified immediately. Census: 35
AR00036799 was in compliance.
AR00037333 was in compliance.
AR00036298 was in compliance.
The facility was in compliance with §483, Subpart
G - Conditions of Participation for Psychiatric
Residential Treatment Center.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that
other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days
following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14
days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued
program participation.
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID:VSHV11 Facility ID: 3005 If continuation sheet Page 1 of 1

doc_type: Complaint Survey


summary: An x-ray was ordered after a resident complained of right hand pain from “punching something a few weeks ago.”

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 029936
Date of Incident: 5/21/2025
Date Received: 5/21/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: Client
client complained to the nurse of right hand pain. Client reported to the nursing staff
that she "punched something a few weeks ago". An x-ray was ordered :
.
Interim Action Narrative:
Narrative:
Licensing Narrative: 05/22/2025 Licensing Specialist inquired of the facility nurse's note.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: An x-ray was ordered after a resident complained of a growth on her right wrist.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 029935
Date of Incident: 5/21/2025
Date Received: 5/21/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: Client ,
complained to nursing of a growth on her right wrist. An x-ray was ordered and
results are as followed:
Interim Action Narrative:
Narrative:
Licensing Narrative: 05/22/2025 Licensing Specialist Horton inquired of the facility
nursing note.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: The facility was still not in compliance during the re-visit performed on 5/20/2025.

raw_content:
Division of Provider Services
& Quality Assurance
P.O. Box 8059, Slot S404
Little Rock, AR 72203-8059
May 30, 2025
Craig Gammon, Administrator
United Methodist Childrens Home
2002 S Fillmore St
Little Rock, AR 72214-4848
IMPORTANT NOTICE - PLEASE READ CAREFULLY
Dear Mr.. Gammon:
On December 4, 2024, a complaint survey was conducted at your facility by the Office of Long
Term Care to determine compliance with Federal requirements for Psychiatric Residential
Treatment Facilities participating in the Medicaid program(s). This survey found your facility
was not in substantial compliance with participation requirements. Please refer to our letter,
dated December 18, 2024.
A revisit was conducted on May 20, 2025, and your facility was still not in substantial
compliance with the following participation requirement(s):
N188 and N189: Post Intervention Debriefings
Plan of Correction (PoC)
A Plan of Correction (PoC) for the cited deficiencies must be submitted within 10 calendar days
of receipt of this letter to:
Breanna Marengo, Reviewer
OLTC, Survey & Certification Section
PO Box 8059, Slot S404
Little Rock, AR 72201-4608
(501) 320-6280
email to breanna.marengo@dhs.arkansas.gov.
A revisit will be authorized after an acceptable PoC is received. A completion date for each
deficiency cited must be included. Your Plan of Correction must also include the following:
Craig Gammon - United Methodist Childrens Home - - (AOLTC - PRTF CNC) Page 1]

1. What corrective action(s) will be accomplished for those residents found to have been
affected by the deficient practice;
2. How you will identify other residents having the potential to be affected by the same
deficient practice and what corrective action(s) will be taken;
3. What measures will be put into place or what systemic changes you will make to ensure
that the deficient practice does not recur; and,
4. Indicate how the facility plans to monitor its performance to make sure that solutions
are sustained. The facility must develop a plan for ensuring that correction is achieved and
sustained. This plan must be implemented, and the corrective action evaluated for its
effectiveness. The plan of correction is integrated into the quality assurance system. At the
revisit, the quality assurance plan is reviewed to determine the earliest date of compliance.
If there is no evidence of quality assurance being implemented, the earliest correction date
will be the date of the revisit; and
5. Include dates when corrective action will be completed. The corrective action
completion dates must be acceptable to the State. Your facility is ultimately accountable for
its own compliance. The plan of correction will serve as the facility’s allegation of
compliance. Unless otherwise stated on the PoC, the last completion date will be the date of
alleged compliance.
Informal Dispute Resolution
In accordance with 42 CFR § 488.331, you have one opportunity to question deficiencies through
an informal dispute resolution (IDR) process. To obtain an IDR, you must send your written
request to Health Facility Services, Arkansas Department of Health and Human Services
within ten (10) calendar days from receipt of the Statement of Deficiencies. The request
must state the specific deficiencies the facility wishes to challenge. The request should also state
whether the facility wants the IDR to be performed by a telephone conference call, record review,
or a face-to-face meeting.
An incomplete informal dispute resolution procedure will not delay the effective date of any
enforcement action or the requirement for timely submission of an acceptable plan of correction.
Informal dispute resolution in no way is to be construed as a formal evidentiary hearing. It is an
informal administrative process to discuss the findings.
Please submit your request to:
IDR/IIDR Program Coordinator
Health Facilities Services
5800 West 10th Street, Suite 400
Little Rock, AR 72204
Phone: 501-661-2201
ADH.HFS@Arkansas.gov
Craig Gammon - United Methodist Childrens Home - - (AOLTC - PRTF CNC) Page 2]

If you have any questions concerning this letter, please contact your reviewer.
Sincerely,
for Jeff Rosenbaum
Breanna Marengo, RN QA Reviewer
DPSQA/Office of Long Term Care
Survey & Certification Section
bbm
cc: DRA
Craig Gammon - United Methodist Childrens Home - - (AOLTC - PRTF CNC) Page 3]

PRINTED: 05/30/2025
DEPARTMENT OF HEALTH AND HUMAN SERVICES FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING ______________________
R-C
04L106 B. WING _____________________________ 05/20/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
2002 S FILLMORE ST
UNITED METHODIST CHILDRENS HOME
LITTLE ROCK, AR 72214
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETION
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
{N 000} Initial Comments {N 000}
Note: The CMS-2567 (Statement of Deficiencies)
is an official, legal document. All information must
remain unchanged except for entering the plan of
correction, correction dates, and the signature
space. Any discrepancy in the original deficiency
citation(s) will be reported to the Dallas Regional
Office (RO) for referral to the Office of the
Inspector General (OIG) for possible fraud. If
information is inadvertently changed by the
provider/supplier, the State Survey Agency (SA)
should be notified immediately.
Census 32
The facility was not in compliance with §483,
Subpart G - Conditions of Participation for
Psychiatric Residential Treatment Center.
{N 188} POST INTERVENTION DEBRIEFINGS {N 188}
CFR(s): 483.370(a)
Within 24 hours after the use of the restraint or
seclusion, staff involved in an emergency safety
intervention and the resident must have a
face-to-face discussion. This discussion must
include all staff involved in the intervention except
when the presence of a particular staff person
may jeopardize the wellbeing of the resident.
Other staff and the resident's parent(s) or legal
guardian(s) may participate in the discussion
when it is deemed appropriate by the facility. The
facility must conduct such discussion in a
language that is understood by the resident and
by the resident's parent(s) or legal guardian(s).
The discussion must provide both the resident
and staff the opportunity to discuss the
circumstances resulting in the use of restraint or
seclusion and strategies to be used by the staff,
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that
other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days
following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14
days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued
program participation.
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID:6ZZR12 Facility ID: 3005 If continuation sheet Page 1 of 8

PRINTED: 05/30/2025
DEPARTMENT OF HEALTH AND HUMAN SERVICES FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING ______________________
R-C
04L106 B. WING _____________________________ 05/20/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
2002 S FILLMORE ST
UNITED METHODIST CHILDRENS HOME
LITTLE ROCK, AR 72214
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETION
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
{N 188} Continued From page 1 {N 188}
the resident, or others that could prevent the
future use of restraint or seclusion.
This STANDARD is not met as evidenced by:
Based on record review, interviews, and facility
policy review, the facility failed to ensure a
face-to-face debriefing with the client and the staff
was provided or documented within 24 hours
after 1 Client (Client #2) of 3 clients in the case
mix were placed in a restraint.
The findings are:
Review of Client #2's Face Sheet dated
10/3/2024, revealed the client had diagnoses
which included disruptive mood dysregulation
disorder, anxiety disorder, attention deficit
hyperactive disorder, unspecified problem related
to social environment, and parent-child relational
problem.
Review of the facility Seclusion and Restraint Log
indicated Client #2 had an Emergency Safety
Intervention and was restrained on 1/19/2025 at
6:38 PM.
Review of a Nurse Progress note, signed by the
Nurse Manager (NM) on 1/19/25, indicated Client
#2 had to be placed in a physical restraint on
1/19/2025 at 6:38 PM.
Review of an Emergency Intervention packet,
completed and signed by the NM on 1/19/2025 at
8:45 PM, and signed by the physician on
1/20/2025 at 11:07 AM, indicated Client #2 was
placed in a personal restraint on 1/19/2025 at
6:38 PM.
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID:6ZZR12 Facility ID: 3005 If continuation sheet Page 2 of 8

PRINTED: 05/30/2025
DEPARTMENT OF HEALTH AND HUMAN SERVICES FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING ______________________
R-C
04L106 B. WING _____________________________ 05/20/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
2002 S FILLMORE ST
UNITED METHODIST CHILDRENS HOME
LITTLE ROCK, AR 72214
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETION
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
{N 188} Continued From page 2 {N 188}
Review of the Post Intervention Debriefing
documentation page, included with the safety
intervention documentation dated 1/19/2025, did
not contain any information on the client
debriefing section.
Review of the facility Seclusion and Restraint Log
indicated Client #2 had an Emergency Safety
Intervention and was restrained on 1/25/2025 at
5:08 PM.
Review of a Nurse Progress note, signed by the
NM on 1/25/2025, indicated Client #2 had to be
placed in a physical restraint on 1/25/2025 at 5:08
PM.
Review of an Emergency Intervention packet,
completed and signed by the NM on 1/25/2025 at
5:30 PM, and signed by the physician on
1/27/2025 at 5:59 AM, indicated Client #2 was
placed in a physical restraint on 1/25/2025 at 5:08
PM.
Review of the Post Intervention Debriefing
Documentation page, included with the safety
intervention documentation dated 1/25/2025, did
not contain any information on the client
debriefing section.
On 5/20/2025, during an interview, the
Compliance Specialist confirmed that copies of all
Emergency Safety Interventions should be in a
binder which she provided or in the Electronic
Client Record (ECR). Review of the ECR and the
binder provided did not reveal any debriefing
documentation for 1/19/2025, and/or 1/25/2025.
On 5/20/2024 at 12:15 PM, during an interview,
Consultant #1 reported client and staff debriefings
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID:6ZZR12 Facility ID: 3005 If continuation sheet Page 3 of 8

PRINTED: 05/30/2025
DEPARTMENT OF HEALTH AND HUMAN SERVICES FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING ______________________
R-C
04L106 B. WING _____________________________ 05/20/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
2002 S FILLMORE ST
UNITED METHODIST CHILDRENS HOME
LITTLE ROCK, AR 72214
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETION
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
{N 188} Continued From page 3 {N 188}
should be completed and documented no later
than 24 hours after a client had been restrained
or put into seclusion. Consultant #1 reviewed the
debriefing documentation for Client #2, for the
restraint on 1/19/2025 and 1/25/2025, and
verified the documentation did not contain any
information on the client debriefing section, or the
staff debriefing. Consultant #1 reported that he
did not understand how it could be missing,
unless there had been several clients during the
same day having had seclusions or restraints.
On 5/20/2025 at 3:45 PM, during an interview, the
Director of Compliance and the Director of
Nursing (DON) reported that client and staff
debriefings should be completed within 24 hours
of the restraint and usually a consultant will
complete the debriefings or anyone in
management can complete the debriefings.
Review of a facility policy provided by the
Compliance Specialist, titled, "[facility name]
Procedures for the Use of Personal or Chemical
Restraints & Seclusion," with the last revision
date of October 2016, specified in part within 24
hours a face-to-face debriefing must occur after
the emergency safety intervention with all staff
involved and the residents. The discussion must
provide the residents and staff with an opportunity
to discuss events leading to the intervention and
possible ways to prevent future use of restraints
or seclusion. The policy states that all staff
involved in the intervention must participate in the
debriefing unless the resident feels threatened by
a particular staff member, who can then be
excused from the debriefing."
{N 189} POST INTERVENTION DEBRIEFINGS {N 189}
CFR(s): 483.370(b)
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID:6ZZR12 Facility ID: 3005 If continuation sheet Page 4 of 8

PRINTED: 05/30/2025
DEPARTMENT OF HEALTH AND HUMAN SERVICES FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING ______________________
R-C
04L106 B. WING _____________________________ 05/20/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
2002 S FILLMORE ST
UNITED METHODIST CHILDRENS HOME
LITTLE ROCK, AR 72214
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETION
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
{N 189} Continued From page 4 {N 189}
Within 24 hours after the use of restraint or
seclusion, all staff involved in the emergency
safety intervention, and appropriate supervisory
and administrative staff, must conduct a
debriefing session that includes, at a minimum, a
review and discussion of -
483.370(b)(1) The emergency safety situation
that required the intervention, including
discussion of the precipitating factors that led up
to the intervention;
This ELEMENT is not met as evidenced by:
Based on record review, interviews, and facility
policy review, the facility failed to ensure a
debriefing with all staff involved in the emergency
safety intervention within 24 hours after 1 Client
(Client #2) of 3 clients in the case mix were
placed in a restraint.
The findings are:
Review of Client #2's Face Sheet, dated
10/3/2024, revealed the client had diagnoses
which included disruptive mood dysregulation
disorder, anxiety disorder, attention deficit
hyperactive disorder, unspecified problem related
to social environment, and parent-child relational
problem.
Review of the facility Seclusion and Restraint Log
indicated Client #2 had an Emergency Safety
Intervention and was restrained on 1/19/2025 at
6:38 PM.
Review of a Nurse Progress Note, signed by the
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID:6ZZR12 Facility ID: 3005 If continuation sheet Page 5 of 8

PRINTED: 05/30/2025
DEPARTMENT OF HEALTH AND HUMAN SERVICES FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING ______________________
R-C
04L106 B. WING _____________________________ 05/20/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
2002 S FILLMORE ST
UNITED METHODIST CHILDRENS HOME
LITTLE ROCK, AR 72214
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETION
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
{N 189} Continued From page 5 {N 189}
Nurse Manager (NM) on 1/19/25, indicated Client
#2 had to be placed in a physical restraint on
1/19/2025 at 6:38 PM.
Review of an Emergency Intervention packet,
completed and signed by the NM on 1/19/2025 at
8:45 PM, and signed by the physician on
1/20/2025 at 11:07 AM, indicated Client #2 was
placed in a personal restraint on 1/19/2025 at
6:38 PM.
Review of the Post Intervention Debriefing
Documentation page, included with the safety
intervention documentation dated 1/19/2025, did
not contain any information on the staff debriefing
section.
Review of the facility Seclusion and Restraint Log
indicated Client #2 had an Emergency Safety
Intervention and was restrained on 1/25/2025 at
5:08 PM.
Review of a Nurse Progress note, signed by the
NM on 1/25/2025, indicated Client #2 had to be
placed in a physical restraint on 1/25/2025 at 5:08
PM.
Review of an Emergency Intervention packet,
completed and signed by the NM on 1/25/2025 at
5:30 PM and signed by the physician on
1/27/2025 at 5:59 AM, indicated Client #2 was
placed in a personal restraint on 1/25/2025 at
5:08 PM.
Review of the Post Intervention Debriefing
Documentation page, included with the safety
intervention documentation dated 1/25/2025, did
not contain any information on the staff debriefing
section.
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID:6ZZR12 Facility ID: 3005 If continuation sheet Page 6 of 8

PRINTED: 05/30/2025
DEPARTMENT OF HEALTH AND HUMAN SERVICES FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING ______________________
R-C
04L106 B. WING _____________________________ 05/20/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
2002 S FILLMORE ST
UNITED METHODIST CHILDRENS HOME
LITTLE ROCK, AR 72214
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETION
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
{N 189} Continued From page 6 {N 189}
On 5/20/2025, during an interview, the
Compliance Specialist confirmed that copies of all
emergency safety interventions should be in a
binder which she provided or in the Electronic
Client Record (ECR). Review of the ECR and the
binder provided did not reveal any debriefing
documentation for 1/19/2025, and/or 1/25/2025.
On 5/20/2024 at 12:15 PM, during an interview,
Consultant #1 reported client and staff debriefing
should be completed and documented no later
than 24 hours after a client had been restrained
or put into seclusion. Consultant #1 reviewed the
debriefing documentation for Client #2, for the
restraint on 1/19/2025, and 1/25/2025, and
verified the documentation did not contain any
information on the client debriefing section, or the
staff debriefing. Consultant #1 reported that he
did not understand how it could be missing,
unless there had been several clients during the
same day having had seclusions or restraints.
On 05/20/2025 at 3:45 PM, during an interview,
the Director of Compliance and the Director of
Nursing (DON) reported that client and staff
debriefings should be completed within 24 hours
of the restraint and usually a consultant will
complete the debriefings or anyone in
management can complete the debriefings.
Review of a facility policy provided by the
Compliance Specialist, titled, "[facility name]
Procedures for the Use of Personal or Chemical
Restraints & Seclusion," with the last revision
date of October 2016, specified in part within 24
hours a face-to-face debriefing must occur after
the emergency safety intervention with all staff
involved and the residents. The discussion must
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID:6ZZR12 Facility ID: 3005 If continuation sheet Page 7 of 8

PRINTED: 05/30/2025
DEPARTMENT OF HEALTH AND HUMAN SERVICES FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING ______________________
R-C
04L106 B. WING _____________________________ 05/20/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
2002 S FILLMORE ST
UNITED METHODIST CHILDRENS HOME
LITTLE ROCK, AR 72214
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETION
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
{N 189} Continued From page 7 {N 189}
provide the residents and staff with an opportunity
to discuss events leading to the intervention and
possible ways to prevent future use of restraints
or seclusion. The policy states that all staff
involved in the intervention must participate in the
debriefing unless the resident feels threatened by
a particular staff member, who can then be
excused from the debriefing."
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID:6ZZR12 Facility ID: 3005 If continuation sheet Page 8 of 8

Approved 6/11/25 BBM

D. Immediate corrective actions on
this issue were taken by verbally
breifing and retraining the staff who
had failed to complete the briefings,
but also to discuss this with each shift
in advance of retraining. This provided
direction so that should any confusion
or other issue occur, supervisor would
be contacted to assist within the
necessary time frame.
E. There were no other negative
findings discovered for the clients who
were poetentially impacted. The
incidents and circumstances were
discussed and no negative outcomes
noted.
F. Monitoring of these corrections will
continue for a minimum of 3 months
but the plan is to continue for an
extended period to assure compliance

D. Immediate corrective actions on
this issue were taken by verbally
breifing and retraining the staff who
had failed to complete the briefings,
but also to discuss this with each shift
in advance of retraining. This provided
direction so that should any confusion
or other issue occur, supervisor would
be contacted to assist within the
necessary time frame.
E. There were no other negative
findings discovered for the clients who
were poetentially impacted. The
incidents and circumstances were
discussed and no negative outcomes
noted.
F. Monitoring of these corrections will
continue for a minimum of 3 months
but the plan is to continue for an
extended period to assure compliance

doc_type: Revisit Survey


summary: An x-ray of a resident’s jaw was ordered after the resident was punched by a peer.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 029972
Date of Incident: 5/20/2025
Date Received: 5/22/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description:
. On Tuesday, May 20, 2025. was overheard calling someone a nigger.
(client) overheard this and punched in the jaw. Staff intervene by
separating the clients. complained of jaw pain and received on 5/22/2025,
.
Interim Action Narrative:
Narrative:
Licensing Narrative: 05/22/2025 Licensing Specialist inquired of the facility nurse's note
and inquired if the residents were placed on any precautions.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: An x-ray was ordered after a resident rolled his ankle while getting out of a circular bench.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 029773
Date of Incident: 5/15/2025
Date Received: 5/15/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: on 5/15/25 Client
appeared to have rolled onto or sprained his left ankle
earlier today while he was getting out of the donut bench in the boy's unit foyer. By
lunchtime, his left ankle became more painful to walk on causing client to walk off balance
without putting his left heel down. Client reported pain to the lateral side of his left ankle
and heel area. Mild to moderate swelling was noted on exam. An x-ray was ordered of
client's left ankle with three views and medical consult with nurse practitioner Melissa.
The nurse practitioner
ordered for pain/inflammation for 7 days and client also
has PRN order for for pain. Client instructed to rest, elevate, and
utilize ice pack. Nurse practitioner will see him this evening.
Interim Action Narrative:
Narrative:
Licensing Narrative: 05/16/2025 Licensing Specialist inquired of the facility copy of nurse's
note. Facility reported nurse note, documentation uploaded.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was injured when he bumped into a peer and fell while horseplaying.

raw_content:
Division of Provider Services & Quality Assurance
Office of Long-Term Care
P.O. Box 8059, Slot S404, Little Rock, AR 72203-1437
R
Notice of Serious Incident
Case Number: 032099
Date of Incident: 05/04/2025
Date Received: 08/14/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Incident Type: DPSQA - Complaint
Case Status: Not Submitted
DPSQA - Complaint
Report Description: Clients were horseplaying on the courtyard. and client ran and
accidently bumped each other causing them to both fall. hit/bit his sleep which
caused blooding. Client got up and washed his hands/mouth until nurse came.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: An x-ray was ordered after a resident complained of pain in her right hand.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 029334
Date of Incident: 4/27/2025
Date Received: 4/28/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: , private placement, and is an Arkansas
Native. had an x-ray done on 4/27/2024 for pain in her right hand. X-ray findings
were no acute fracture or dislocation.
Interim Action Narrative:
Narrative:
Licensing Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident alleged a staff member pushed him into a wall and left a bruise. This complaint has been UNFOUNDED by Licensing and Crimes Against Children Division (CACD).

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 029345
Date of Incident: 4/27/2025
Date Received: 4/28/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: On 4/28/25 staff member reported to consultant that
Client Arkansas Native, NON DHS client
told the therapist over the phone that alleged that pushed
him into a wall and left a bruise on him on 4/27/25. An internal form of a staff practice was
conducted and alleged the same thing to the consultant. told consultant
where this allegedly happened at, what day, and about what time. Upon camera review, you
notice trying to leave for his shift. was in the dayroom throwing a tantrum,
on the floor, staff is around trying to get him to comply. comes in to assist.
eventually follows to the patio area to get him away from the other clients.
You see speaking to client, gets into the rocking chair and rocks to hard and
falls out. does not complain or cry. goes into the group room and you see
shortly after kicking the door and slamming his body into the door to get through.
After he is let into the group room, he is to go into the hall, you see speaking calmly
and shutting doors and redirecting him. throws trash bag at ceiling, and you hear
tell him to follow instructions. You see at this time targeting him, hitting,
throwing his body at him, swinging, and going for face shots. Staff try and intervene and tell
him to calm down, he is refusing to use coping skills, is walking away from
and then try's to scratch and kick him in his private areas multiple times.
You see extend his leg in attempt to block the kicks. is still attacking
and swings again, and extends his arms to block again and staff intervene and is
seen leaving for his shift.
Interim Action Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Maltreatment Narrative:
Licensing Narrative: 04/29/25 Licensing inquired of the facility that camera footage be
saved for review. Facility reported that there is camera footage. Licensing viewed camera
footage on 04/29/2025. Licensing findings are unfounded. 05/19/2025 Licensing Specialist
inquired of the facility if worker has returned to work. Facility reported that the worker has
not returned to work.

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: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Licensee Address: 2002 SOUTH FILLMORE
LITTLE ROCK AR 72204
Licensing Specialist: Arlene Horton
Person In Charge: Sherika Williams
Record Visit Date: 4/29/2025
Home Visit Date: 4/29/2025
Purpose of Visit: Complaint Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Time: 11:00 a.m. – 11:30 a.m.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 3

Census: 33
Licensing received a complaint on 04/28/2025 for ELS Case #029345.
Licensing Specialist reviewed camera footage for this complaint with Ms. Sherika Williams, Ms. Fatima
Stepps, and Mr. Justin Smith.
Licensing Specialist reviewed camera footage which began at 6:40 p.m. and ended at 6:54 p.m. on Residence
Hall East 1. Licensing observed a ratio of 4:1.
Licensing observed the resident leave the room. Per facility staff it was the group room on Residence Hall
East 1. Licensing observed the resident being redirected several times by staff who were walking with him to
calm him down.
It appeared the resident was unhappy with staff because they took his coping skills box. Licensing heard the
resident say, “you threw my box away.” Facility reported to Licensing that the resident became aggressive
with staff because his coping skills box was taken away.
Licensing observed the resident struggle with being compliant and following staff instructions.
Licensing also observed the resident kicking the door and hitting his body against the door. The resident
displayed aggressive behavior towards staff as he continued to walk Residence Hall with staff present.
It appeared that the resident was targeting a male staff member as staff and the resident walked the hall. The
resident was observed what appeared to swing his arms, hitting staff, and attempting to kick the male staff
between his legs. The male staff member was able to prevent the resident from kicking him by putting his
arms out in front of his private area.
The staff members were observed assisting the male staff member during this time during this time to calm
the resident down after several redirections. Eventually, the resident did calm down.
The facility provided Licensing with a nursing note for this complaint. Licensing reviewed the nurse’s note.
Licensing complaint case #029345 is UNFOUNDED for violation of Minimum Licensing Standards:
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.
Licensing findings are unfounded.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 3

***** Pursuant to A.C.A. § 9-24-406(e) (3-4): If you believe that the Department’s notice of noncompliance
is in error, you may ask for reconsideration. The request for reconsideration must be in writing and delivered
to the Department by certified mail within twenty (20) business days of receipt of the notice of
noncompliance. The request must specify the parts of the notice that are alleged to be in error, explain why
you believe those parts are in error, and include documentation to support the allegation of error. Once
received the Department shall issue a decision on your request within twenty (20) days after receipt of the
request.
Provider Comments:
CCL Staff Signature : Date: 4/29/2025
Provider Signature : Date: 4/29/2025
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 3 of 3


summary: A resident reported that a staff member choked him. This complaint has been UNFOUNDED by Licensing and UNSUBSTANTIATED by the Division of Children and Family Services (DCFS).

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 029333
Date of Incident: 4/26/2025
Date Received: 4/28/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: private placement and an
Arkansas Native. was in his room, when entered his room while
redirecting was in his room for at least five to six seconds, reported
that choked him.
. Our corrective action plan: was suspended until the pending
investigation is completed.
Interim Action Narrative:
Narrative:
Licensing Narrative: 04.29/2025 Licensing inquired of the facility if there is camera footage
to view. Facility reported that there was camera footage. Licensing viewed camera footage
04/29/3025. Licensing finding. is unfounded.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident reported swollen knuckles after punching a peer in the face. An x-ray was ordered.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 028925
Date of Incident: 4/7/2025
Date Received: 4/10/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: ON 4/7/25 Client
NON DHS client, Arkansas native got into a verbal argument that turned physical after
another client was being racist. Client punched another client in the face for the
remarks, staff broke it up. He was assessed by nursing on that day of 4/7/25. On 4/10/25
nursing noticed one of his knuckles to look swollen. APRN checked out client and ordered
an X-ray. X-ray results are as followed. X-ray result report indicated no acute fracture
(normal anatomy) of right hand. Client has an order for as needed for any
discomfort.
Interim Action Narrative:
Narrative:
Licensing Narrative: 04.11.2025 Licensing Specialist Horton inquired of the facility what
precautions was the resident placed on? Request copy of the nurse's note and x-ray results.
Facility reported to Licensing that the resident was placed on assault precautions for the
incident. Facility reported the only paperwork they (facility) received was from
document uploaded.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was transported to the Emergency Room after reporting a tampon she inserted was stuck.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 028843
Date of Incident: 4/6/2025
Date Received: 4/7/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: , private placement and
Arkansas Native. She was taken to due to alleging that she
inserted a tampon in her vagina that got stuck. After being assessed by the physician at
, there was no foreign body present. will not be allowed to use tampons moving
forward, she will be given a pad instead.
Interim Action Narrative:
Narrative:
Licensing Narrative: 04/08/2025 Licensing Specialist inquired of the facility a copy of
nurse's note and discharge summary from . Facility reported nurse notes and
document from . Documents uploaded.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Three residents took a staff member’s keys while he was playing with other residents and ran out the side door of the gym. The residents were later returned by police.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 028838
Date of Incident: 4/6/2025
Date Received: 4/7/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: On 4/6/25 Client DHS client,
Arkansas Native was in the gym with peers and staff. Client is seen in the gym playing a
game of knockout with basketball. Client along with two other peers grabbed staffs keys
that were in the chair next to the door and eloped from the property. Client has returned to
the RTC.
Interim Action Narrative:
Narrative:
Licensing Narrative: 04/08/2025 Licensing Specialist inquired of the facility were the
police called? What precautions were the resident placed on? Police documentation
requested. Facility reported to licensing that the police were called, and the residents were
returned on 4/6/25 by Facility reported that the residents were placed on unit
restriction, building restriction, and elopement precautions until their behavior improves.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 028837
Date of Incident: 4/6/2025
Date Received: 4/7/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: On 4/6/25 client non DHS client,
arkansas native, was in the gym with peers and staff. Client is seen in the gym playing a
game of knockout with basketball. Client along with two other peers grabbed staffs keys
that were in the chair next to the door and eloped from the property. Client has not returned.
Interim Action Narrative:
Narrative:
Licensing Narrative: 04//08/2025 Licensing Specialist inquired of the facility what
policy/procedure has been put in place to prevent another incident? Has the resident
returned? Facility reported the resident has been placed on unit restriction, building
restriction, and elopement precautions and the resident was returned to the facility by
police on 04/07/2025. Police documentation requested. 4/8/2025, police
documentation received and uploaded. Licensing Specialist notified on 4/15/2025.
Licensing Specialist reviewed documentation.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Three residents took a staff member’s keys while he was playing with other residents and ran out the side door of the gym. The residents were later returned by police. The residents were placed on Elopement precautions and building restriction.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 028836
Date of Incident: 4/6/2025
Date Received: 4/7/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: On 4/6/2025 client non
DHS client, arkansas native was in the gym with peers and staff. Client is seen in the gym
playing a game of knockout with basketball. Client along with two other peers grabbed
staffs keys that were in the chair next to the door and eloped from the property. Client has
not returned.
Interim Action Narrative:
Narrative:
Licensing Narrative: 04/08/201 Facility reported to licensing that the resident returned to
the facility on 04/07/2025 by . Police documentation requested. 4/8/2025, police
documentation received and uploaded. Licensing Specialist notified on 4/15/2025.
Licensing Specialist reviewed documentation.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident reported red and swollen knuckles to the APRN and stated that he could not remember injuring them. An x-ray was ordered and showed no fracture or soft tissue swelling.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 028776
Date of Incident: 4/3/2025
Date Received: 4/4/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: On 4/3/2025 client non DHS
client, Arkansas resident. was getting checked out by the APRN due to a rash and
noticed his knuckles to be swollen and red. Client could not remember how he hurt them
but stated he was fine. Nursing contacted guardian, , and she
mentioned that likes to do push-ups on his knuckles, and that he was told to do
triangle pushups instead and exercises without putting pressure on his knuckles. She said
she wouldn't be surprised if that has something to do with the state of his knuckles. An x-
ray was ordered and results are as followed: x-ray result showed no acute fracture
or soft tissue swelling. All structures were well-aligned and intact (normal anatomy). Nurse
practitioner by mouth three times daily for 5 days.
Interim Action Narrative:
Narrative:
Licensing Narrative: 04/04/2025 Licensing Specialist inquired of the facility nurse's note.
Facility reported nurse's note document uploaded.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident injured his hand by punching a wall while he was upset. An x-ray was ordered.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 028775
Date of Incident: 4/3/2025
Date Received: 4/4/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: On 4/3/2025 client non DHS
resident, Arkansas native got upset with another client. went to the hallway to utilize
a self-timeout. When he was, he got upset and punched a wall. APRN was in the building
and noticed swelling. An x-ray was ordered. Results are as followed. showed no acute
fracture or dislocation. They did note his old, healed fracture of his right 5th finger (pinky).
No new injuries. Nurse practitioner by mouth three
times daily for 5 days.
Interim Action Narrative:
Narrative:
Licensing Narrative: 04/04/2025 Licensing Specialist inquired of the facility nurse's note.
Facility reported nurse's notes documents uploaded.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident punched a door while upset and injured her finger. The resident was assessed and taken for an x-ray.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 028702
Date of Incident: 3/31/2025
Date Received: 4/1/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: On 3/31/25 Client non DHS client,
Arkansas resident got upset and punched a wall. Client complained of finger pain and an x-
ray was ordered. Results are as followed.
She was transported to where she was
evaluated and sent back to the facility with a splint on her finger and a follow-up appt for
4/4 at 2:40 at . She is now on LOS 24/7, Assault Precautions, Suicidal
Precautions, Finger Foods, No sharps, sport watch.
Interim Action Narrative:
Narrative:
Licensing Narrative: 04.02.2025 Licensing Specialist inquired of the facility nurse's note
and summary from . Facility reported nurse's notes to Licensing documents
uploaded. Facility reported to Licensing that a summary from was not
provided to the facility.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was injured after hitting a wall while upset. The resident was assessed, and an x-ray of his hand was ordered.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 028544
Date of Incident: 3/24/2025
Date Received: 3/26/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: On 3/24/25 Client non DHS
client, Arkansas resident got upset at a client. Went into the hallway and punched a wall. a
X-ray was ordered and results are No fractures or dislocations were noted. *3-view x-ray of
right hand was ordered due to swelling of client's right hand likely related to him punching
a wall while he was upset on 2nd shift Monday 3/24/25; client refused ice pack or pain
medicine at that time. Per nurse on duty, the physician was notified on Mon 3/24/25 and
order for x-ray and med consult was received on Tues 3/25/25. Results were shared with
nurse practitioner, and she ordered every 4 hours as needed for right hand
pain for 5 days.
Interim Action Narrative:
Narrative:
Licensing Narrative: 03.27.2025 Licensing Specialist inquired of the facility nurse's notes
and the date of the x-ray. Facility reported to Licensing nurse's notes and reported date of
X-ray was 3/25. Licensing Specialist uploaded documents,
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: After a resident attempted to spit on a staff member, the staff member pushed her hand into the resident’s face and slapped the resident on the shoulder. Technical assistance was given for 109.1.g due to the inappropriate de-escalation technique used by staff.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 028274
Date of Incident: 3/13/2025
Date Received: 3/14/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: , is an Arkansas
Native and . was off task by spitting and hitting
(staff member). was attempting to spit on tried blocking by
pushing her hand into face. then slapped on the shoulder after
spit on her.
We are still working on what corrective action
plan we be put in place for .
Interim Action Narrative:
Narrative:
Licensing Narrative: 03/17/2025 Licensing Specialist inquired of the facility if there is
camera footage. Facility reported to Licensing that there is camera footage. Licensing
Specialist to view camera footage 03.19.2025. 03/19/2025 Licensing Specialist viewed camera
footage.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident complained of right knee pain after falling while playing basketball in the gym. An x-ray was ordered and showed no fracture or abnormality.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 028244
Date of Incident: 3/12/2025
Date Received: 3/13/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: ON 3/12/25 client Arkansas native,
non DHS client complained to the nurse of right knee pain. Client stated to the nurse he
was in the gym playing basketball and fell on his knee. Right knee mildly red and swollen
with increased warmth and tenderness to touch. Client reports difficulty extending or
flexing right knee. He refused ice pack, but did request and take his . APRN
was notified and an x-ray was ordered. The x-ray results report for right knee
indicates no fractures or other acute abnormalities (normal anatomy). Nursing will continue
to monitor for changes or worsening of symptoms, and manage symptoms with PRN pain
medication(s) unless otherwise advised by Dr. Hogan and/or APRN Melissa. Client did
later agree to ice pack and utilized it.
Interim Action Narrative:
Narrative:
Licensing Narrative: 03/13/2025 Licensing Specialist inquired of the facility copy of nurse's
note. 03/14/2025 Facility reported copy of nurse's note and Licensing Specialist uploaded
document.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident exhibited aggressive behavior during an incident where he kicked a staff member in a private area and spit in his face. The resident also alleged the staff member was going to hit him.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 028189
Date of Incident: 3/10/2025
Date Received: 3/11/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: ON 3/10/25 Client
Arkansas resident, non DHS client was on the unit, yelling, cursing, threatening to leave the
unit. Client was demanding a staff member to leave the unit. This occurred around 7:30pm.
Client was on the unit due to getting an ice pack, due to an earlier situation where client
punched a door 6 times. Staff was on the foyer redirecting the client, " time to calm down"
and "its bed time" Client ran down a hallway and shut the door. Another client ran down
the hall as well. Staff opened the door as client was leaning up against it trying to prevent
the staff from coming in. When staff opened up the door, staff instructed the other client to
come off of the hall, she complied. Staff stood in doorway. Staff is instructing to go into
his bedroom, was not complying. Staff is trying to prevent the clients from being
around each other. is yelling, screaming at staff to get out of his way, staff is calm and
redirecting client. rams his body into staff resulting in the client falling to the floor,
while in the floor, the client kicks the staff in the privates. Staff has his hands out to prevent
client from kicking. At this point supervisor is coming towards the unit, when supervisor
and lead arrive, the staff is walking out whipping spit from his face. Client spit in staffs face.
Staff is told to leave the unit as the client is targeting him. alleged that the staff " was
going to hit me" As I was around during the incident, and was watching camera footage,
staff did not say he was going to hit client. As an allegation was made, the supervisor called
the hotline to report the incident.
Client was transported to for
aggression towards others on 3.10.25
Interim Action Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Narrative:
Licensing Narrative: 03/12/2025 Licensing Specialist inquired of the facility if there is
camera footage to view. Facility reported to Licensing that there is camera footage.
Licensing Specialist requested facility to save footage for Licensing to view. Facility
reported to Licensing that there is camera footage. Licensing Specialist to view camera
footage 03.19.2025. 03/19/2025 Licensing Specialist viewed camera footage.

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#$%(cid:28)(cid:29)(cid:30)$(cid:29)&(cid:0),D(cid:30)(cid:28)’((cid:28))(cid:0)*))$-$,(cid:29)*9(cid:0)(cid:30)-*22(cid:0)*’’$((cid:28))(cid:0)$;;(cid:28))$*-(cid:28)9F(cid:0)-,(cid:0)*(cid:30)(cid:30)$(cid:30)-(cid:0)-<(cid:28)(cid:0)(cid:30)-*22(cid:0);(cid:28);D(cid:28)’(cid:0):$-<(cid:0)-<(cid:28)(cid:0)’(cid:28)(cid:30)$)(cid:28)(cid:29)-8(cid:0)
JJJJJ(cid:0)K(cid:31)’(cid:30)(cid:31)*(cid:29)-(cid:0)-,(cid:0)L8(cid:27)8L8(cid:0)M(cid:0)7G1NGN.OP(cid:28)Q(cid:0)P!GNQ (cid:0)R2(cid:0)F,(cid:31)(cid:0)D(cid:28)9$(cid:28)((cid:28)(cid:0)-<*-(cid:0)-<(cid:28)(cid:0)S(cid:28)+*’-;(cid:28)(cid:29)-I(cid:30)(cid:0)(cid:29),-$%(cid:28)(cid:0),2(cid:0)(cid:29),(cid:29)%,;+9$*(cid:29)%(cid:28)
$(cid:30)(cid:0)$(cid:29)(cid:0)(cid:28)’’,’@(cid:0)F,(cid:31)(cid:0);*F(cid:0)*(cid:30)>(cid:0)2,’(cid:0)’(cid:28)%,(cid:29)(cid:30)$)(cid:28)’*-$,(cid:29)8(cid:0)H<(cid:28)(cid:0)’(cid:28)T(cid:31)(cid:28)(cid:30)-(cid:0)2,’(cid:0)’(cid:28)%,(cid:29)(cid:30)$)(cid:28)’*-$,(cid:29)(cid:0);(cid:31)(cid:30)-(cid:0)D(cid:28)(cid:0)$(cid:29)(cid:0):’$-$(cid:29)&(cid:0)*(cid:29))(cid:0))(cid:28)9$((cid:28)’(cid:28))
-,(cid:0)-<(cid:28)(cid:0)S(cid:28)+*’-;(cid:28)(cid:29)-(cid:0)DF(cid:0)%(cid:28)’-$2$(cid:28))(cid:0);*$9(cid:0):$-<$(cid:29)(cid:0)-:(cid:28)(cid:29)-F(cid:0)P1.Q(cid:0)D(cid:31)(cid:30)$(cid:29)(cid:28)(cid:30)(cid:30)(cid:0))*F(cid:30)(cid:0),2(cid:0)’(cid:28)%(cid:28)$+-(cid:0),2(cid:0)-<(cid:28)(cid:0)(cid:29),-$%(cid:28)(cid:0),2
(cid:29),(cid:29)%,;+9$*(cid:29)%(cid:28)8(cid:0)H<(cid:28)(cid:0)’(cid:28)T(cid:31)(cid:28)(cid:30)-(cid:0);(cid:31)(cid:30)-(cid:0)(cid:30)+(cid:28)%$2F(cid:0)-<(cid:28)(cid:0)+*’-(cid:30)(cid:0),2(cid:0)-<(cid:28)(cid:0)(cid:29),-$%(cid:28)(cid:0)-<*-(cid:0)*’(cid:28)(cid:0)*99(cid:28)&(cid:28))(cid:0)-,(cid:0)D(cid:28)(cid:0)$(cid:29)(cid:0)(cid:28)’’,’@(cid:0)(cid:28)U+9*$(cid:29)(cid:0):<F
F,(cid:31)(cid:0)D(cid:28)9$(cid:28)((cid:28)(cid:0)-<,(cid:30)(cid:28)(cid:0)+*’-(cid:30)(cid:0)*’(cid:28)(cid:0)$(cid:29)(cid:0)(cid:28)’’,’@(cid:0)*(cid:29))(cid:0)$(cid:29)%9(cid:31))(cid:28)(cid:0)),%(cid:31);(cid:28)(cid:29)-*-$,(cid:29)(cid:0)-,(cid:0)(cid:30)(cid:31)++,’-(cid:0)-<(cid:28)(cid:0)*99(cid:28)&*-$,(cid:29)(cid:0),2(cid:0)(cid:28)’’,’8(cid:0)V(cid:29)%(cid:28)
’(cid:28)%(cid:28)$((cid:28))(cid:0)-<(cid:28)(cid:0)S(cid:28)+*’-;(cid:28)(cid:29)-(cid:0)(cid:30)<*99(cid:0)$(cid:30)(cid:30)(cid:31)(cid:28)(cid:0)*(cid:0))(cid:28)%$(cid:30)$,(cid:29)(cid:0),(cid:29)(cid:0)F,(cid:31)’(cid:0)’(cid:28)T(cid:31)(cid:28)(cid:30)-(cid:0):$-<$(cid:29)(cid:0)-:(cid:28)(cid:29)-F(cid:0)P1.Q(cid:0))*F(cid:30)(cid:0)*2-(cid:28)’(cid:0)’(cid:28)%(cid:28)$+-(cid:0),2(cid:0)-<(cid:28)
’(cid:28)T(cid:31)(cid:28)(cid:30)-8(cid:0)(cid:0)
WXYZ[\]X(cid:0)^Y__]‘abc
dde(cid:0)(cid:15)(cid:19)(cid:4)(cid:25)(cid:25)(cid:0)(cid:15)(cid:17)(cid:9)(cid:7)(cid:4)(cid:19)f(cid:5)(cid:16)(cid:0)g h(cid:4)(cid:19)(cid:16)g(cid:0)i(cid:12)jk(cid:12)(cid:26)l(cid:26)m
(cid:24)(cid:5)(cid:10)(cid:11)(cid:17)(cid:13)(cid:16)(cid:5)(cid:0)(cid:15)(cid:17)(cid:9)(cid:7)(cid:4)(cid:19)f(cid:5)(cid:16)(cid:0)g(cid:0) h(cid:4)(cid:19)(cid:16)g(cid:0)i(cid:12)jk(cid:12)(cid:26)l(cid:26)m
(cid:0)
(cid:2)(cid:2)(cid:2)(cid:3)(cid:4)(cid:5)(cid:6)(cid:4)(cid:7)(cid:8)(cid:4)(cid:8)(cid:3)(cid:9)(cid:10)(cid:11)(cid:12)(cid:13)(cid:14)(cid:8)
(cid:15)(cid:16)(cid:5)(cid:11)(cid:17)(cid:7)(cid:9)(cid:0)(cid:18)(cid:10)(cid:5)(cid:16)(cid:0)(cid:19)(cid:14)(cid:4)(cid:7)(cid:0)(cid:10)(cid:7)(cid:16)(cid:0)(cid:18)(cid:17)(cid:20)(cid:20)(cid:17)(cid:10)(cid:7)(cid:0)(cid:21)(cid:5)(cid:6)(cid:4)(cid:7)(cid:8)(cid:4)(cid:7)(cid:8)(cid:0)(cid:16)(cid:4)(cid:22)(cid:14)(cid:0)(cid:23)(cid:16)(cid:4)(cid:5)(cid:0) (cid:0) (cid:24)(cid:4)(cid:9)(cid:16)(cid:0)(cid:26)(cid:0)(cid:10)(cid:25)(cid:0)(cid:26)


summary: A resident complained of ankle pain stemming from a skateboarding accident that occurred before he was admitted. An x-ray was ordered. The x-ray showed no fracture or abnormalities.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 027928
Date of Incident: 2/27/2025
Date Received: 2/28/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: Client complained of ankle pain. This is the second X-
ray we have done on this ankle since he has been admitted with us. stated this pain
happened before he was admitted, and it was from skateboarding incident.
NON DHS client, . He complained of this pain, so
the Nurse practitioner ordered the x-ray for evaluation. X-ray of the left ankle was
normal with no acute findings/abnormalities (no fractures/displacements).
Interim Action Narrative:
Narrative:
Licensing Narrative: 03/03/2025 Licensing Specialist inquired of the facility nurse's note
and resident's DOB. Facility reported nurse's note with resident's DOB nurse's note
uploaded.
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humanservices.arkansas.gov


summary: A resident reported to his mother that a staff member pulled him out of his room for misbehaving, leaving a scratch on his face. The resident also reported that he hit his head on a wall while being pulled from the room.  The facility was cited 109.1.g and 905.4.g for the incident, and the staff member was terminated.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 027862
Date of Incident: 2/25/2025
Date Received: 2/26/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: , an ,
and private placement. While on his weekend pass, reported to his mother that a staff
member pulled him out of his room for misbehaving. His mother called the facility asking if
we know anything regarding this incident. After speaking with , he informed Sherika
Williams (supervisor) that he was off task one morning and the staff member
pulled him out of his room resulting in a small scratch on his face. He also said
during this incident when he was coming out of his room, he hit his head on the wall.
. The is . Our
corrective action plan was suspending until the pending investigation is
completed.
Interim Action Narrative: Facility's corrective action plan was suspending worker until the
pending investigation is completed.
Narrative:
Licensing Narrative: 02/27/2025 Licensing Specialist requested
to contact the facility.
. Licensing inquired of the facility if there is a timeframe of this incident
to see if there is camera footage or nurse's note. Licensing inquired of the facility if the
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humanservices.arkansas.gov

resident disclosed if there was anyone else around who witnessed this incident? If so, please
provide witness statement/s. Licensing Specialist to view camera footage 02/28/2025.


summary: A resident reported pain after punching a wall while upset. An x-ray was ordered and showed no fractures to his hand.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 027861
Date of Incident: 2/25/2025
Date Received: 2/26/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: an and
private placement. became upset regarding a comment made a peer made toward
him. Upon transitioning to class, asked to take a self-timeout, while being in the
hallway during his self-time out, punched the wall. was assessed by the nurse;
an x-ray was ordered. The x-ray was completed on 2/25/25, the x-ray results showed no
fracture of the left hand.
Interim Action Narrative:
Narrative:
Licensing Narrative: 02/27/2025 Licensing Specialist Horton inquired of the facility a copy
of the nurse's note. 03/03/2025 Facility reported nurse's note document uploaded.
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humanservices.arkansas.gov


summary: While upset, a resident walked out of her designated area and began punching walls and doors. Bruising and swelling were noted on both hands after the incident. An X-ray was ordered.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 027649
Date of Incident: 2/18/2025
Date Received: 2/18/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: in private placement
and an . She was observed being upset and emotional. walked out
of her designated area into the hallway. She was punching the walls and doors due to being
upset. She was assessed by the nurse finding bruising to both hands and swelling. X-ray
results found no acute fractures.
Interim Action Narrative:
Narrative:
Licensing Narrative: 02.18.2025 Licensing Specialist inquired of the facility nurse's note and
if the resident was placed on any precautions. Facility reported requested nursing note for
resident and the document has been uploaded.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident complained of pain after punching a door while upset. An x-ray was performed and showed no fracture or abnormalities.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 027550
Date of Incident: 2/12/2025
Date Received: 2/12/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: On february 12th 2025 client
non DHS client was in the hallway after walking out of the
classroom. Client was instructed to use a timeout and calm down, client walked over to the
dayroom door and punched it. Client complained of hand pain and an x-ray was ordered. X-
ray results show that her hand was normal (no fractures or other abnormalities noted).
Client will continue on assault precautions and nursing will monitor client.
Interim Action Narrative:
Narrative:
Licensing Narrative: 02.13.2025 Licensing Specialist Horton inquired of the facility nurse's
note. Facility reported nurse note to Licensing and document uploaded.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A complaint received states that a staff member kicked a resident in the face causing a nosebleed. Video reviewed did not support the allegation but did show the staff member using inappropriate language toward the resident. The facility was cited 905.4.c for the inappropriate language used.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 027800
Date of Incident: 2/11/2025
Date Received: 2/24/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: , private placement and an
. We became aware of as of today regarding an
incident on 2/11/25. arrived at the facility at 2:05 pm, to speak with
and regards to an incident reported that (staff) kicked him in the
face resulting in him having a nosebleed. never reported to anyone at the facility
that kicked him in the nose. Bridget Powell (staff member) did report on 2/11/25
to supervisor Sherika Williams the inappropriate language used toward .
Supervisor watched the camera footage which resulted in wrote up for
inappropriate language toward the client. While watching the camera footage, it does not
appear that kicked in the nose. The and Sherika
Williams (supervisor) watched camera footage of the incident on 2/24/25 at approximately
215ish. While watching the footage the stated, " she did not see kick
the client either". The referral number for the incident is , is currently
suspended as of /25, at 2:28 until pending investigation is complete.
Interim Action Narrative: Staff member is currently suspended as of /25, at 2:28 until
pending investigation is complete.
Narrative:
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humanservices.arkansas.gov

Licensing Narrative: 02/24/2025 Licensing Specialist requested
to contact the facility regarding referral . Licensing Specialist inquired
of the facility if there is camera footage and if so, save it for Licensing to review. Licensing
Specialist inquired if there are any witness statements and nurse's note. 2/25/2025, Program
Coordinator
. Licensing Specialist to view camera footage 02/26/2025.
Facility reported to Licensing nursing note and witness statements. Documents uploaded.
Licensing Specialist reviewed camera footage on 2/26/2025.


summary: A resident tripped on his shoe and fell on his shoulder while playing in the courtyard. The resident was evaluated, and an x-ray was performed.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 027475
Date of Incident: 2/8/2025
Date Received: 2/10/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: , who is an
and private placement. He was playing in the courtyard during lunch, he tripped over his
shoe and fell on his left shoulder. The on-call MD ordered an x-ray, the x-ray findings was
No acute findings. No fracture or dislocation of the left shoulder. Intact AC joint. Normal
acromiohumeral interval.
Interim Action Narrative:
Narrative:
Licensing Narrative: 02.11.2025 Licensing Specialist inquired of the facility nurse's note.
Inquire if the x-ray was completed in-house. Facility provided requested documents.
Documents uploaded.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident injured his big toe while outside playing tag.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 027300
Date of Incident: 2/3/2025
Date Received: 2/4/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: , non
, was outside playing tag with peers in the courtyard. Client tripped and hurt is
big right toe. An x-ray was ordered, and
. No articular involvement. Normal appearance of the joint spaces and
growth plates. Went to due to the x-ray. Client received
.
Interim Action Narrative:
Narrative:
Licensing Narrative: Licensing Specialist Horton inquired of the facility nurse's note,
results, and if resident was placed on any safety precautions due to his injury. Facility
reported to Licensing they (facility) do not have discharge paperwork as he is
currently still there. Stephanie nurse with the facility reported to Licensing that she spoke
with the MD directly,
. He was not placed on any
precautions as the injury was accidental and occurred while he was playing with peers.
02/14/2025 Licensing inquired of facility if the resident has returned to the facility. Facility
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

reported to Licensing that the resident was seen the following day and has been under the
care of . He had a follow up yesterday and has a follow up scheduled for 2/27/25.


summary: A resident reported that a staff member pushed him in the hallway causing him to hit his head on the wall. He also reported that he hit the staff member, and the staff member hit him back. The staff member was terminated after walking out after the incident.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 027360
Date of Incident: 2/2/2025
Date Received: 2/6/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type:
Report Description: . PRFC listed as . AO is
, who is a staff member at Methodist Residential Treatment Center. is in
and currently in residential treatment at the Methodist Residential Treatment
Center in Little Rock. The guardian provided is his caseworker. reported this week
that a staff member ) pushed him in the hallway causing him to hit his head on
the wall. reported he then hit and then hit him back.
stated this occurred around lunch time this past Sunday.
Interim Action Narrative:
Narrative: AV is PRFC listed as . AO is
, who is a staff member at Methodist Residential Treatment Center is in
and currently in residential treatment at the Methodist Residential Treatment
Center in Little Rock. The guardian provided is his caseworker. reported this week
that a staff member ) pushed him in the hallway causing him to hit his head on
the wall. reported he then hit and then hit him back.
stated this occurred around lunch time this past Sunday.
Licensing Narrative: Program Coordinator reported to Licensing Specialist Horton that
permission had been granted to contact the facility. Program Coordinator received an email
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humanservices.arkansas.gov

from the . Licensing Specialist inquired of the facility
the DOB, guardianship, and which program the resident is in. Facility reported to Licensing
that the resident is a part of LR RTC (PRTF), , .
Licensing Specialist to confirm when the child first made the accusation. Licensing
Specialist also inquired about an ICA for the staff member named in this complaint. The
facility reported to Licensing that the employee was termed this weekend ,
, 2025.


summary: A resident reported that a staff member put him in a choke hold while trying to restrain him during an altercation with a peer. The complaint was UNFOUNDED by Licensing and UNSUBSTATIATED by CACD. The staff member was allowed to return to duty after completing retraining.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 027443
Date of Incident: 2/2/2025
Date Received: 2/7/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: . who is an
and private placement. reported top his therapist he was involved in a fight
with (peer), when (staff) put him in a choke hold and
whispered in his ear "I don't want to have to put you to sleep." After reviewing camera
footage, is observed with his arm around neck in attempt to break up the
fight. Once pulled , it appears that the pressure was relieved off of
neck and escorted from the room with his arm around
shoulders/collarbone.
Interim Action Narrative: Staff member placed on suspension pending the investigation.
Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Licensing will request for camera footage to be saved to be reviewed, witness statements,
and when the resident reported the incident to his therapist. Licensing Specialist attempted
to view camera footage, but it was reported by the facility that their IT Department was
experiencing hard drive failure with this camera footage. Licensing Specialist unable to view
camera footage. The facility reported to Licensing it will update Licensing when footage is
available. Facility reported the resident reported the incident to his therapist on 2/6/25.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident punched a wall because she was upset about being placed on precautions. An x-ray was ordered and showed no fracture or dislocation.

raw_content:
AR KANS A S&S
DEPARTMENT OF

4 HUMAN
<a¥ SERVICES

Placement and Residential Licensing Unit
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
Case Number: 026812
Date of Incident: 1/13/2025

Date Received: 1/14/2025

Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115

Incident Type: Licensing

Report Description: is an fF
| and private placement. She was upset due to being placed on precautions, she
refused to follow instructions from staff. fF | was seen by staff punching the wall with
her right hand. An x-ray was ordered after being assessed by the nurse. The x-ray findings

were no fracture or dislocation.

Interim Action Narrative:

REE No :2tve:

Licensing Narrative: 01/14/2025 Licensing inquired of the facility was the resident placed
on a precaution for hitting the wall? Please provide nurse's note. Facility reported to
Licensing the resident was placed on assault precautions. Facility reported it will provide
nursing note. 01/29/2025 Facility reported nurse's note and document had been uploaded.

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


summary: A resident kicked and punched a door while upset about a peer’s tantrum. The resident was assessed, and an x-ray was ordered. The x-ray was negative for fracture or abnormality.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 026745
Date of Incident: 1/11/2025
Date Received: 1/12/2025
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: , an and
private placement. became upset when (peer) was in active
tantrum due to them supposedly dating each other. All clients were given the instructions to
line up to transition to the classroom. got in the line and transitioned to the
classroom but turned around returning back to the dayroom attempting to tell to
stop and get on task. When staff redirected to returned back to her assigned area she
refused and began cursing. Staff continue to redirect behaviors and asked to
step into the hallway. then sat down in a chair in the dayroom. Staff was trying to de-
escalate walks out the dayroom yelling "I'm on precautions already
right," she then kicked the door and punched the wall twice. She stated she was trying to
kick out the door to run away. The nurse later assessed the client, and x-ray was ordered for
her hand and ankle. x-ray results are both of her hand and foot/ankle are negative
for any fractures or other abnormalities.
Interim Action Narrative:
Narrative:
Licensing Narrative: 01/13/2025 Licensing inquired of the facility a copy of the nurse's
note. Was the resident placed on any safety precautions? The facility reported to Licensing
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via email the on-call MD placed the resident on assault precautions for her behavior. The
facility reported to Licensing that a request has been made for the nurse manager Stephanie
to send the nurse's note to Licensing. Facility emailed nursing note document to Licensing
and document 026745 uploaded.