summary: A resident was not following instructions and pushed a staff member as she was walking out the door. The staff member backhanded the resident, hitting him in the face. The facility was cited 109.1.g, 905.4.g, and 110.9.a as a result of this 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
Notice of Serious Incident
Case Number: 022673
Date of Incident: 7/17/2024
Date Received: 7/18/2024
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Dual
Report Description:
was not following instructions and refused to put his book inside of his
coping skills box. (staff) and the other staff were telling they were
not going back and forth with him anymore. The staff informed they were going to
put his books in his take-home bin upstairs, if he doesn't put the book back in his coping
skill box. continued to ignore staff instructions and ask staff "so you going to take all
my books". Another staff ( began calling name, stating " you are doing
too much and is too old for that". began laughing at the staff, (staff) got out
of seat and got the book off the table, as (staff) proceeds to walk out the door
pushes (staff). (staff) then backhand hitting in the face. The
other staff members ( and tell (staff) to leave the room, began
charging out the door at (staff) yelling "give me my book". The staff ( and
tried to stop from going out the door and began attacking the other two
staff ( and refused to be assessed by the nurse on the night of the
incident. When nursing assessed on 7/17/24, had no markings or bruises. A
(staff) was suspended on 7/17/2024 due to pending investigation.
Interim Action Narrative: Resident and staff member were separated. Resident was assessed
by the nurse. Staff member was susupended pending
investigation on 7/17/2024.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Maltreatment Narrative: AV is 17yo AO is . PRFC is
. was not following instructions and refused to put his book inside of
his coping skills box. (staff) and the other staff were telling they were not
going back and forth with him anymore. The staff informed they were going to put his
books in his take-home bin upstairs, if he doesn't put the book back in his coping skill box.
continued to ignore staff instructions and ask staff "so you going to take all my
books". Another staff began calling name, stating " you are doing too
much and is too old for that". began laughing at the staff, (staff) got out of
seat and got the book off the table, as (staff) proceeds to walk out the door
pushes (staff). (staff) then backhand hitting in the face. The
other staff tells (staff) to leave the room, began charging out the door at
(staff) yelling "give me my book". The staff tried to stop
from going out the door and began attacking the other two staff .
refused to be assessed by the nurse on the night of the incident. When nursing
assessed on 7/17/24, had no markings or bruises.
Licensing Narrative: Program Coordinator reviewed complaint for licensing concerns.
Program Coordinator will inquire about late reporting, camera footage, witness statements,
nursing note, and . Facility reported there is camera footage and that
the wrong date was entered into ELS. Facility reported the incident happened on 7/17/2024
and the report was completed on 7/18/2024. Permission granted from and
requested confirmation of the exact date of incident. Facility confirmed that incident did
happen on 7/16/2024 and the was made on 7/17/2024. The reporter thought
the facility had 24 hours from making the to complete the incident in ELS.
7/22/2024, Program Coordinator reviewed camera footage and requested witness
statements from the staff members in the dayroom. Facility reported that resident was
placed on assault precautions and unit restrictions. The police and MEMS were called and
the female staff member will be pressing charges. 7/24/2024, witness statements were
received and uploaded. Program Coordinator emailed witness statements to the
. 8/19/2024, facility provided licensing with documentation showing case was
found unsubstantiated. Progam Coordinator checked to verify. 8/21/2024, facility
reported that staff member was unavailble to complete training on 8/20/2024 but would
complete training before he returns to work. Documenation of training will be provided.
8/27/2024, facility provided copy of training documentation. 8/30/2024, Case complete.


state: AR

facility_name: United Methodist Children's Home - Little Rock

summary: No licensing concerns observed during the buildings and grounds walkthrough.

doc_type: Compliance Report


summary: Licensing conducted an annual review of policies for the facility. All policies complied with minimum licensing standards.


summary: A resident reported that a peer touched him between his legs. The residents were placed on 10-foot restrictions, and the peer will be moved to a different room.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 022418
Date of Incident: 7/3/2024
Date Received: 7/5/2024
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: , who is in and an
reported that , who is in
and an touched him between his legs on 7/3/24 or 7/4/24. was
unsure the day this happened but requested to be 10ft from and
will be placed on 10ft from each other and will be moved to a different room.
Interim Action Narrative: Residents were placed on a 10 foot restriction from one another
and placed in different rooms.
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concers. Program Coordinator inquired if incident
Facility reported that the incident was
. Facility reported that
incident and that the incident reportedly happened in a
classroom. Program Coordinator inquired about camera footage. Facility reported that there
is a camera in the classroom. Progam Coordinator requested to review camera footage and
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

will schedule a day and time next week. 7/8/2024, Program Coordinator followed up with
facility and scheduled day and time to review camera footage, 7/10/2024. 7/10/2024,
Program Coordinator reviewed camera footage for 7/3/2024. The alleged incident took
place in the classroom, ratio 4:13

doc_type: Notice of Incident


summary: Licensing conducted a buildings and grounds walkthrough of the facility. 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: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Licensee Address: 2002 SOUTH FILLMORE
LITTLE ROCK AR 72204
Licensing Specialist: Tara Norton
Person In Charge: Fatima Stepps
Record Visit Date: 5/15/2024
Home Visit Date: 5/15/2024
Purpose of Visit: Subsequent Building and Grounds
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Time of visit: 10:00 a.m. to 10:30 a.m.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Census: 30
Licensing Specialist Norton and Program Coordinator Rice completed full buildings and grounds forUnited
Methodist Children’s Home Little Rock Campus. Kaylynn Barrett and Fatima Stepps, escorted Program Coordinator and
Licensing Specialist throughout the building and grounds.
The following areas were observed: bedrooms in A and B Hallways, bathrooms, administration building, direct care office,
dining room, multi-purpose room, day rooms, art room, and classrooms. The boys’ hallways and bathrooms were not
observed due to several residents being on “sick rule” at the time of the inspection.
The bedrooms in A Hallway and bedrooms in B Hallway were all single bedrooms and were clean and sanitary. All
furnishings were safe, clean, and in good repair. Bathrooms were being cleaned by housekeeping and smelled of cleaning
supplies.
Classroom (2105) was observed during instructional time and had a ratio of 3:7. The high school boys were not present due to
touring the University of Central Arkansas. Classroom (1130) had a ratio of 2:6.
Provider Comments:
CCL Staff Signature : Date: 5/15/2024
Provider Signature : Date: 5/15/2024
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident complained of hand pain after punching walls while 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
Notice of Serious Incident
Case Number: 021171
Date of Incident: 5/9/2024
Date Received: 5/10/2024
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: On 5/9/2024 Client
, went into tantrum. Client got upset and
hit/punched walls. He complained of hand pain, and an x-ray was ordered. Results are, no
broken bones or soft tissue swelling/inflammation. Client will be placed on Assault
Precautions and a focus system for this behavior.
Interim Action Narrative: Resident had a tantrum and began hitting/punching walls. After
complaining of hand pain, an x-ray was ordered and
Resident was placed on assault precautions and a focus
system for his behavior.
Maltreatment Narrative:
Licensing Narrative: 5/10/24, Licensing Specialist, reviewed Provider Reported Incident
for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was injured in an altercation with a peer. The facility was cited 907.2 for staff members failing to intervene in the altercation.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 020986
Date of Incident: 5/1/2024
Date Received: 5/2/2024
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: ON 5/1/24 client age
was involved in a verbal altercation with another client. The verbal
altercation became physical and client hit another client. His hand swelled up and an x-ray
was ordered. results are:
Client will
receive a His precautions are, Assault, focus system, and line of sight 24/7 due to
wearing the brace, and 10 ft from other client.
Interim Action Narrative: Resident and peer had a physical altercation. Resident fractured
hand after hitting the peer. Staff put the following precautions in place: Assault, focus
system, line of sight 24/7 due to wearing the brace, and 10 ft from other client.
Maltreatment Narrative:
Licensing Narrative: 5/2/24, Licensing Specialist reviewed Provider Reported Incident for
licensing concerns. Sent email to facility to inquire if video footage would be available for
review. 5/2/24, Visit to review video footage was scheduled for 5/3 at 10:00 a.m. 5/3/24,
Facility visited to review video. Facility cited 907.2 for failing to intervene in altercation.
5/10/24, Uploaded signed 521 into ELS.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Staff will be retrained on proper protocol such as professionalism, being proactive, warning signs, 5 second
rule, Tantrum Management, and The Teaching Family Model.


summary: Two residents were involved in multiple physical altercations with 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
Notice of Serious Incident
Case Number: 020916
Date of Incident: 4/27/2024
Date Received: 4/29/2024
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description:
was in the dayroom along with Andrea Williams (staff), Lisa
Barnes (staff), and Da'Sha Washington, when open hand
slapped him in the face. stated, he slapped because he wouldn't stop
humming. Later that day was getting prepared for hygiene. Da'Sha Washington
(staff) took several youths to their room to get ready for showers. and
were running backing and forth in room while he was getting
clothes for showers. All clients began walking to the foyer area to get in the shower when
they continue to horse play and trying to hit ran down the hall went after
him and pushed back inside of the room, comes down the hallway and goes
inside of room. comes out of room as Da'Sha (staff) was coming out
down the hall.
Interim Action Narrative:
Per facility, there is an assault precaution put in place, keeping the resident and client 10
feet from one another.
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: 4/29/24, Licensing Specialist reviewed Provider Incident Report for
licensing concerns. Will follow up to the facility to see what measures have been taken to
keep the two residents separated and if video footage is available. 4/29/24, Per facility,
incident took place in the dayroom with the staff present at the table. Footage should be
available. The residents are on assault precaution, meaning that they should be 10-feet from
one another. 5/1/24, Licensing Specialist sent email to facility to set up time to review video
footage of incident on 5/3/24 at 10:00 a.m. 5/1/24, Visited facility and reviewed video
footage of incident.


summary: A resident injured her foot by kicking a door while upset. An x-ray was ordered. The facility was cited 110.17 for late reporting.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 020520
Date of Incident: 4/10/2024
Date Received: 4/12/2024
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: ,
had an x-ray on her right foot. became upset while in
the dayroom when her peers was discussing a topic about bullying. She transitioned to the
cafeteria for dinner and was still upset. Anthony (staff) asked to take a self-timeout.
went into the hallway for her self-timeout and began cursing. Anthony (staff) began
redirecting her behavior by using the Teaching Family Model. kicked the hallway
door twice that resulted in her injuring her right foot. Nurse Brittany assessed foot
and contacted the on-call medical doctor. An x-ray was ordered and completed. There were
no findings of a fracture or dislocation.
Interim Action Narrative: Staff redirected resident's behavior. Resident was assessed by the
nurse and sent for an x-ray.
Maltreatment Narrative:
Licensing Narrative: 4/12/24, Licensing Specialist reviewed Provider Reported Incident for
licensing concerns. 4/29/24, Facility cited for 110.17 for late reporting.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Complaint (AR00032493) related to restraints and seclusions at the facility was found to be In Compliance with federal regulations.

raw_content:
Division of Provider Services
& Quality Assurance
P.O. Box 8059, Slot S404
Little Rock, AR 72203-8059
April 12, 2024
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 April 4, 2024. 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 April 4,
2024, 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: Theresa.Forrest@dhs.arkansas.gov.
If you have any questions please contact your reviewer at 501-320-6235.
Sincerely,
DPSQA/Office of Long Term Care
Survey and Certification Section
tf
cc: DRA
Craig Gammon - United Methodist Childrens Home - 04/12/2024- (AOLTC - PRTF No Def) Page 1]

PRINTED: 04/12/2024
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 _____________________________ 04/04/2024
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.
Complaint (AR00032493) related to restraints and
seclusions the facility was found to be In
Compliance with federal regulations.
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:X8VK11 Facility ID: 3005 If continuation sheet Page 1 of 1

doc_type: Complaint Survey


summary: A resident reported an injury to his right ankle after playing kickball. 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
Notice of Serious Incident
Case Number: 020232
Date of Incident: 3/29/2024
Date Received by DCCECE: 4/1/2024
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: On 3/29/24 , who is in and
an Native received an x-ray. injured his right ankle while playing kickball. He
tripped over a peer foot and landed wrong on his ankle. Nurse Adrianna Lockhart assessed
foot and contacted the on-call medical doctor. The doctor on-call ordered an x-ray,
the x-ray results was no findings of an acute fracture.
Interim Action Narrative: Resident was assesed by the nurse and an x-ray was completed.
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident reported allegations of a staff member slapping and grabbing her. The facility was cited 110.12 for late reporting and 109.1 for unprofessional conduct as a result of this incident.

raw_content:
4/4/2024, informed Program Coordinator that she will complete the
interview with staff member involved via telephone and case would be
Facility inquired about getting ICA lifted. Facility expressed their concern about the citation
given. 4/9/2024, Program Manager informed facility that ICA cannot be lifted due to case
not being closed. 4/16/2024-The facility reached out for an update on the status of the case
and was informed that it is still pending, and the ICA cannot be lifted. Program Manager
emailed the to determine the progress of the

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: Kendra Rice
Person In Charge: Shannon Rouse
Record Visit Date: 4/3/2024
Home Visit Date: 4/3/2024
Purpose of Visit: Complaint Visit
Regulations Out of Compliance:
Regulation Number: 900.905.4.c
Regulation Description: The following actions shall not be used, including as discipline:
Finding Description: Staff member heard using obscene language at a resident.
Action Due Date:
Action Due Description:
Comply Date:
Sub-Regulation Level 1 Description: Lewd or obscene language;
Action Due Description:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 3

Regulations Not Correctable:
Narrative:
Time of visit: 12:30 pm to 1:30 pm
Census: 30
Licensing received a maltreatment/complaint on 3/29/2024.
Program Coordinator Rice and Licensing Specialist Norton accompanied Investigator Dominique Rudley to
review camera footage.
Licensing observed resident and staff in the milieu. Licensing could hear a staff member requesting resident to
stop and let go of the key. Resident was observed grabbing at a staff member’s wrist that was in a brace. The
staff member was heard several times requesting for resident to let go of her arm/wrist.
Resident informed staff member that she was going to tell. Staff was heard stating, “I don’t give a shit who
you tell.” The staff member was observed trying to move away from resident and the resident kept following
behind the staff member. Other staff members were observed trying to keep the resident from the staff
member.
Resident was observed running down the hallway with the staff member’s keys out of camera view with her
shirt off. Staff ran behind the resident to get the keys. Staff returned to the milieu and allowed resident time to
calm down. A staff member was observed walking down the hallway with the resident’s shirt. Resident then
returned to the milieu and starting swinging what appeared to be a jacket at staff.
Facility reported that resident came back from acute placement on 3/13/2024, Staff member mentioned in this
maltreatment/complaint was off from work 3/13/2024 to 3/15/2024. Staff member returned to work on
3/18/2024 and was out again from 3/19/2024 to 3/22/2024.
Facility reported that upon return, the staff member involved will be retrained on verbal de-escalation. Facility
will be cited for 905.4.c, staff member used obscene language toward a resident.
Provider Comments: While we acknowledge that there was an unfortunate use of crude language there are two issues we need to point out.
First there are extenuating circumstances that we feel should be considered. The youth in this situation was actively
attempting to inflict injury on the staff by grabbing the staff members already injured wrist. The staff member was trying
to escape the grip and was in obvious discomfort if not significant pain. A small slip in terms of language in such a
circumstance while not acceptable, would certainly seem to be mitigated by the severity of the assualt and pain inflicted.
Secondly in looking at the citation the regulation listed does not match the wording of the MLS found on the DHS website.
Per that publication 905.4. reads as follows: "4. The following disciplinary actions shall not be used: c. Lewd or obscene
language;" The languaged used was not part of any disciplinary action. This was an utterance that apparently resulted
from pain and possibly frustration at being assualted. The staff member clearly instructed the client to let go, then asked
her to please let go before pulling away and making the comment. The comment in itself was in no way disciplianry and
did not involve any potential consequence regarding the child's behavior. We would therefore respectfully request that
this citationbe reconsidered and removed from the record.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 3

CCL Staff Signature : Date: 4/3/2024
Provider Signature : Date: 4/3/2024
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 3 of 3


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

raw_content:
521 Visit Compliance Report

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

Licensee: United Methodist Children's Home Little Rock Campus

Facility Number: 115

Licensee Address: 2002 SOUTH FILLMORE
LITTLE ROCK AR 72204

Licensing Specialist: Kendra Rice
Person In Charge: Shannon Rouse
Record Visit Date: 3/20/2024
Home Visit Date: 3/20/2024

Purpose of Visit: Subsequent Building and Grounds

Regulations Out of Compliance:

Regulations Needing Technical Assistance:

Regulation Not Applicable:

Regulations Not Correctable:

Narrative:

Time of visit: 11:00 am to 12:00 pm

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

Page 1 of 3

Census: 30

Program Coordinator Rice and Licensing Specialist Norton completed buildings and grounds for United
Methodist Children’s Home Little Rock Campus. Kaylynn Barrett and Fatima Stepps, escorted Program
Coordinator and Licensing Specialist throughout the building and grounds.

The following areas were observed: bedrooms, bathrooms, administration building, exam room, gym,
cafeteria, seclusion rooms, therapy offices, group rooms, nurse’s station, courtyard, phone rooms, laundry
room, library, day rooms, and art room.

Upon arrival, residents and staff were observed getting on two (2) vans. The residents loaded the vans
according to gender. There were two staff members per van. Per facility, residents and staff were going on an
outing (fishing and cook out).

The units observed consisted of ten (10) bedrooms, one (1) resident to each room. There are two (2)
bathrooms and two (2) laundry rooms per unit. There was a total of four (4) units. All bedrooms were
organized, and bathrooms were clean and sanitized. All furnishings observed were in good repair.

Residents were observed throughout the building: Mr. D’s room, ratio 1:1; Day Room IstFloor, ratio 1:4;
Girls Unit, ratio 1:1; Multiple Purpose Room, ratio 3:8, and Group Room, ratio 1:1.

Program Coordinator and Licensing Specialist reviewed the MAR’s for the residents listed below:

All initialed and up to date.

Provider Comments:

CCL Staff Signature : Date: 3/20/2024
h | Y |
Yr |
\) v
Provider Signature : Date: 3/20/2024

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

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


summary: An officer made contact with Cynthia Ragland at the 12th street patrol substation. Ragland reported that she was attacked by a juvenile at the Methodist Children’s home where she is a behavioral instructor.

raw_content:
Report Contains Juvenile Information
INCIDENT NUMBER 2024-028906 JUVENILE INFORMATION Report generated: 3/7/2024 5:17 PM
Redact Before Release
NARRATIVE
ON MARCH 7TH, 2024 AT 1501 HOURS, I MADE CONTACT WITH CYNTHIA RAGLAND AT THE 12TH STREET PATROL
SUBSTATION. RAGLAND WAS REPORTING AN ASSAULT.
RAGLAND ADVISED TODAY, AROUND 0930 HOURS, SHE WAS ATTACKED BY A JUVENILE AT THE METHODIST
CHILDREN'S HOME. RAGLAND IS A BEHAVIORAL INSTRUCTOR AT THIS BUSINESS.
RAGLAND SAID THE JUVENILE PULLED HER HAIR, PUNCHED HER IN THE RIGHT SHOULDER AND GRABBED HER
WRIST THEN TWISTED IT IN WAY THAT RAGLAND BELIEVED IT TO BE INJURED.
RAGLAND WENT TO BAPTIST HEALTH URGENT CARE AND RECEIVED AN X-RAY ON HER WRIST. MEDICAL
DOCUMENTATION PROVIDED BY RAGLAND SHOWED THAT THERE WAS NO DEFINITE EVIDENCE OF A FRACTURE
OR ACUTE BONE ABNORMALITY. THE DOCUMENT PROVIDED BY RAGLAND WAS ATTACHED TO THIS REPORT.
WHEN I SPOKE WITH RAGLAND, SHE DID HAVE INJURIES CONSISTENT WITH HER STATEMENT, BRUISING TO HER
RIGHT SHOULDER AND BRUISING TO HER LEFT WRIST. RAGLAND SAID THE METHODIST CHILDREN'S HOME HAD
THE INCIDENT ON CAMERA. RAGLAND WAS ADVISED TO OBTAIN THE VIDEO FOOTAGE AND TAKE IT WITH HER AND
A COPY OF THIS REPORT TO THE PROSECUTOR'S OFFICE TO FILE FOR A WARRANT.
Page 5 of 6

doc_type: Police Report


summary: A resident was transported to Arkansas Children’s Hospital after ingesting an unknown amount of Ibuprofen she had taken from the nurse’s station.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019701
Date of Incident: 3/6/2024
Date Received by DCCECE: 3/7/2024
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: On 3/6/24 Client age
went to the nurse station to ask for a PRN due to being upset around 2pm.
When nurse was getting the client the PRN, client stuck her hand into the nurse
window grabbing a bottle of Ibuprofen. Client ran down the hallway and refused to give it to
staff, opening up the bottle and ingesting undisclosed amount. Client ran into the restroom
before staff could get it out of the clients mouth. Client had stated on Monday that she was
trying to find a way to go to Arkansas Children's Hospital. was called and MEM's was
ordered to come and transport client to Children's Hospital. Client returned back at the
RTC around 8pm. What we have done to change protocol on this, is make sure staff is
always present at the window when clients are asking for medicine. Nursing staff is to close
window if they move from the nurse window area, and we also have tapped off an area that
"items" should not be, so clients can not obtain. Client arrived at Children's for ingestion,
blood work was all normal, an EKG was done and normal, and and Oral Fluid Challenge
was completed.
Interim Action Narrative: Staff tried to get the medication from resident, the doctor was
called, and MEMS transported resident to ACH.
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns. Program Coordinator inquired if resident was on a safety plan after
making as stated on Monday. Facility reported resident was already on suicidal precautions
and remains on the precautions.


summary: An officer transported a juvenile from the facility to Pinnacle Pointe Hospital.

raw_content:
LITTLE ROCK POLICE DEPARTMENT ABBREVIATED INCIDENT REPORT

JUVENILE INFORMATION INCIDENT Report generated: 3/5/2024 9:05 PM

INCIDENT NUMBER | UNIT ASSIGNED CALL DATE CALL TIME TYPE OF CALL

2024-028039 03/05/2024 17:15:00 DIS

INCIDENT DATE LOCATION OF INCIDENT (ADDRESS / BUSINESS NAME) DISTRICT
2002 S FILLMORE ST

3/5/2024 5:15:59 PM 54

OFFENSE

NON POLICE INCIDENT

TRANSPORTED JUVENILE TO PINNACLE POINT HOSPITAL

ENTRY DATE REPORTING OFFICER ORIGINAL APPROVING SUPERVISOR MVRi
03/06/2024 03:02:36 | GAEL SNOW - GAEL SNOW - a in use

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


summary: Officers responded to the facility for a disturbance involving several juvenile males that were destroying property.

raw_content:
INCIDENT NUMBER 2024-027229 JUVENILE INFORMATION Report generated: 3/18/2024 11:20 AM
PROPERTY DRUG INFORMATION
P.LOSS P.DES QTY Description (ser#, color, make, model) PROP TAG VALUE TYPE QUANTITY MEASURE
4 31 1.00 NONE NONE + 0 900 0.00
NONE PROPERTY DAMAGE
TYPE PROPERTY LOSS: (0) Stored (1) None (2) Burned (3) Counterfeited/Forged (4) Damaged/Destroyed/Vandalized (5) Recovered (6) Seized (7) Stolen, etc (8) Unknown
PROPERTY DESCRIPTION: (10) Drugs/Narcotics (21) Negotiable Instruments (32) Structures-Industrial/Manufacture
(11) Drug/Narcotic Equipment (22) Nonnegotiable Instruments (33) Structures-Public/Community
(01) Aircraft (12) Farm Equipment (23) Office-Type Equipment (34) Structures-Storage
(02) Alcohol (13) Firearms (24) Other Motor Vehicles (35) Structures-Other
(03) Automobiles (14) Gambling Equipment (25) Purses/Handbags/Wallets (36) Tools-Power/Hand/Lawnmower
(04) Bicycles (15) Heavy Equipment Construction/ (26) Radios/TVs/VCR (37) Trucks
(05) Buses Industry (27) Recordings-Audio/Visual (38) Vehicle Parts/Accessories
(06) Clothes/Furs (16) Household Good (28) Recreational Vehicles (39) Watercraft
(07) Computer Hardware/ (17) Jewelry/Precious Metal (29) Structures-Single Occupancy (77) Other
Software (18) Livestock (30) Structures-Other Dwellings (88) Pending Inventory (of Property)
(08) Consumable Goods (19) Merchandise (31) Structures-Commercial/Business
(09) Credit Cards/Debit Cards (20) Money
TYPE DRUG MEASUREMENT:
DRUG TYPE: (D) Heroin (H) Other Narcotics (L) Amphetamines/ (O) Other Depressants
Units Weight
(A) Crack Cocaine (E) Marijuana (I) LSD Methamphetamines (P) Other Drugs
(DU) Dosage Unit (GM) Gram (OZ) Ounce
(B) Cocaine (F) Morphine (J) PCP (M) Other Stimulants (U) Unknown Type
(Pills, etc) (KG) Kilogram (LB) Pound
(C) Hashish (G) Opium (K) Other Hallucino. (N) Barbituates (NP) Number of Plants
Capacity
FOR BURGLARIES: Point of Entry: (ML) Milliliter (GL) Gallon
(LT) Liter (FO) Fluid Ounce
Tools Apparently Used:
Page 17 of 19

INCIDENT NUMBER 2024-027229 JUVENILE INFORMATION Report generated: 3/18/2024 11:20 AM
NARRATIVE
ON MARCH 3RD, 2024 AT 2117 HOURS, I RESPONDED TO 2002 SOUTH FILLMORE STREET (METHODIST CHILDREN'S
HOME) FOR A DISTURBANCE INVOLVING SEVERAL JUVENILE MALES THAT WERE DESTROYING PROPERTY.
CONTACT WAS MADE WITH EMPLOYEES OF METHODIST CHILDREN'S HOME AND THEY TOOK OFFICERS TO THE
JUVENILES CAUSING THE ISSUES. CONTACT WAS MADE WITH ALL JUVENILE SUSPECTS, J1-J6. THEY WERE
COMPLIANT AND WERE TAKEN TO THE NURSES STATION AS REQUESTED BY EMPLOYEES. SHERIKA WILLIAMS, THE
ON-DUTY SUPERVISOR, PROVIDED THE JUVENILE SUSPECTS INFORMATION.
CONTACT WAS MADE WITH ASHLEY FOOTS, A BEHAVIORAL INSTRUCTOR FOR METHODIST CHILDREN'S HOME.
FOOTS ADVISED SHE WAS SPIT ON BY J1, A 13-YEAR-OLD BLACK MALE. FOOTS ALSO SAID SHE WAS HURT BY A
DOOR BEING FORCED OPEN BY THE JUVENILE SUSPECTS.
WILLIAMS ADVISED THEY HAVE A LEGAL TEAM FOR DAMAGE RESTITUTION THROUGH THE PARENTS PER THEIR
SIGN-IN FORMS FOR THE FACILITY. BOTH WILLIAMS AND FOOTS WERE PROVIDED THE INCIDENT NUMBER AND
ADVISED TO CONTACT THE PROSECUTOR'S OFFICE FOR CHARGES, IF ANY.
DAMAGE SUSTAINED TO THE BUILDING WAS SEVERAL DAMAGED WALLS FROM BEING KICKED IN BY THE JUVENILE
SUSPECTS, ALONG WITH TWO KEYCARD SENSORS THAT WERE RIPPED OFF THE WALLS BY THE JUVENILES.
Page 18 of 19


summary: A resident reported she had been joking around with a staff member, but that led to the staff member putting the resident’s hand in a toilet. The resident also reported she ended up on the floor with a split lip at the end of 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
Notice of Serious Incident
Case Number: 019579
Date of Incident: 3/1/2024
Date Received by DCCECE: 3/4/2024
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Dual
Report Description: On Friday 3/1/24 a
age DOB native and resident. Non DHS
client. reported to her therapist that : " reported during her individual session
that the week before, between Wednesday and Friday (Feb 21-Feb 23), she was getting her
things ready to shower when a staff member came into the bathroom with her. She stated
they were initially "joking around" by throwing tissues at each other but then the staff
member tried to put head into the toilet. stated that she was trying
to "fight against" the staff member to prevent her head from going into the toilet but the
staff member was successful in putting hand into the toilet. then
stated that she "somehow ended up on the floor with a split lip. " reported that
the staff member told her not to tell what happened because it would get her in trouble and
to inform the nurses that she fell and split her lip. reported that during the
altercation in the bathroom, another staff member closed the bathroom door and informed
other clients that "they did not need to see this. " stated she exited the bathroom
with the original staff member and informed the nurse she fell and split her lip.
also reported an incident that occurred the night of 02/26/24. She stated that she fought
with staff and that staff "threw her on the ground and was on top of her," threw a shoe at
her, and was pushing and hitting her during the altercation. reported that the
staff who was in the bathroom was and the staff that closed the door was
reported that the staff who threw the shoe at her and threw her
on the ground on the 26th was
After review of camera footage on the incident of the bathroom you see
and staff horse playing around. Both are joking, laughing, and
continuously playing around with each other. You see client throw a jacket at staff, as
staff is playing back with her. Staff does follow the client into the bathroom as other
staff is in the foyer and at the door of the bathroom. You can hear but not
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

see the client and the staff laughing, joking, horse playing around. A couple minutes later
you see staff leave laughing and then client comes out and throws wet toilet paper at the
staff. They continue to laugh and joke during the duration of the evening until the client
goes to bed. The staff had pour boundaries of horse playing with the clients. We have
instructed her that this can not happen moving forward. We have not been able to find any
evidence that the client reported this to the nurse of the "busted lip."
On the next incident, you see client get upset
after phone call with her mom. She came out of the phone booth, yelling, cursing, at staff.
Staff redirect client about behavior, and client throws shoe at staff ,staff picks up
the shoe and takes it into the Bi office. We have not been able to find any evidence of staff
throwing a shoe at client
Interim Action Narrative: . Staff members were suspendd
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed complaint for licensing concerns.
Program Coordinator will check for and request permission to contact
the facility. Program Coordinator inquired about camera footage and ICA for staff members
mentioned. 3/5/2024, Program Coordinator checked for and request
permission to contact the facility. Program Coordinator reviewed camera footage and
requested nursing notes. 3/12/2024, Program Coordinator inquired if resident was still at
the facility. Facility reported resident is still at the facility. 4/2/2024, Program Coordinator
checked case still pending.

Provider corrective action: Staff on supspension pending outcome of investigation.


summary: A resident reported injuring his toe while playing. An x-ray was ordered.

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019506
Date of Incident: 2/28/2024
Date Received by PRLU: 2/29/2024
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: y/o male, dob , who is in private placement and
Arkansas native received an x-ray on 2/28/24 due to pain in right toes. reported to Nurse
Brittany, that he hit his foot/toe while playing yesterday. is unable to recall exactly what he
did when he hurt his toe, and just remembers bumping it on something. The findings of the x-ray
results were no acute fractures or dislocation.
Interim Action Narrative: Resident was assessed by the nurse and an x-ray was completed.
______________________________________________________________________________
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for licensing
concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident injured his hand by hitting windows and doors while upset. An x-ray was ordered.

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019418
Date of Incident: 2/24/2024
Date Received by PRLU: 2/26/2024
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: On the evening of 2/24/24 Client age DOB
Arkansas Native, non DHS client, got upset and began to hit windows and doors. After hitting the
items, the clients hand became swollen. An x-ray was ordered that evening and found that he had :
angulated deformity of the distal shaft of the fifth metacarpus ( broke his pinky). Client was sent to
Arkansas Children's Hospital for a soft ace bandage cast. Client was placed on Assault Precautions
and Line of sight 24/7 for the incident.
Interim Action Narrative: X-ray completed and resident transported to ACH for treatment.
______________________________________________________________________________
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for licensing
concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident injured his hand by punching the wall out of anger. An x-ray was ordered.

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019201
Date of Incident: 2/15/2024
Date Received by PRLU: 2/15/2024
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: Client age DOB , parent custody client, Arkansas
native, was in his bedroom upset. Client began to punch the wall out of anger. He came out of his
room and was still upset but was able to calm down. An x-ray was ordered and was results are:
normal with no acute hand fracture or dislocation. Safety Plan is client will be placed on Suicide
Precautions. Police and Hotline were not called.
Interim Action Narrative: X-ray completed and resident placed on suicide precautions.
______________________________________________________________________________
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for licensing
concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


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

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019202
Date of Incident: 2/15/2024
Date Received by PRLU: 2/15/2024
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: /o male, DOB , parent custody and an Arkansas
native. was in the gym playing a basketball game with some of his peers. and peer
were going for the rebound when they collided into each other, falling on the floor.
complained of right knee pain. The doctor was called and ordered for client to be transported to
Arkansas Children's Hospital for evaluation. was transported by MEMS and released at 3:19
pm. The ER did not find any fracture on the x-ray and the diagnosis was most likely deep bruise.
There were no police report made or hotline.
Interim Action Narrative: Resident was transported to ACH for an evaluation via MEMS.
______________________________________________________________________________
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for licensing
concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A staff member used inappropriate crisis management after being spit on by a resident. The facility was cited 905.4.g as a result of this incident.

raw_content:
and nursing note. Program Coordinator will inquire about investigator and request permission to
contact the facility. Facility reported camera footage is available. Program Coordinator will schedule
a day and time to review camera footage. 2/9/2024, Program Coordinator requested permission
from investigator to contact the facility. Investigator gave permission to contact the facility. Program
Coordinator inquired if staff member involved was placed on administrative leave or terminated.
2/12/2024, Program Coordinator reviewed camera footage and requested documenation of staff
member's suspension. Facility cited 905.4.g. Resident placed on 60K Focus and assault precautions.
3/11/2024, Program Coordinator requested an update. Investigator reported case is still pending.
3/13/2024, facility provided documentation that case was found unsubstantiated. 3/14/2024,
facility provided training documentation for staff member mentioned in the incident. 3/15/2024,
ICA approved to be lifted.

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: Kendra Rice
Person In Charge: Sherika Williams
Record Visit Date: 3/14/2024
Home Visit Date: 3/14/2024
Purpose of Visit: Revisit Complaint
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
No in-person licensing visit was completed on 3/14/2024.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Licensing received a complaint on 2/7/2024 for ELS Case #019036.
Facility was cited for standard 905.4.g on 2/12/2024.
Provider Comments:
CCL Staff Signature : Date: 3/14/2024
Provider Signature : Date: 3/14/2024
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident eloped out of the building during a fire alarm.

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
Case Number: 018904
Date of Incident: 2/1/2024
Date Received by DCCECE: 2/1/2024
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: On 2/1/24, ,
eloped out of the building at 8:24am. (staff) stepped inside of the office,
picks up a chair the staff was seating in and begin walking down the hallway with the
chair. walks inside of (client) room with the chair who was in the bed
due to refusing to get up. While is standing in the doorway talking to , the fire
alarm starts going off. waits a second, the fire alarm continues to go off, then
put the chair down and walk to the exit door and go out of the door. She goes down the
stairs to the first floor and go out of the building. gets up and go report to the staff
that has went out of the door. (nurse) runs down the hall to look for
and other staff comes to assist. did not leave off campus, she returns to the front
door at 8:27 am and rings the doorbell. The therapist opens the door and walks her back to
the unit.
Interim Action Narrative: Staff looked for resident.
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns. Program Coordinator inquired about camera footage. 2/9/2024,
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Program Coordinator will schedule a day and time to review camera footage. 2/12/2024,
Program Coordinator reviewed camera footage.

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Licensee Address: 2002 SOUTH FILLMORE
LITTLE ROCK AR 72204
Licensing Specialist: Kendra Rice
Person In Charge: Shannon Rouse
Record Visit Date: 2/12/2024
Home Visit Date: 2/12/2024
Purpose of Visit: Self Report Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Time of visit: 11:45 am to 1:00 pm
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Census: 31
Licensing received a provider reported incident on 2/1/2024 for ELS Case #018904.
Program Coordinator reviewed camera footage for the provider reported incident with Methodist staff.
Resident was observed in the foyer standing by a wall. Where the resident was standing, Program Coordinator
observed ratio 1:2. There was a resident sitting on the floor by the wall. Program Coordinator observed
another staff member enter the foyer area.
Resident was observed walking down the hallway with a chair to a peer’s bedroom. Resident entered the
peer’s bedroom with the chair. Program Coordinator observed the lights flashing on the hallway. Staff
reported that a quarterly drill was being conducted at the time of this incident. Because of the drill/alarm, the
magnetic doors automatically unlocked.
Program Coordinator observed resident run toward and out of the exit door. The peer was observed walking
down the hall to alert staff that resident went out the exit door. Staff was observed running down the hall and
through the door that resident left out of.
Facility reported they will work with maintenance to prevent future incidents of this nature when drills are
being conducted.
Provider Comments:
CCL Staff Signature : Date: 2/12/2024
Provider Signature : Date: 2/12/2024
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident wrapped his sweater around his neck and pulled it tight in an attempt to self-harm.

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 018933
Date of Incident: 2/1/2024
Date Received by PRLU: 2/2/2024
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: On 2/1/24 years old, , in DHS placement, got
upset and walked out the classroom. or (staff) did not follow
he wrapped his red sweater around his neck and started pulling it tight. He then began
coughing, his airway was not obstructed. Shawanda Martin intervened by taking the sweater from
around neck.
Interim Action Narrative: Staff intervene by taking the sweater from resident.
______________________________________________________________________________
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for licensing
concerns. 2/9/2024, Program Coordinator will schedule a day and time to review camera footage.
2/12/2024, Program Coordinator reviewed camera footage.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident complained of hand pain after playing in the gym. An x-ray was ordered.

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
Case Number: 018793
Date of Incident: 1/26/2024
Date Received by DCCECE: 1/29/2024
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: On the evening of 1/26/24, Client
was playing in the gym. She complained after playing in the
gym of hand pain. An x-ray was ordered. Results are delivered on 1/28/24 : revealed no
abnormalities or dislocation.
Interim Action Narrative: An x-ray was ordered.
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident complained of left knee pain after playing in the gym. An x-ray was ordered.

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
Case Number: 018758
Date of Incident: 1/25/2024
Date Received by DCCECE: 1/26/2024
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: ON 1/25/24 Client
was playing in the gym. X-ray was ordered on left knee due to client complaining of
knee pain and having palpable knot on the lower part of his knee with increased warmth
and some possible swelling. Results came back and are : No acute fracture or effusion, but
did show fragmentation along the tibial tuberosity with mild overlying soft tissue swelling
suggestive of Osgood-Schlatter disease (more so from overuse).
Interim Action Narrative: An x-ray was ordered on resident's knee.
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Buildings & Grounds conducted. No deficiencies cited.

raw_content:
521 Visit Compliance Report

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

Licensee: United Methodist Children's Home Little Rock Campus

Facility Number: 115

Licensee Address: 2002 SOUTH FILLMORE
LITTLE ROCK AR 72204

Licensing Specialist: Clayton DeBoer
Person In Charge:

Record Visit Date: 1/23/2024

Home Visit Date: 1/23/2024

Purpose of Visit: Monitor Visit

Regulations Out of Compliance:

Regulations Needing Technical Assistance:

Regulation Not Applicable:

Regulations Not Correctable:

Narrative:

Buildings & Grounds conducted from 9:30AM-10:30AM. Census: 28

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

Page 1 of 2

Classroom | staff/client ratio: 2:8
Classroom 2 staff/client ratio: 2:8
Hallway staff/client ratio: 2:7
Milieu staff/client ratio: 1:2

All buildings and sleeping areas clean, safe and in good repair. Bathrooms observed clean and sanitary with
functioning sinks, showers and toilets. Grounds clean and free of safety hazards. Fire and severe weather drill

logs checked today.

MAR checked for:

All initialed and up to date.

Provider Comments:

CCL Staff Signature :

A)
Vy
‘ al

I HA

/

Provider Signature :

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

Date: 1/23/2024

Date: 1/23/2024

Page 2 of 2


summary: A complaint received by Licensing stated that a resident reported he had been picked on and sexually assaulted by peers while at the facility.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 018655
Date of Incident: 1/22/2024
Date Received: 1/22/2024
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Dual
Report Description: Licensing received maltreatment report 1/22/24 as follows: The av is
He is currently in DCFS
Custody. The ao is unknown. This incident happened at the Methodist Group Home in
Little Rock. said that other kids would pick on him. They would touch him
inappropriately while they would shower. They would touch his penis. He did tell them to
stop, and they would not stop. also said that would touch his butt and put a finger
inside of his rectum. He told them to stop, and he would not stop. This happened prior to
11-17-23. It is unknown when he was placed at Methodist. never did say how many
people would do this to him but he said that there were a lot of them.
Interim Action Narrative: Client discharged from facility 11/17/23.
Maltreatment Narrative: -The av is
. He is currently in DCFS Custody. The ao is unknown. This
incident happened at the Methodist Group Home in Little Rock. said that other
kids would pick on him. They would touch him inappropriately while they would shower.
They would touch his penis. He did tell them to stop, and they would not stop. also
said that would touch his butt and put a finger inside of his rectum. He told them to stop,
and he would not stop. This happened prior to 11-17-23. It is unknown when he was placed
at Methodist. never did say how many people would do this to him but he said that
there were a lot of them.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing received maltreatment report 1/22/24 as follows: The av is
. He is currently in
DCFS Custody. The ao is unknown. This incident happened at the Methodist Group Home
in Little Rock. said that other kids would pick on him. They would touch him
inappropriately while they would shower. They would touch his penis. He did tell them to
stop, and they would not stop. also said that would touch his butt and put a finger
inside of his rectum. He told them to stop, and he would not stop. This happened prior to
11-17-23. It is unknown when he was placed at Methodist. never did say how many
people would do this to him but he said that there were a lot of them. 1/22/24-Licensing
phoned Fatima Stepps of UMCH to ascertain client's DOB: and Guardianship: AR
Foster Care. Client discharged from UMCH 11/17/23. No timeframe is given to review
video. No video is available for shower area where some of the alleged incidents occurred.
Case remains under review pending investigation outcome. Sherika Williams of UMCH
stated that clients shower alone, no other clients present. 3/8/2024, Program Coordinator
requested an update from investigator. 3/13/24-Received notification that maltreatment
complaint was unfounded.


summary: A resident complained of pain after rolling his left ankle while playing in the gym. An x-ray was ordered.

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
Case Number: 018727
Date of Incident: 1/24/2024
Date Received by DCCECE: 1/25/2024
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: on January 24th,
client was in the gym playing. Client rolled his left ankle and complained of pain. An x-ray
was ordered and results are : There is no acute fracture or dislocation. He was given an ice
pack, elevation, and PRN Tylenol.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 1/25/24-Received provider reported incident that on 1/24/24 client
rolled his ankle in the gym. X-ray ordered. No findings. No licensing concerns
noted from this report.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident reported wrist pain after trying to dodge a ball during recreational therapy. An x-ray was ordered.

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
Case Number: 018447
Date of Incident: 1/6/2024
Date Received by DCCECE: 1/8/2024
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: On 1/6/24 , had to
have an x-ray. reported he injured his hand outside of the facility, but during
Recreational Therapy, he was running trying to dodge a ball and fell on his right wrist. An x-
ray was completed finding no acute fractures or dislocations.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 1/8/24-Received provider reported incident that on 1/6/24
, had to have an x-ray. reported he
injured his hand outside of the facility, but during Recreational Therapy, he was running
trying to dodge a ball and fell on his right wrist. An x-ray was completed finding no acute
fractures or dislocations. No licensing concerns regarding this report.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident injured his wrist while playing in the gym. An x-ray was ordered.

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
Case Number: 018443
Date of Incident: 1/4/2024
Date Received by DCCECE: 1/8/2024
Facility Name: United Methodist Children's Home Little Rock Campus
Facility Number: 115
Incident Type: Licensing
Report Description: On 1/4/24
clients, had to have an x-ray done on his right wrist. was playing a game in the gym
with his peers, when he slid into the base and fell on his right arm. An x-ray was completed
finding no acute fractures or dislocation.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 1/8/24-Received provider reported incident that on 1/4/24
, had to have an x-ray done on his right
wrist. was playing a game in the gym with his peers, when he slid into the base and
fell on his right arm. An x-ray was completed finding no acute fractures or dislocation.
Email sent to facility to ascertain the exact date the x-ray was performed. 1/9/24-Facility
visited. Client received an x-ray on 1/4/24 and it was reported to licensing 1/8/24.
Facility cited 110.17: The agency shall notify the Licensing Unit by the next business day of
serious injuries requiring emergency medical treatment, agency vehicle accidents, arrests,
elopements, suicide attempts, or deaths and maintain documentation of the incident and
notification.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov