summary: Officers were dispatched to the facility in response to a disturbance where two subjects had suffered injuries.

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

Case P23-002392 Printed on March 17, 2023

Approved
Report Type Patrol
Primary Officer David Guarno
Investigator None
Records Technician
Reported At 02/24/23 11:46
Incident Date 02/24/23 11:46
Incident Code DIST : DISTURBANCE
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
2
Southwest
None
Ereferral County None

Disposition P- PENDING
Disposition Date/Time 02/24/23 12:45
Disposition Comments

Approved JDN2590 02/24/2023
Review for Gang Activity None

Primary Narrative By David Guarno, 02/24/23 13:08
BATTERY SECOND DEGREE-CERTAIN VICTIMS

On 2/24/2023, at 11:46 hours, | was dispatched to 20400 Colonel Glenn in reference to a disturbance where two
subjects had suffered injuries.

Upon arrival, | made contact with Youth Home staff, who advised me that (offender) had assaulted two
staff members and was currently cooling down in another room. | was advised by several staff members that the
victims were in separate rooms and needing medical attention, at which time | requested that MEMS unit come to our
location to treat injuries of both victims. After receiving a brief report of the altercation, | made contact with

and placed him into handcuffs. He was pat down for weapons and placed in the back of my patrol unit. At this time,
Sgt. Simmons stood by my patrol unit and observed the offender while | went inside to make contact with both victims
and Youth Home staff to gather further information.

| made contact with the first victim, Vincent Hunter. V. Hunter had a very large and noticeable knot above his left eye at
the time of our interview. V. Hunter stated that on 2/23/2023, around 11:30 hours, he and the other victim, Stephen
Webb, were tasked with restraining and placina him into a small room that they frequently utilize for
residents that need time to cool down. He advised that had been angry because he was not allowed to get a
library book and had been kicking the wall and causing a disturbance. V. Hunter advised that when he got

into the room, he attempted to retrain him by placing him up against the wall and facing away from him. V. Hunter
advised that while doing this, threw his own head backward, striking V. Hunter in the head and causing a
large knot to form above his left eye. V. Hunter advised that he and S. Webb continued to restrain until he
calmed down, at which time they contacted the Sheriff's office. Photos were taken of V. Hunter's injuries and uploaded
to this report.

| then made contact with S. Webb in regards to the aforementioned incident. S. Webb advised the same story as V.

Hunter and that he was attempting to restrain 1 and calm him down. S. Webb advised that while _. ..-__-..

was being held against the wall, that swung his arm around and grabbed at S. Webb's face in an attempt to

get away. S. Webb advised that when swung his arm around, that he pulled on S. Webb's left ear, pulling

the earrina out of his ear lobe. | observed a small laceration to S. Webb's left ear. He advised that he continued to

restrain until he was able to calm down and deputies arrived S. Webb advised that he has had dealings with
in the past and described him as a good but troubled kid. Photos were taken of S. Webb's injuries and

Case P23-002392 Page 1 of 2

uploaded to this report.

| spoke to management staff at the Youth Home and was advised that they already had a treatment plan in place and
were requesting that be transported to Children's Hospital so that he could be put into an acute care facility.
It was reiterated several times that they did not wish to be charged and taken to jail and were hopeful that
he could simply be taken to the hospital prior to being put into a different facility that would more adequately meet his
needs. was described by several individuals as a good kid but with a troubled past who was in need of
additional help that could not be provided in their facility.

| then made contact with . Post Miranda, advised that he did, in fact, throw his head back while
attempting to avoid being restrained, striking V. Hunter. He further advised that he inadvertently pulled S. Webb's
earring out of his ear when he was wildly throwing his arms around. Photographs were taken of and
uploaded to this report.

At this time, | spoke with Sgt. Nutt and briefed him on the situation. Due to Youth Home staff requesting he be taken for
additional medical treatment as opposed to incarceration and taking into account his current demeanor along with
details of his situation that led him to be placed into Youth Home, it was determined that he would be transported to
Children's Hospital via MEMS to be referred to an acute care facility.

was then taken out of handcuffs and MEMS unit 608 transported to Children's Hospital.

Both victims were given a report number and Youth Home staff advised that they were aware of the warrant process
should they later decide to pursue charges.

All parties were advised to contact PCSO with any further information.

Case P23-002392 Page 2 of 2


state: AR

facility_name: Youth Home

summary: Officers were dispatched to the facility to assist EMS with a patient.

raw_content:
Case P23-002253 Printed on March 17, 2023
Status Approved
Report Type Patrol
Primary Officer Jeremy Lawson
Investigator None
Records Technician
Reported At 02/21/23 17:21
Incident Date 02/21/23 17:21
Incident Code ASTA : ASSIST AMBULANCE
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
Zone 2
Beat Southwest
Court None
Ereferral County None
Disposition P- PENDING
Disposition Date/Time 02/22/23 01:13
Disposition Comments
Approved ADG2870 2-22-2023
Review for Gang Activity None
Primary Narrative By Jeremy Lawson, 02/21/23 21:38
Information
On 2/21/2023 at approximately 1724 hours I responded to the Colonel Glenn Youth Home to assist MEMS with a
suicidal juvenile. Upon my arrival I made contact with the staff and they advised that the juvenile was completely calm
and compliant. I waited for ambulance outside as the building was unmarked and it took me several tries to find the
right location. After several minutes of waiting the staff advised that their medical staff made the decision to transport
the juvenile to the treatment facility in the company van that was assigned to the cottage. I advised dispatch that they
could 10-22 the ambulance. I then went back into service.
Case P23-002253 Page 1 of 1

doc_type: Police Report


summary: A resident was transported to Arkansas Children’s Hospital due to continued vomiting.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 2/21/2023
Date Received by DCCECE: 2/22/2023
Facility Name: Youth Home, Inc.
Facility Number: 128
Facility Type: Residential
Incident Type: Licensing
Report Description: Incident Report for DOB: Private
placement client in our PRTF program and resides in Chestnut House Incident Report
date/time: 02/21/2023 1:30pm Location: Chestnut Incident Description: Medical
Emergency (Trip to ER/Urgent Care) Staff Involved: Jonathan Pulliam, Shelia Glass,
Elizabeth Larson-nurse, Angela Shy-doctor Events Leading: Due to PT's inability to hold
anything down and continuing to throw up and/or dry heave, Pt was transported to
Children's ER. Nursing Assessment date/time 02/22/23 1:25pm: Pt has been assessed by
nursing and Dr. Shy. After Zofran pt continues to vomit. Unable to hold down clear liquids.
Pts pallor is pale, states that he feels shaky on the inside and like he is going to pass out. Pt
has not eaten or drink since 3 to 11 shift last night other than a few sips of sprite that he
vomited up immediately. Assisted pt. into a rolling chair and out to the van to be
transported to ACH ER Guardian was notified on 02/22/23 at 4:46pm
Interim Action Narrative: Resident was assessed by nursing and transported to AR
Children's Hospital.
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative:Licensing Specialist reviewed provider reported incident. Licensing
Specialist will follow-up with facility on resident's outcome. Licensing Specialist informed
that resident is still in the hospital. 2/23/2023, Licensing Specialist informed that resident
was still in the hospital and was discharged from the facility. Resident's discharge was
previously scheduled before his hospital admission. Resident is now with his guardian. No
licensing concerns noted.

doc_type: Notice of Incident


summary: Officers were dispatched to the facility in response to a runaway juvenile report.

raw_content:
Case P23-002203 Printed on March 17, 2023
Status Approved
Report Type Patrol
Primary Officer Jeremy Lawson
Investigator None
Records Technician
Reported At 02/20/23 17:17
Incident Date 02/20/23 17:17
Incident Code INFO : INFORMATION
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
Zone 2
Beat Southwest
Court None
Ereferral County None
Disposition P- PENDING
Disposition Date/Time 02/20/23 18:14
Disposition Comments
Approved ADG2870 2-21-2023
Review for Gang Activity Not Applicable
Primary Narrative By Jeremy Lawson, 02/20/23 18:18
Information
On 2/20/2023 at approximately 1720 hours I responded to Colonel Glenn Youth Home INC. for a runaway juvenile
report. Upon my arrival I began speaking with the staff members gathering information on the juvenile
who ran away from the home. The staff was able to tell me their location. I departed the scene and responded to the
area where was located and found him walking on the side of the road talking to the staff member. The staff
member  was driving in his POV. I stopped my patrol vehicle behind the car and exited my patrol vehicle. I was able
to place in my patrol vehicle without incident and took him back to Youth Home INC..  Upon our arrival back at
the home the staff took custody of and I departed the scene. I then advised dispatch that I would be back in
service.
Case P23-002203 Page 1 of 1


summary: A resident was transported to Arkansas Children’s Hospital for evaluation due to profound weakness, poor urination, and poor PO intake.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 2/19/2023
Date Received by DCCECE: 2/20/2023
Facility Name: Youth Home, Inc.
Facility Number: 128
Facility Type: Residential
Incident Type: Licensing
Report Description: Client: DOB: Private Placement
Incident Type: ER Visit Date of ER Visit: 2/19/23 at 12:30 PM Chestnut house in PRTF
program Staff Involved: Tatiana Buskirk (Nurse), Beauticia Moore (Milieu) William Givens
(Milieu) Bentron Parker (Milieu) Events Leading to ER Visit: Poor PO intake since Friday,
asleep majority of the day, profound weakness, poor urination, c/o "not feeling well and
N", arouses to verbal/tactile stimuli, but falls asleep shortly after. VS 100/57, Hr 113, temp
97.5, RR 18, SpO2 97% RA. Cody Horn, APRn notified of the findings and on progression of
pt condition, ordered to take pt to ACH ER for evaluation and Tx. UM on call Ashley
notified. Nursing Face-To-Face Assessment: 2/19/23 1:30 PM Pt been on sick status as of
yesterday due to not feeling well. Night shift reported that pt had trouble sleeping through
the night, refused breakfast and been refusing food since Friday. Poor PO intake. asleep
majority of the day, profound weakness, poor urination, c/o "not feeling well and N",
arouses to verbal/tactile stimuli, but falls asleep shortly after. VS 100/57, Hr 113, temp 97.5,
RR 18, SpO2 97% RA. Cody Horn, APRn notified of the findings and on progression of pt
condition, ordered to take pt to ACH ER for evaluation and Tx. UM on call Ashley notified.
left the facility at 2:11 pm with Mr Pete, QBHP. Mom notified upon departure. Nusing
Face-to-Face Assessment: 2/19/23 9:45 PM Patient received back to campus at 945pm
walking under his own power to his room. Patient appears alert and is able to answer
questions. Order received to give PM medications late. Patient took medications and then
was given his CPAP machine which he applied by himself. Guardian
2/19/23 1:45 PM and 9:46 PM
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Interim Action Narrative: Resident was assessed by nursing and transported to AR
Children's Hospital Emergency Room.
Maltreatment Narrative:
Licensing Narrative:Licensing Specialist reviewed provider reported incident. Licensing
Specialist will follow-up with facility. Licensing Specialist informed that resident was
diagnosed with a when discharged from AR Children's Hospital. No licensing
concerns noted.


summary: Licensing visited the facility to conduct a buildings and grounds walkthrough. 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: Youth Home, Inc.
Facility Number: 128
Licensee Address: 20400 COLONEL GLENN ROAD
LITTLE ROCK AR 72210
Licensing Specialist: Kendra Rice
Person In Charge: Adria Riley
Record Visit Date: 2/17/2023
Home Visit Date: 2/17/2023
Purpose of Visit: Subsequent Building and Grounds
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Time of visit: 11:15 am to 1:30 pm
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 3

Census: 31
Licensing Specialist completed a buildings and grounds walkthrough of Mabee, Rose, Chestnut, and Sturgis
houses. Licensing Specialist was escorted by Mr. Jon Pulliam, Lead Unit Manager. Licensing Specialist
observed the following areas: bedrooms, bathrooms, laundry rooms, milieus, comfort rooms, seclusion rooms,
kitchen areas, the grounds around the houses, and group rooms. All grounds around the houses were clean
with no debris.
Mabee House (girls): all bedrooms were organized with no debris and bathrooms were clean. There was a
chair in the milieu that was worn out in the seat. Mr. Pulliam requested to have the chair removed. All other
rooms of the house were clean, organized, and free of debris. Residents were in school during Licensing
Specialist walkthrough.
Sturgis House (boys): Ratio 1:1. Residents were at school when Licensing Specialist completed the
walkthrough. Bathrooms were clean and free of debris. All bedrooms were organized, beds were either made
up or had folded bedding at the foot of the bed. Licensing Specialist observed a water fountain for the
residents to have drinking water. Licensing Specialist observed laundry in the milieu that was being folded.
Chestnut House (boys): Children rights were observed on the wall by the milieu. The comfort room, seclusion
room, day area, game room, and milieu were clean and free of debris. All bathrooms were cleaned. Licensing
Specialist observed all bedrooms. The bedrooms were cleaned and organized.
Rose House (girls): Ratio 1:1, other residents were at school. Licensing Specialist observed the following
rooms: laundry room, seclusion room, and comfort room. All bedrooms and bathrooms were clean, and
organized. Licensing Specialist observed contractors rebuilding/renovating the pavilion between the Rose and
Mabee houses.
Licensing Specialist and Mr. Pulliam discussed the chair at Mabee House that was worn out in the seat area.
Mr. Pulliam requested for the chair to be removed.
Provider Comments:
CCL Staff Signature : Date: 2/17/2023
Provider Signature : Date: 2/17/2023
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

doc_type: Compliance Report


summary: Multiple deficiencies were noted in the Inspection of Care performed on 2/2/2023.

raw_content:
Inspection of Care Summary
Facility Tour:
Upon arrival to facility, AFMC staff was promptly greeted at the entrance by a Youth Home, Incorporated
staff member. AFMC was immediately taken to a conference room where they were met by the Chief
Operations Officer and the Human Resource Director. There were limited administrative support staff due
to many administrative staff working from home due to inclement weather, but available facility staff
were able to accommodate AFMC staff during inspection.
A tour of the facility was completed with the Chief Operations Officer. Several staff members were
observed interacting calmly with clients throughout the facility. Most clients were noted to be in their
assigned dormitories due to school being out due to inclement weather. Staff were able to answer
questions regarding the facility. There were four dormitories that were toured along with the school
building, cafeteria, gymnasium, and outside grounds. The following is a list of environmental
observations found during the facility tour.
• Sturgis House:
o Front door had been recently broken by a client and was not being utilized as the main
entry point at time of inspection. Entry was made in the back of the building utilizing a
set of steep steps. Steps were iced over due to recent ice storm. Melt off of ice from roof
was pouring onto walkway and steps making area extremely slippery and dangerous.
o Clients were noted in the common area and game room of dorm. There were two rooms
that had clients in their beds. There were two staff members, and all clients were within
eyesight of staff.
o One client bathroom had dirty towels in the floor and on the counter.
o There was a sticky substance and dirt build up along the baseboards noted on the floor
throughout several of the client rooms.
o Several rooms had a lot of client’s personal belongings scattered on the floor.
o Dormitory smelled strongly of urine.
• Chestnut House:
o Clients were noted in the common area of dormitory under direct staff supervision.
o Several client rooms had puzzles and a large amount of Lego blocks spilt out on the floor
blocking the walkway of the room.
o Dormitory smelled strongly of urine.
• Rose House:
o Carpet in dormitory has recently been replaced with new vinyl flooring.
o All showers in dormitory have been recently renovated.
o Dormitory was extremely clean and well organized.
o Clients were in the common area and in their rooms under direct staff supervision.
• Mabee House:
o Carpet in dormitory has recently been replaced with new vinyl flooring.
o All showers in dormitory have been recently renovated.
o Dormitory was extremely clean and well organized.
o There were no clients in this dormitory at time of tour because they were at lunch in the
cafeteria.
• School was not in session day of inspection due to inclement weather. School building was noted
to be extremely clean, and classrooms were very well organized. No issues noted during tour of
this building.
• Lunch was being served to a group of adolescent males during the tour. Cafeteria was noted to be
extremely clean. Staffing for the clients in the cafeteria appeared adequate to accommodate the
needs of the clients.
• Gymnasium was noted to be a very large space and was clean and well organized.
Youth Home, Incorporated Final IOC Report 2 | P ag e

• The outside grounds were noted to be under new renovations with a new patio being built and the
pavilion being renovated. Side walks were noted to be free of ice from the recent storm. The
bridge on the walkway was covered with ice and did not appear to have been treated.
Facility Review-Policies and Procedures:
Upon review of the site’s policies and procedures, the following deficiencies were noted:
Regulation Deficiency Statement Reviewer Notes
Medicaid IP Sec. 2: HR records did not indicate training in the During personnel record review,
221.804; use of nonphysical intervention skills, such it was noted that the provider is
CFR 42 482.130, as de-escalation on an annual basis. not in compliance with
483.376 documentation of annual
training in the use of
nonphysical intervention skills,
such as de-escalation, mediation
conflict resolution, active
listening, and verbal and
Medicaid IP Sec. 2: HR records did not indicate that all direct During personnel record review,
221.804; care personnel have ongoing education, it was noted that the provider is
CFR 42 482.130, training, and demonstrated knowledge of not in compliance with
483.376 techniques to identify staff and resident documentation of all direct care
behaviors that may trigger an emergency personnel have ongoing
safety situation semi-annually. education, training, and
demonstrated knowledge of
techniques to identify staff and
resident behaviors, events
Medicaid IP Sec. 2; There is no documentation in the HR During personnel record review,
CFR 42 482.130, records that all direct care personnel are it was noted that the provider is
483.376 trained in facility's Restraint and Seclusion not in compliance with
policy. documentation of all direct care
personnel are trained, as well as
demonstrate competency, in
facility's Restraint and Seclusion
policy and appropriate
procedures to
Personnel Records- Licenses, Certifications, Training:
There were thirty-two personnel records requested, eight (27%) professional staff and twenty-four (25%)
paraprofessional staff. During the review of the personnel records, the following deficiencies were noted:
Personnel Rule Credential Outcome Reviewer Notes
Record Validated
Number
SR012585 Medicaid IP Sec. 2: Restraint and Failed Last completed on 04/18/2022.
SR012586 221.804; 42 CFR Seclusion Last completed on 04/04/2022.
SR012589 482.130, 483.376 Training (CPI) Last completed on 03/21/2022.
SR012590 Last completed on 03/25/2022.
SR012591 Last completed on 04/14/2022.
SR012592 Last completed on 12/13/2021.
SR012593 Last completed on 02/28/2022.
SR012596 Last completed on 05/10/2022.
SR012598 Last completed on 11/10/2021.
SR012600 Last completed on 06/06/2022.
SR012602 Last completed on 06/15/2022.
Youth Home, Incorporated Final IOC Report 3 | P ag e

SR012604 Training evidence was not received
SR012605 Last completed on 05/17/2022.
SR012607 Last completed on 05/11/2022.
SR012612 Last completed on 03/07/2022.
SR012613 Last completed on 03/21/2022.
Clinical Summary
As a part of the Quality of Care survey of the IOC, an active Fee for Service (FFS) Medicaid client list
was requested, client and/or guardian interviews were conducted, and a clinical record review was
completed. There was no active FFS Medicaid clients at the time of the inspection.
Client/Guardian Interviews:
No active FFS Medicaid clients currently admitted at the time of IOC. Therefore, there were no client
interviews were conducted.
Clinical Record Review Deficiencies:
No active FFS Medicaid clients currently admitted at the time of IOC. Therefore, there were no clinical
records reviewed.
Program Activity/Service Milieu Observation:
During the facility tour, clients were observed in the dormitories and the cafeteria. Staff were calmly
interacting and engaged with clients.
Medication Pass:
No active FFS Medicaid clients received medications during medication pass. Due to the observation of
non-Medicaid clients not being complaint with the HIPAA minimal necessary rule, no medication pass
was observed. AFMC RN visited with the medication nurse who was able to show AFMC RN the facility
policies and procedures regarding medication administration, narcotic count/reconciliation/handling, and
medication discrepancies. Tour of medication room completed with the Youth Home, Incorporated
medication nurse and no discrepancies with medication storage, cleanliness of medication room, and
knowledge of medication dispensing found.
Corrective Action Plan:
The CAP must be completed within 30 calendar days of the date of the email notice of the IOC report
available for review. The IOC Report and Request for Corrective Action can be accessed through the link
to AccessPoint, provided via email.
*For more details on the individual related deficiencies, please log into the portal.
Respectfully,
AFMC Inspection Team
InspectionTeam@afmc.org
1020 W. 4TH ST., SUITE 300
LITTLE ROCK, AR 72201 • afmc.org
Youth Home, Incorporated Final IOC Report 4 | P ag e

doc_type: IOC Report


summary: A resident was sent to Arkansas Children’s Hospital for evaluation of hand pain after punching his door and bed following a physical altercation with another resident.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 2/15/2023
Date Received by DCCECE: 2/16/2023
Facility Name: Youth Home, Inc.
Facility Number: 128
Facility Type: Residential
Incident Type: Licensing
Report Description: Incident Report for DOB: Private
placement client in our PRTF program resides in Sturgis House Incident Report date/time:
02/15/23 8:05pm Location of Incident: Sturgis House Incident Description: Aggressive to
Peers, Medical Emergency (Trip to ER/Urgent Care) Staff Involved: Bruce Horton, Patrick
Gill, Broderick Parker, Ebony Galmore-nurse, Elizabeth Larson-nurse Events Leading:
Client was in the milieu playing a card game with his peers. Client began to yell at one of
his peers and then attempted to strike his one of his peers. Client began to swing at his peer
and hit his peer several times. Staff gave a verbal direction to stop and stepped between the
two peers and asked this client to go to his room. Client went to his room and was yelling
out of his room. Client punched his door several times and then punched his bed. Nursing
Assessment date/time: 02/15/23 8:26pm: Assessment of client done at this time. Client
states that he punched his peer in the head and was punching the wall related to being
upset at a peer. Pt states that his pain in right hand is 9/10. Hand assessed and noted to be
swollen, red, and bruised. Gross swelling and deformity noted to 4th and 5th knuckles.
Push, Pulling, and grasps are not equal bilaterally. Weakened in Right hand compared to
left hand. Pt has limited range of motion in right hand, unable to make a fist or grip a cup.
Pt denies need for PRN Pain medication this time. Offered Ice pack and pt allowed ice
pack. Notified on call provider, Orders to be send to ACH for Evaluation. Guardian was
notified by nurse on 02/15/23 at 8:41pm Note: Nurse was called to Sturgis house due to peer
hitting another staff. Patient stated he was playing magic and got upset with peer. He
punched peer in the head and punched the wall. Patient right swollen at the 3rd and 4th
digits with redness noted. Patient do not have limited ROM, grip is not equal and weaker
than the left hand. Patient refused medication but did take ice pack. On call MD notified at
gave order for to go ACH for xray and approved freeze order. Patient mother notified at 841
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

of incident and ask for return called in the AM. No further complaints or concerns noted.
The results from ER per nurse's email from 02/15/23 2:29am: STURGIS HOUSE: WDS: -
Went out to ACH ER to have RIGHT hand evaluated after altercation with peer over magic
cards on 2/15/23 and came back @ around 0100 -X-rays Negative for fracture -Has a splint
to wear for comfort
Interim Action Narrative: Resident was assessed by nursing and transported to AR
Children's Hospital for an x-ray per doctor's order. X-ray negative for fracture. Splint given
to wear for comfort. Both residents were placed on freeze.
Maltreatment Narrative:
Licensing Narrative:Licensing Specialist reviewed provider reported incident. Licensing
Specialist will inquire about camera footage and precautions. Licensing Specialist informed
that both residents were placed on freeze. Licensing Specialist reviewed camera footage.


summary: While escalated a resident attempted to choke himself with clothing, punched walls and glass, and bit and scratched himself.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 2/2/2023
Date Received by DCCECE: 2/3/2023
Facility Name: Youth Home, Inc.
Facility Number: 128
Facility Type: Residential
Incident Type: Licensing
Report Description: Incident Report for DOB: Private placement
client in our PRTF program and resides in Chestnut House Incident date/time: 02/02/2023
7:30pm Intervention Type: Locked Seclusion, Unlocked Seclusion Incident Description: Self
Injury (Not Suicidal), Aggressive to Peers, Aggressive to Adults, Excessive Rule Violation,
Threat to Safety, Property Destruction Staff Involved: Stephen Murdock, William Givens,
Darryel Sanders, Ashlee Jackson, Joseph Davis-nurse Events Leading: Pt became upset after
dinner due to being placed on pause due to cursing in line. Pt continued being escalated at
the house when he was asked to take a time out continued cursing and yelling at his peers,
Pt also continued cursing staff out when being redirected to stay in his area, Pt continued
coming in and out of his area throwing things and knocking things off of table. Pt was
asked to take a time out, Pt agreed to taking time out and when pt walked out of his room
he knocked all the hygiene boxes over the milieu. Pt walked to time out room but refused to
give his blanket up after being redirected several of times to give his blanket to staff. Pt then
threw his blanket at staff and continued slamming door to wall and continued making
threatening postures towards staff. 7:30pm Unlocked Seclusion: Pt was placed in unlocked
seclusion due to his unpredictable behavior pt was asked several of times to give his blanket
up pt refused several of times before throwing blanket at staff, Pt also continued slamming
unlocked seclusion door into wall and showing aggressive postures towards staff. 7:31pm
Unlocked Seclusion End: Pt released from locked seclusion due to his unpredictable
behaviors. 7:32pm Locked Seclusion: Pt contiued cursing yelling and wrapped his sweater
around his neck trying to choke himself. 7:33pm Locked Seclusion End: Staff had to remove
sweatshirt from Pt due to Pt self-harming himself. 7:34pm Locked Seclusion: Pt continued
spitting and scratching himself with his watch and began trying to choke himself with his t-
shirt. 7:35pm Locked Seclusion End: Staff had to remove Pt watch, t-shirt, glasses. 7:36pm
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Locked Seclusion: Pt continued cursing yelling punching the wall and glass, Pt also
urinated on floor and continued spitting and scratching himself. 7:51pm Locked Seclusion:
Pt took his pants down walking around seclusion room naked and continued cursing and
yelling at staff. 8:06pm Locked Seclusion: Pt continued yelling out "hey daddy" to staff and
also continued yelling at staff, Also continued trying to force door open as well. 8:21pm
Locked Seclusion: Pt was laid down on seclusion room floor and also relaxing on wall.
8:35pm Locked Seclusion End: Pt process about why he was upset and also was given his
instruction of to contract to clean his urine up and contract to his room to get ready for bed.
Patient Debriefing date/time: 02/02/2023 8:36pm: Pt felt as if he was upset about being
placed on pause and his peers instigating him, Pt feels as if he knew he was upset about
situation it was just hard for him to calm down when he became upset. Pt. Understood why
the intervention took place and agreed to compliance. Nursing Assessment date/time:
02/02/23 8:30pm: Client required locked seclusion for physical aggression towards staff.
Client seen standing shirtless in locked seclusion, biting his right wrist and urinating on the
door/floor. Client smeared and spit blood on the seclusion window. Order obtained to
transfer to acute for treatment/evaluation. Nursing Assessment date/time: 02/02/23
8:38pm: Client released from seclusion. Client has wound to right wrist, no drainage noted.
This was an old wound that was reopened by client biting skin. Wound care provided.
Client denies any other pain/injury from this incident. Client has no other obvious injury,
no redness, bruising, swelling. Client is calm and cooperative, alert and oriented,
respirations even and unlabored. Client mopped the seclusion room floor and went to bed.
Client is resting quietly with eyes closed at 9pm. Guardian was notified by nurse on
02/02/23 at 8:01pm Injuries to staff or client: Client has wound to right wrist, no drainage
noted. This was an old wound that was reopened by client biting skin. Wound care
provided. Client denies any other pain/injury from this incident. Follow-up to the injuries:
Wound care
Interim Action Narrative: Resident was placed in unlocked and locked seclusion. Staff
intervened and took items that could be used to self-harm for resident's safety. Resident was
assessed by nursing and acute placement was ordered.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist will review camera footage and inquire about
nursing notes. Licensing Specialist reviewed camera footage. No licensing concerns noted.

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Youth Home, Inc.
Facility Number: 128
Licensee Address: 20400 COLONEL GLENN ROAD
LITTLE ROCK AR 72210
Licensing Specialist: Kendra Rice
Person In Charge: Robbie Lagrone
Record Visit Date: 2/6/2023
Home Visit Date: 2/6/2023
Purpose of Visit: Self Report Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Time of Visit: 10:45 am to 12:15 pm
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 3

Census: 35
Licensing Specialist reviewed camera footage for provider reported incident that happened on 2/2/2023.
Licensing Specialist heard staff trying to get resident to comply with taking a time out. Licensing Specialist
observed resident going in and out of the game room and slamming the door up against the wall. When
resident agreed to take a time out, resident took his arm and knocked over the hygiene container to the floor
and walked to the seclusion room.
Resident had his blanket and Licensing Specialist heard staff requested for resident to hand over his blanket.
Ratio 2:1, Licensing Specialist observed resident throwing his blanket outside of the seclusion room on the
floor. Resident was then placed in locked seclusion. Resident took off what appeared to be sweatshirt and put
it around his neck in a resting like position. Resident then appeared to pull the arms of his sweatshirt as
though if he was tightening it around his neck.
Staff entered the seclusion room and removed the sweatshirt from the resident’s possession. Resident got
upset and kicked the door to the seclusion room. Resident removed his t-shirt and rolled the t-shirt up.
Resident placed the t-shirt around his neck and tightened it. Staff entered the seclusion room and removed the
resident’s shirt and watch. Resident slammed the seclusion door and Licensing Specialist heard resident using
foul language toward staff.
Licensing Specialist observed resident standing against the wall by the seclusion door with his arms folded
while talking with staff. Resident took off one sock, played with the sock, and placed the sock into his mouth.
Resident stretched his sock, placed the sock around his neck, and held the sock. Resident removed the his
other sock, placed the sock back in his mouth, and took his sock and started rubbing the sock on the door
window of the seclusion room.
At one point it appeared that resident could of possibly doing something with his arm. Resident was sitting
with his back to the camera so Licensing Specialist was unable to determine what resident was doing, ratio
3:1. Resident threw his sock at the door. Licensing Specialist observed resident walk to the seclusion door and
stood. It appeared that resident had his hands in his pants. Licensing Specialist observed resident pulled down
his pants. From the way the resident was standing in front of the seclusion door, it appeared that resident was
urinating on the floor of the seclusion room. Resident then pulled his pants back up.
Resident pulled down his pants again slaps his butt and began masturbating in front of the seclusion door.
Licensing Specialist observed resident jumping around the seclusion room and continued to masturbate.
Resident was observed pulling up his pants, sitting in the floor with is head down, with his arms folded.
Licensing Specialist was unable to observe what resident was doing while on the floor due to his back being
toward the camera. Licensing Specialist heard resident yelling to come out of seclusion.
Licensing Specialist heard staff processing with resident, ratio 1:1. Licensing Specialist observed the nurse
return to the seclusion door. The nurse and staff were processing with resident, ration 2:1. Resident was able
to contract with staff, locked seclusion ended, and resident went to his room.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 3

Licensing Specialist spoke with Mr. Jon, PRTF Lead Unit Manager. Mr. Jon informed Licensing Specialist
that resident is scheduled to be discharged on 2/7/2023. Licensing Specialist did not observed any licensing
concerns on camera review.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 3 of 3


raw_content:
Case P23-001330 Printed on February 17, 2023
Status Approved
Report Type Patrol
Primary Officer Jeremy Schoff
Investigator None
Records Technician
Reported At 01/31/23 19:21
Incident Date 01/31/23 19:21
Incident Code ASTA : ASSIST AMBULANCE
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
Zone 2
Beat Southwest
Court None
Ereferral County None
Disposition P- PENDING
Disposition Date/Time 01/31/23 21:05
Disposition Comments
GD 4303.
Review for Gang Activity None
Primary Narrative By Jeremy Schoff, 01/31/23 21:06
Assist Medical
On (1/31/23), at approximately 1933 hours I was dispatched to 20400 Colonel Glenn Road (Youth Home), in reference
to a medical assist. Upon arrival contact was made with juvenile . Youth Home staff advised that
was suicidal, and acting out. I observed acting unruly. I instructed to sit down in his room, which he
complied. MEMS unit 81 arrived on scene, and was placed in the ambulance by MEMS personnel. MEMS
advised would be transported to Children's Hospital in Little Rock.
Case P23-001330 Page 1 of 1


summary: Officers were dispatched to the facility in response to a disturbance. Dispatch advised that two females were trying to fight staff members and another patient.

raw_content: Case P23-001080 Page 2 of 2


summary: A resident was sent to Arkansas Children’s Hospital for evaluation after his knee popped out of place while playing basketball.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 1/22/2023
Date Received by DCCECE: 1/23/2023
Facility Name: Youth Home, Inc.
Facility Number: 128
Facility Type: Residential
Incident Type: Licensing
Report Description: Incident Report for DOB: 9 Private
Placement client in our PRTF program and resides in Sturgis House Incident Report
date/time: 01/22/2023 12:20pm Location of Incident: Gymnasium Incident Description:
Medical Emergency(Trip to ER/Urgent Care), Patient Injury Staff Involved: Broderick
Parker, Bentron Parker, Gregory Nesdahl Events Leading: While in the gym the pt was
playing basketball today and while he was playing, he stated that his knee popped out of
place. Pt stated that he could not walk so staff called to Sturgis and they brought the van
down since he was not able to walk back to the house. The nurse assessed him out and he
will be going to the hospital for his knee per on call practitioner's orders. IR Nursing
Assessment date/time: 01/22/23 12:36pm: Patient presents in his room at Sturgis house as
he was just transported by two staff by shoulder assisted ambulation. Pt presents on bed
verbalizing 9/10 pain at left knee medial aspect. No discoloration, or swelling noted. Pt
grimacing and favoring left extremity consistently. Pt unable to tolerate range of movement
both active or passive. Cap refill brisk distal of injured area. Full sensation distal of injured
area present. Pt and father of Pt report history of trauma to left knee. Order received to
transport to AR children's hospital ER for evaluation. Contact made with guardian on
1/22/23 by phone at 1:17pm and understanding of the event. On call practitioner notified on
1/22/23 at 12:53pm. Will mail notification to guardian.
Interim Action Narrative: Resident was assessed by the nurse and transported to AR
Children's Hospital for further evaluation.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed Provider Reported Incident. Per
resident's discharge summary from AR Children's Hospital, diagnosis:
. No licensing concerns noted.


summary: A resident reported that a staff member grabbed him by the arm, leaving a bruise. This complaint was UNSUBSTANTIATED.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 1/16/2023
Date Received by DCCECE: 1/17/2023
Facility Name: Youth Home, Inc.
Facility Number: 128
Facility Type: Residential
Incident Type: Maltreatment
Report Description: Client: DOB: Private Placement report
# Reporting staff: Deidre Gray, LMSW disclosed in therapy session that
staff member grabbed him by the arm and left a bruise. Therapist noted a small mark on
clients arm. Therapist made report via online form. Report was accepted # .
Therapist notified clinical director that call was made.
Interim Action Narrative: Licensing Specialist was informed that staff members ( and
) have been suspended pending investigation.
Maltreatment Narrative: UNSUBSTANTIATED
Licensing Narrative: Licensing Specialist contacted investigator to gain permission to
contact facility. Investigator granted Licensing Specialist permission. Licensing Specialist
contacted facility for possible names of staff members. Licensing Specialist will schedule a
visit to review camera footage. The facility provided the names of staff as
and Both staff members have been suspended pending investigation.
1/18/2023, Licensing Specialist reviewed camera footage. Licensing Specialist will inquire
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

about witness statements and/or contact information from other staff members that were
present. 1/19/2023, Licensing Specialist informed there are no witness statements.
1/25/2023, Licensing Specialist reviewed and uploaded nursing statements. 1/31/2023,
Licensing Specialist emailed Investigator Johnson for an update. Investigator informed
Licensing Specialist that she was the on-call investigator who responded. Licensing
Specialist inquired about primary investigator. Licensing Specialist informed by
Investigator Walker case is closed. Licensing Specialist informed facility that staff would
need to be retrained (physical restraint) before returning to work. 2/15/2023, Licensing
Specialist informed facility had not received documentation for staff to return to work.
2/21/2023., Licensing Specialist uploaded training roster.

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Youth Home, Inc.
Facility Number: 128
Licensee Address: 20400 COLONEL GLENN ROAD
LITTLE ROCK AR 72210
Licensing Specialist: Kendra Rice
Person In Charge: Robbie Lagrone
Record Visit Date: 1/18/2023
Home Visit Date: 1/18/2023
Purpose of Visit: Complaint Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulations Not Correctable:
Narrative:
Time of visit: 9:15 am to 1:00 pm
Census: 34
Licensing Specialist received a complaint on 1/17/2023 regarding a resident and staff member. Licensing
Specialist reviewed camera footage on 1/18/2023.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year
Page 1 of 2

Licensing Specialist observed the resident going in and out of his bedroom. Licensing Specialist observed a
door that was partially opened, and the resident closed the door at 12:27 pm. Resident was escorted to the
seclusion room from his bedroom at 12:29 pm and his shoes were removed. Licensing Specialist heard
resident yelling and observed him throwing a tantrum. Staff was observed watching the resident through the
window of the seclusion door.
At 12:39 pm, resident’s tantrum stopped. Licensing Specialist observed resident on his knees on the floor.
Resident rolled up his sleeve and was rubbing his arm in a circular motion. From 12:41 pm to 12:46 pm,
resident was observed hitting the wall and door, pacing the seclusion room, picking at the door lock and
window. At one point resident was out of view of the camera but Licensing Specialist observed resident’s arm
in the air at 12:57 pm.
Licensing Specialist heard staff encouraging resident to use his coping skills and if he needed anything. At
1:00 pm, Licensing Specialist heard staff debriefing with resident. At 1:02 pm, resident left the seclusion
room and went into his bedroom.
Licensing is not prepared to leave a finding at this time.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year
Page 2 of 2

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Youth Home, Inc.
Facility Number: 128
Licensee Address: 20400 COLONEL GLENN ROAD
LITTLE ROCK AR 72210
Licensing Specialist: Kendra Rice
Person In Charge: Robbie Lagrone
Record Visit Date: 1/31/2023
Home Visit Date: 1/31/2023
Purpose of Visit: Complaint Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
No in-person licensing visit completed on 1/31/2023.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Licensing Specialist received a complaint on 1/16/2023.
Licensing Specialist contacted investigator who informed Licensing Specialist that case was closed as
unsubstantiated.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident became dysregulated and attempted to choke himself with articles of clothing. The resident was placed in seclusion due to being a threat to safety and excessive rule violation.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 1/16/2023
Date Received by DCCECE: 1/17/2023
Facility Name: Youth Home, Inc.
Facility Number: 128
Facility Type: Residential
Incident Type: Licensing
Report Description: Client: DOB: Private Placement Date of
Incident: 1/16/23 Time: 8:30 PM Staff involved: Cedric Payne - Personal Restraint,
Reporting, Observed Darryel Sanders - Personal Restraint, Seclusion, Observed Jeremy
Burks - Milieu Valerie Alvarez - Nurse Events Leading: Client began to severe limit test
shortly after dinner, Client would not stay in his authorized area, Client began to instigate
his peers and was asked to take a timeout and use his coping skills in the comfort room,
Client then went to the comfort room where his limit testing continued and he began
slamming doors and turning lights on and off , Client eventually decided to leave the
comfort room and go back to his assigned area where he was not compliant and continued
to be oppositional, Client was then asked again after to go back to the comfort and stay until
he was not escalated anymore, Client walked around the milieu instigating peers and
making inappropriate noises , Client was walked to the comfort for a a second time, Client
began to make comments that he was going to hurt someone then laugh and say he was just
joking, Client was not ready to talk and given his squeeze ball to help deescalate him and
help him calm down, Client again walked out the comfort room and was directed to go to
his room and calm down , Client still was not compliant and continued to test limits as he
tested personal space boundaries with staff and used profanity towards staff saying Fuck
You , Client was then placed on freeze , Client told staff that since he was placed on freeze
he was not going to sleep and began more limit testing and oppositional behavior, Client
would not go to this room and again began to go to his peers room calling them names and
attempting to instigate even more, Client was given more directives from staff that he was
going to the seclusion room , Client advised staff that he did not want to be restrained and
would walk to the seclusion room on his own, Intervention Narratives: 8:30 Locked
Seclusion: Due to client being a threat to safety and excessive rule violation he was walked
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

to the seclusion room 8:39 Locked Seclusion End: Client was showing threats of self harm
placing his t-shirt around his neck attempting to choke himself, Staff contacted medical
staff 8:40 Personal Restraint: Client t-shirt was removed for his safety 8:41 Personal Restraint
End: Client was released from personal restraint after t-shirt was removed from client 8:42
PM Locked Seclusion: Client was placed back in locked seclusion and asked to continue to
use his coping skills 8:44 PM Lockes Seclusion End: Client pants were removed for his
safety after threatening to choke himself 8:45 PM Personal Restraint: Client was placed in a
personal restraint to removed his pants and socks for his safety 8:47 PM Personal Restraint
End: Client was released from personal restraint after client pants and socks were removed
8:48 PM Locked Seclusion: Client was placed back in locked seclusion to continue to use
his coping skills and not become a threat himself 9:06 PM Locked Seclusion End: Client
agreed to take a prn to help him calm down 9:06 PM Chemical Restraint: Client was given a
prn by the nurse to help client calm down 9:07 PM Unlocked Seclusion: After receiving a
prn client began to deescalate and transition to unlocked seclusion and began to debrief
9:22 PM Unlocked Seclusion End: Client debriefed with staff and contracted for safety,
Client was upset that he wanted to go outside but would have to give up his video game
time and was not able to do both activities 9:18 PM Nursing Face-to-Face Assessment:
09:18pm: was observed in unlocked seclusion, processing and debriefing with team
member. Fairly calm and cooperative at this time. AAOx3. Denies any SI or thoughts of self-
harm. Stated "Oh, I only did that to get attention". He was playful during this time as he
would make remarks then state "Oh, I'm just kidding". VS: 98/78, HR 82. Respiratory rate
is 18 breaths/minute, unlabored, regular. No retractions, accessory muscle use, or nasal
flaring. No signs of respiratory distress. No signs of physical markings around neck, neck
edema, ptosis, nausea, vomiting, hoarseness, coughing, or difficulty swallowing. Clear,
calm, coherent speech. Denies any pain, soreness, or injuries. No apparent physical
markings, erythema, bruising, or abrasions noted. Active and passive ROM to all
extremities. 9:23 PM Nursing Face-to-Face Assessment: anoa was released from unlocked
seclusion at 09:22pm. He started to put his clothes back on and voiced being tired, ready to
go to bed. He was notified he will be placed on close observation as a safety measure due to
attempted strangulations with clothes. He was receptive towards this, although made
sarcastic statements stating "I don't care about being on close observations. I like being on
close observations. This won't effect my level. I won't apply for a level for 3 years". He then
went to his room for the evening without further incident. 9:22 PM Patient Debriefing:
Client was upset that he was not able to go outside and participate in outside activity time ,
Client was playing video games for his free time and did want not lose his turn playing video
games to go outside for free time Staff involved in debriefing - Darryel Sanders, Cedric
Payne, Valerie Alvarez Psychiatrist On Call Contacted 1/16/23 at 8:30 PM Nurse Contacted
- Valerie Alvarez at 8:34 PM Clinical Therapist On call Contacted - Peggy Kelly, Chief
Clinical Officer at 8:53 PM Unit Manager On Call Contacted - Aquarius Walker at 8:36 PM
Guardian Contacted at 9:48 PM

Interim Action Narrative: Resident was taken to the comfort room for a timeout and use his
coping skills. He was placed in seclusion due to being a threat to safety and excessive rule
violation. Resident was assessed by nursing, debrief, and put his clothes back on.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist will inquire about camera footage and restraint
documentation. 1/18/2023, Licensing Specialist 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: Youth Home, Inc.
Facility Number: 128
Licensee Address: 20400 COLONEL GLENN ROAD
LITTLE ROCK AR 72210
Licensing Specialist: Kendra Rice
Person In Charge: Robbie Lagrone
Record Visit Date: 1/18/2023
Home Visit Date: 1/18/2023
Purpose of Visit: Self Report Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulations Not Correctable:
Narrative:
Time of visit: 9:15 am to 1:00 pm
Census: 34
Licensing Specialist reviewed camera footage of a Provider Reported Incident on 1/16/2023.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year
Page 1 of 2

Licensing Specialist observed resident and staff walking to the seclusion room, ratio 2:1. Resident was
encouraged to take a time out. The other residents were sitting in the milieu watching television. At 20:00,
resident was observed talking with staff and throwing a ball (coping skill) against a wall. At 20:23, Licensing
Specialist observed resident walk out of the seclusion room and back into the seclusion room. Resident was
observed walking out of the seclusion room and into the milieu. Resident stood by the dorm area and walked
into the game room and bounced his ball on the floor and off the walls.
Licensing Specialist heard staff trying to get resident to comply with given directions. Resident’s ball was
taken by staff. At 20:30, resident went into his bedroom and staff followed, ratio 2:1. Resident was walked to
the seclusion room for not following directions. Licensing Specialist heard staff explaining to resident why he
was going to the seclusion rom. Once in the seclusion room, resident was observed covering his ears while
staff was talking to him standing against a wall.
At 20:36, Licensing Specialist observed resident kicking the door. At 20:39, resident removed his shirt and
tied the shirt around his neck. Staff member called for another staff member and resident put his shirt back on
and started jumping up and down. Licensing Specialist observed staff entering the seclusion to remove
resident’s shirt. Staff was heard explaining to the resident why his shirt was being removed. Resident was
observed trying to leave the seclusion room.
At 20:41, resident took off his pants and placed his pants around his neck. Staff called for another staff
member. Licensing Specialist heard resident laughing while staff removed his pants and socks. Once pants
were removed, staff closed the door and continued to encourage resident to comply. At 20:48, resident was
observed banging on the window.
The nurse was observed entering the area by the seclusion room. Licensing Specialist heard resident telling
the nurse he was not going to talk to her. Nursed continued to talk with resident and asked if he needed
anything. Resident agreed to PRN medication. At 20:57, Licensing Specialist observed resident adjust his
underwear and hit himself on the buttocks. At 21:06, Licensing Specialist observed the nurse give resident
PRN medication and debrief with him. Resident was able to debrief with staff, he assessed by the nurse, and
was given back his clothes to put on.
Licensing Specialist and Mr. Pulliam (PRTF Lead Unit Manager) discussed the incident. Mr. Pulliam
informed Licensing Specialist of the different techniques that were used with resident in this incident.
Licensing Specialist did not observe any licensing concerns during review of camera footage.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year
Page 2 of 2


summary: Officers were dispatched to the facility in response to a physical disturbance. Dispatch advised that staff were trying to separate 3 students and needed officers to assist.

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

Case P23-000450 Printed on January 24, 2023

Status Approved

Report Type Patrol

Primary Officer Dylan Burke
Investigator None

Records Technician

Reported At 01/11/23 15:09
Incident Date 01/11/23 15:09
Incident Code BATT : BATTERY
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
Zone 2

Beat Southwest

Court None

Ereferral County None

Disposition CA- Cleared by Arrest
Disposition Date/Time 01/11/23 16:39
Disposition Comments

GD 4303.
Review for Gang Activity None

Primary Narrative By Dylan Burke, 01/11/23 15:10

Battery

On 1/11/2023 (Wednesday), at approximately 1510 hours, | was dispatched to 20400 Colonel Glenn Road (Youth
Home) in reference to a physical disturbance. Dispatch advised that staff is trying to separate 3 students and needs a
Deputy to respond. | responded light and sirens to the scene.

On arrival, | observed several staff members, who had restrained on the ground with their combined
body weight. | placed in hand restraints. | double locked them to prevent tightness and | assisted him off the
ground. | placed him in the back of my patrol unit. Sgt. Kirkwood detained | in the Sturgis House of
the Youth Home.

| made lh (Peggy Kelly), who provided me with face sheets of all the juveniles involved (
and .
Sat. Kirkwo | made contact with witnesses, Stephen Webb and Jonathan Pulliam. Jonathan advised that
a and were involved in a physical altercation with being the primary aggressor of the altercation.
Jonathan advised that was threating his roommate i. Jonathan advised that attempted to attack
but staff restrained him. Jonathan advised while in the midst of attempting to restrain that he elbowed
Caitlin Henthorne several times in the arm and kicked Emma Nix several times. Deputies made contact with Stephen
Webb, whom advised that while restraining he observed him kick Emma in the side.

| made contact with both victims. Caitlin advised that attempted to assault another juvenile. Caitlin advised while
staff was attempting to restrain that he struck her in the left arm several times and Emma Nix was kicked. |
observed redness on Caitlin’s left upper arm.

| made contact with Emma Nix, who advised that she was attempting to restrain after he attempted to assault
another juvenile. Emily advised that in the midst that she was restraining that he kicked her in the abdomen.

| took pictures of Caitlin’s injuries and uploaded them to evidence.

Emma and Caitlin advised that they did not need medical attention.

Case P23-000450 Page 1 of 2

| made contact with at my patrol unit, who advised that he did not medical attention.

| contacted the Pulaski County Juvenile Intake Officer, Elizabeth Mahan, and advised her of the situation. Officer
Mahan advised to issue a court date of 3/14/2023 at 0930 hours at the Pulaski County Juvenile Court.

Arrest Deposition Report was completed. Peggy signed as the guardian for
Emma, Caitlin, Stephen, and Jonathan all completed witness statements, which were submitted into evidence.

| made contact with and removed his hand restraints. | advised him of his court date and he signed the Arrest
Deposition Report.

Case P23-000450 Page 2 of 2


raw_content:
Case P23-000462 Printed on January 24, 2023
Status Approved
Report Type Patrol
Primary Officer Jeremy Schoff
Investigator None
Records Technician
Reported At 01/11/23 17:37
Incident Date 01/11/23 17:37
Incident Code ASTA : ASSIST AMBULANCE
Location 20400 COLONEL GLENN RD, LITTLE ROCK
Zone 2
Beat Southwest
Court None
Ereferral County None
Disposition P- PENDING
Disposition Date/Time 01/11/23 19:22
Disposition Comments
GD 4303.
Review for Gang Activity None
Primary Narrative By Matthew Knobloch, 01/11/23 19:23
Assist MEMS
On 1/11/2023, at approximately 1756 I, Deputy Knobloch, was dispatched to 20400 Colonel Glenn Rd, Little Rock, AR
72210 in regards to assisting MEMS personnel.

Upon arrival I made contact with Colonel Glenn youth home staff who advised me that juvenile was
going to be transferred to the hospital. MEMS unit #76 then arrived and transported . No further action was
taken.
Case P23-000462 Page 1 of 1


summary: Officers were dispatched to the facility in response to an assist citizen call. A staff member informed officers that a resident was being defiant and would not comply and he wanted officers to talk to the resident, because “the next stop was jail.”. Officers advised the staff member that the resident could not be arrested unless she committed a crime.

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

Case P23-000032 Printed on January 23, 2023

Approved
Report Type Patrol
Primary Officer Myron Bell
Investigator None
Records Technician
Reported At 01/01/23 19:16
Incident Date 01/01/23 19:16
Incident Code ASTC : ASSIST CITIZEN
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
2
Southwest
None
Ereferral County None

Disposition P- PENDING
Disposition Date/Time 01/01/23 20:20
Review for Gang Activity None

Primary Narrative By Myron Bell, 01/01/23 21:13

Assist Citizen

On January 1, 2023 around 1918 hours Deputy Bell responded to 20400 Colonel Glenn in reference to an assist citizen
call. Upon Deputy Bell arrival contact was made with David Barnes who stated has been throwing books,
being openly defiant and won't do anything we tell her to do. Mr. Barnes stated he just wanted a deputy to talk to
because the next stop was jail. Deputy Bell advised Mr. Barnes unless _ committed a crime she could not be
arrested. Mr. Barnes stated __hit him prior to staff member placing her in a restraint but didn’t expressed his desire to
file charges. Mr. Barnes did not have any injuries. Mr. Barnes stated attempted to cut herself with some plastic.
Deputy Bell made contact with and ask sis she wanted to talk about what was going on and she shook her head no.
Moments later staff member and Mr. Barnes ask did she want to rectify the situation by picking up the mess she
made and she stated yes. _ proceeded to pick up the books in her room she had thrown on the ground, then she
went to the kitchen area and picked up the books she had thrown on the ground. Mr. Barnes stated they were
attempting to get to Arkansas Children’s Hospital and to Pinnacle Pointe from there. Deputy Bell advised Mr.
Barnes if he need any further assists to contact the Sheriff Office.

Case P23-000032 Page 1 of 1


state: MN

facility_name: 180 Degrees Inc

raw_content:
August 20, 2025

Dan Pfarr, Authorized Agent 180 Degrees Inc

236 Clifton Avenue South Minneapolis, MN 55403

License Number: 1074484 (CRF)

CORRECTION ORDER

Dear Dan:

On May 24, June 2, 17, and 20, and August 16, 2025, DHS Licensing received 8 critical incident reports from your facility, 180 Degrees Inc, located at  . As a result, DHS is issuing this order which requires you to take the correction action as described below. Details of our findings, next steps, and your options are explained below.

LICENSING VIOLATIONS

DHS determined that your program failed to follow licensing rules and statutes, as described below.

Program Practices

1. Violation: The license holder did not meet critical incident reporting requirements. The following incidents met the definition of a critical incident and were not submitted to DHS within 10 days of learning of the incident, they were submitted late:

a. An incident dated May 11, 2025, was submitted on May 24, 2025;

b. An incident dated May 19, 2025, was submitted on June 2, 2025;

c. Two incidents dated May 20, 2025, were submitted on June 20, 2025;

d. An incident dated May 29, 2025, was submitted on June 17, 2025;

e. An incident dated June 6, 2025, was submitted on June 17, 2025;

f. An incident dated August 2, 2025, was submitted on August 16, 2025; and

g. An incident dated August 3, 2025, was submitted on August 16, 2025.

Rule Violated: Minnesota Rules, parts 2960.0080, subpart 17, item A, and 2960.0020, subpart 24.

Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure the reporting of critical incidents meets all applicable requirements.

YOUR RIGHT TO REQUEST RECONSIDERATION

You have the right to request reconsideration of this order and the cited violations. Your request must:

· Be in writing

· List each violation you are challenging and identify what is inaccurate or incomplete about the information in the order

· Supply information that is accurate or more complete

· Be made before the deadlines provided below

If you are mailing your request, it must be received by DHS within 20 calendar days from when you received this order. If you do not meet this deadline, you lose your right to request reconsideration. The timeline to appeal began when you received this order. Please send it to:

Office of Inspector General Legal Counsel’s Office Attn: Licensing Legal Unit PO Box 64953

St. Paul, MN 55164-0953

If your request is being personally delivered, it must be received by DHS within 20 calendar days from when you received this order. Please bring it to:

Commissioner, Department of Human Services

Office of Inspector General, Legal Counsel’s Office - Licensing 444 Lafayette Road North

St. Paul, MN 55155

Legal authority

This action is taken under Minnesota Statutes, section 245A.06, subdivision 1. The timeline to request reconsideration of the order is provided in Minnesota Statutes, section 245A.06, subdivision 2.

Questions

If you have any further questions regarding this matter, you may contact me at 651-431-6270 or at hannah.horsch@state.mn.us.

Sincerely,

Hannah Horsch, Licensor Licensing Division

Office of Inspector General

PO Box 64242 • Saint Paul, Minnesota • 55164-0242 • An Equal Opportunity and Veteran Friendly Employer
https://mn.gov/dhs/general-public/licensing/

doc_type: Correction Order


report_date: December 2, 2024

raw_content:
December 2, 2024

Daniel Pfarr, Authorized Agent 180 Degrees

236 Clifton Avenue

Minneapolis, MN 55403

License Number: 1074484

CORRECTION ORDER

Dear Daniel Pfarr:

On September 17 through 19, 2024, Department of Human Services (DHS) licensors conducted a licensing review at 180 Degrees Inc, located at  . This review was conducted to determine compliance with state and federal laws and rules governing the provision of children’s residential care under Minnesota Rules, parts 2960.0010 through 2960.0120, group residential services under Minnesota Rules, parts 2960.0130 through 2960.0220, transitional services under Minnesota Rules, part 2960.0500, shelter care services under Minnesota Rules, parts 2960.0510 through 2960.0530, and the Family First Preservation Services Act under Minnesota Statutes, section 245A.25. As a result, DHS is issuing this order which requires you to take the correction action as described under each violation. Details of our findings are provided below. Our next steps and your options are also detailed.

LICENSING VIOLATIONS

DHS determined that your program failed to follow licensing rules and statutes, as described below.

Practices

1. Violation: The first aid kit was locked in a staff area and not accessible to youth without staff assistance.

Rule Violated: Minnesota Rules, part 2960.0110, subpart 4.

Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure that the first aid kit is accessible. This violation was corrected onsite during the license review and no further corrective action is required.

2. Violation: The license holder’s review of the plan for transfer of clients and records did not meet requirements. There was no documentation to demonstrate a controlling individual reviewed and signed the plan for calendar year 2023.

Statute Violated: Minnesota Statutes, section 245A.04, subdivision a, paragraph (a).

Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure a controlling individual annually reviews and signs the plan of transfer of client and records upon closure.

3. Violation: The license holder’s review of the program abuse prevention plan (PAPP) did not meet requirements. There was no documentation to demonstrate the PAPP was reviewed annually, by February of 2024.

Statute Violated: Minnesota Statutes, section 245A.65, subdivision 2, paragraph (a).

Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure the review of the PAPP meets all applicable requirements.

Personnel Files

4. Violation: Two of two personnel files reviewed for requirements governing ongoing training did not meet requirements (personnel files numbered 1 and 2). There was no documentation to demonstrate the emergency plan was reviewed at least once every six months.

Rule Violated: Minnesota Rules, part 2960.0080, subpart 14.

Repeat Violation: This is a repeat violation. The license holder was cited for a similar violation in a Correction Order dated May 21, 2021.

Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure the ongoing and annual training meets all applicable requirements. Within 30 days receipt of this order, provide training and submit documentation for personnel files numbered 1 and 2 to demonstrate compliance.

Resident Files

5. Violation: One of three resident files reviewed for requirements governing resident admission documentation did not meet requirements (resident file numbered 3). The resident file did not include a description of safety concerns, including assaultive behavior and victimization, and the resident’s assets and strengths.

Rule Violated: Minnesota Rules, part 2960.0070, subpart 3, item B.

Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure that resident information meets all applicable requirements.

6. Violation: One resident file reviewed for requirements governing shelter admissions did not meet requirements (resident file numbered 2). The resident file did not include an assessment of the resident’s vulnerability to maltreatment.

Rule Violated: Minnesota Rules, part 2960.0520, subpart 2, item A.

Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure that shelter admissions meet all applicable requirements.

7. Violation: One of three resident files reviewed for requirements governing admission procedures did not meet requirements in the following ways (resident file numbered 1). There was no documentation to demonstrate the resident received verbal and written communication about the facility’s rules and due process system; and there was no documentation to demonstrate that the resident received a written copy of the resident’s basic rights.

Rule Violated: Minnesota Rules, parts 2960.0080, subpart 4, 2960.0050, subpart 3, item A.

Repeat Violation: This is a repeat violation. The license holder was cited for a similar violation in a Correction Order dated May 21, 2021.

Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure that admission procedures meet all applicable requirements.

8. Violation: Two of three resident files reviewed for requirements governing admission screenings did not meet requirements in the following ways:

a. The resident file did not include health, mental health, education, sexually abusive behavior, vulnerability, and gender-specific needs screenings (resident file numbered 3); and

b. There was no documentation of inquiries or the results of inquiries regarding the degree to which the resident’s family desires to be involved during the resident’s stay at the facility. (resident file numbered 1).

Rule Violated: Minnesota Rules, part 2960.0070, subpart 5, items A, B, C and D

Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure that admission screenings meet all applicable requirements.

9. Violation: Two of three resident files reviewed for requirements governing trauma informed care did not meet requirements in the following ways:

a. The screening for trauma was completed late (resident file numbered 1);

b. The resident file did not include a screening for trauma (resident file numbered 3); and

c. There was no documentation to demonstrate that trauma-based interventions were available (resident file numbered 3).

Statute Violated: Minnesota Statute, section 245A.25, subdivision 3, paragraph (c).

Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure that admission screenings meet all applicable requirements.

10. Violation: One resident file reviewed for requirements governing health care did not meet requirements in the following ways (resident file numbered 1):

a. There was no record of illness reported by the resident, including action taken by the license holder and dates of care provided to the resident.

b. There was no documentation from a prescriber with information about medication administration, targeted symptoms, side effects warranting consultation with physician.

c. There was no documentation seeking parent or guardian permission to administer medication.

d. There was no documentation of the initial quantity of medication received from the pharmacy.

Rule Violated: Minnesota Rules, part 2960.0080, subpart 11, item B, D and E.

Repeat Violation: This is a repeat violation. The license holder was cited for a similar violation in a Correction Order dated May 21, 2021.

Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure that health care services and documentation meet all applicable requirements.

11. Violation: One of two resident files reviewed for requirements governing discharge procedures did not meet requirements (resident file numbered 3). There was no signature upon discharge from the client when client’s personal property was returned.

Rule Violated: Minnesota Rules, part 2960.0090, subpart 3.

Repeat Violation: This is a repeat violation. The license holder was cited for a similar violation in a Correction Order dated May 21, 2021.

Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure that discharge procedures meet all applicable requirements.

Written Response Required

If you fail to correct the violation(s) specified in the Correction Order within the prescribed time lines the Commissioner may issue an Order of Conditional License or may impose a fine and order other licensing sanctions pursuant to Minnesota Statutes, sections 245A.06 and 245A.07.

Submissions required as part of the corrective action ordered must be sent to your licensor by email at laura.huff1@state.mn.us or by mail:

Commissioner, Department of Human Services ATTN: Laura Huff

Licensing Division PO Box 64242

St. Paul, MN 55164-0242

YOUR RIGHT TO REQUEST RECONSIDERATION

You have the right to request reconsideration of this order and the cited violations. Your request must:

· Be in writing

· List each violation you are challenging and identify what is inaccurate or incomplete about the information in the order

· Supply information that is accurate or more complete

· Be made before the deadlines provided below

If you are mailing your request, it must be received by DHS within 20 calendar days from when you received this order. If you do not meet this deadline, you lose your right to request reconsideration. The timeline to appeal began when you received this order. Please send it to:

Office of Inspector General Legal Counsel’s Office Attn: Licensing Legal Unit PO Box 64953

St. Paul, MN 55164-0953

If your request is being personally delivered, it must be received by DHS within 20 calendar days from when you received this order. Please bring it to:

Commissioner, Department of Human Services

Office of Inspector General, Legal Counsel’s Office - Licensing 444 Lafayette Road North

St. Paul, MN 55155

Legal authority

This action is taken under Minnesota Statutes, section 245A.06, subdivision 1. The timeline to request reconsideration of the order is provided in Minnesota Statutes, section 245A.06, subdivision 2.

Questions

If you have any further questions regarding this matter, you may contact me at 651-431-4234 or at laura.huff1@state.mn.us

Sincerely,

Laura Huff, Licensor

Licensing Division

Office of Inspector General

PO Box 64242 • Saint Paul, Minnesota • 55164-0242 • An Equal Opportunity and Veteran Friendly Employer
https://mn.gov/dhs/general-public/licensing/


facility_name: 180 Degrees Inc Hope House

raw_content:
December 2, 2024

Daniel Pfarr, Authorized Agent 180 Degrees Hope House

236 Clifton Avenue

Minneapolis, MN 55403-3466 License Number: 1086169 (CRF)

CORRECTION ORDER

Dear Daniel Pfarr:

On September 23, 2024, a Department of Human Services (DHS) licensor conducted a licensing review at your facility located at  .

This review was conducted to determine compliance with state and federal laws and rules governing the provision of children’s residential care under Minnesota Rules, parts 2960.0010 through 2960.0120, shelter care services under Minnesota Rules, parts 2960.0510 through 2960.0530, and the Family First Preservation Services Act under Minnesota Statutes, section 245A.25. As a result, DHS is issuing this order which requires you to take the correction action as described under each violation. Details of our findings are provided below. Our next steps and your options are also detailed.

LICENSING VIOLATIONS

DHS determined that your program failed to follow licensing rules and statutes, as described below.

PERSONNEL

1. Violation: One personnel file reviewed for requirements governing ongoing training did not meet requirements (personnel file numbered 1). The following trainings were not completed annually for 2024:

a. Vulnerable adults maltreatment reporting requirements;

b. The license holders program abuse prevention plan

c. All internal policies and procedures related to the prevention and reporting of maltreatment of individuals receiving services;

d. Maltreatment of minors reporting requirements;

e. Concepts of trauma informed care and how to provide services according to these concepts;

f. Impacts of culture, race, gender, and sexual orientation on individual youth’s behavioral health and experiences of trauma; and

g. Human trafficking training.

Statute/Rule Violated: Minnesota Statues, section 245A.25, subdivision 3, paragraph (h) and subdivision 5, paragraph (f) and 245A.65, subdivision 3 and 245A.66, subdivision 4 and Minnesota Rules part 2960.0100, subpart 3, items A and B and subpart 5 and 2960.0150, subpart 4, items B and D.

Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure that ongoing training meets all applicable requirements. Within 30 days receipt of this order, submit documentation for personnel file numbered 1 that demonstrates compliance.

2. Violation: One personnel file reviewed for requirements governing training did not meet requirements (personnel file numbered 1). There was no documentation that the emergency plan was reviewed with staff at least every six months for the calendar year 2024.

Rule Violated: Minnesota Rules, part 2960.0080, subpart 14.

Repeat Violation: This is a repeat violation. The license holder was cited for a similar violation in a Correction Order dated May 21, 2021.

Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure that ongoing training meets all applicable requirements. Within 30 days receipt of this order, submit documentation for personnel file numbered 1 that demonstrates compliance.

RESIDENT FILES

3. Violation: Two of three resident files reviewed for requirements governing resident admission information did not meet requirements. The was no documentation of the following:

a. A description of assests and strengths of the resident (resident file numbered 1); and

b. The placing agency’s case plan goals for the resident (resident file numbered 3). Rule Violated: Minnesota Rules, part 2960.0070, subpart 3, item B.

Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure that resident information meets all applicable requirements.

4. Violation: Two of two resident files reviewed for requirements governing admission procedures did not meet requirements (resident files numbered 2 and 3). The inventory and handling of resident property upon admission did not include a date the form was completed. DHS licensing was unable to determine if it was completed upon admission.

Rule Violated: Minnesota Rules, part 2960.0070, subpart 4.

Repeat Violation: This is a repeat violation. The license holder was cited for a similar violation in a Correction Order dated May 21, 2021.

Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure that admission procedures meets all applicable requirements. Within 30 days receipt of this order, submit documentation for one resident demonstrating compliance.

5. Violation: One resident file reviewed for requirements governing individual abuse prevention plans (IAPP) did not meet requirements (resident file numbered 1). There was no documentation to demonstrate that the resident was involved in the creation of the IAPP.

Statute Violated: Minnesota Statutes, section 245A.65, subdivision 2, paragraph (b).

Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure that individual abuse prevention plans meet all applicable requirements.

6. Violation: Three of three resident files reviewed for requirements governing admission screenings did not meet requirements (resident files numbered 1 through 3. The screening for trauma was completed late, after the residents admission.

Statute Violated: Minnesota Statutes, section 245A.25, subdivision 3, paragraph (c).

Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure that admission screenings meet all applicable requirements.

If you fail to correct the violations specified in the Correction Order within the prescribed timelines the Commissioner may issue an Order of Conditional License or may impose a fine and order other licensing sanctions pursuant to Minnesota Statutes, sections 245A.06 and 245A.07.

Submissions required as part of a corrective action ordered must be sent to DHS Licensing at:

1. By secure email to: Maddy.Moore@state.mn.us; or

2. By mail to: Commissioner, Department of Human Services ATTN: Maddy Moore

Licensing Division PO Box 64242

St. Paul, MN 55164-0242

YOUR RIGHT TO REQUEST RECONSIDERATION

You have the right to request reconsideration of this order and the cited violations. Your request must:

· Be in writing

· List each violation you are challenging and identify what is inaccurate or incomplete about the information in the order

· Supply information that is accurate or more complete

· Be made before the deadlines provided below

If you are mailing your request, it must be received by DHS within 20 calendar days from when you received this order. If you do not meet this deadline, you lose your right to request reconsideration. The timeline to appeal began when you received this order. Please send it to:

Commissioner, Department of Human Services Office of Inspector General

Legal Counsel’s Office Attn: Licensing Legal Unit PO Box 64953

St. Paul, MN 55164-0953

If your request is being personally delivered, it must be received by DHS within 20 calendar days from when you received this order. Please bring it to:

Commissioner, Department of Human Services Office of Inspector General

Legal Counsel’s Office Attn: Licensing Legal Unit 444 Lafayette Road North St. Paul, MN 55155

Questions

If you have any further questions regarding this matter, you may contact Maddy Moore, Senior Licensor, at 651-431-4585.

Sincerely,

MaddyMoore

Maddy Moore, Senior Licensor Licensing Division

Office of Inspector General

PO Box 64242 • Saint Paul, Minnesota • 55164-0242 • An Equal Opportunity and Veteran Friendly Employer
https://mn.gov/dhs/general-public/licensing/


facility_name: 180 Degrees Rochester

raw_content:
June 20, 2023

Daniel Pfarr, Authorized Agent

180 Degrees Rochester

236 Clifton Avenue

Minneapolis, MN 55403-3466

License Numbers:   1106748 (CRF)

Dear Daniel Pfarr:

On April 17, 2023, the Minnesota Department of Human Services (DHS), Division of Licensing, received your request for reconsideration of citations in the Correction Order (Attachment A) issued to you by the Department of Human Services on April 4, 2023. You requested reconsideration of citations 10 and 16. You did not request reconsideration of the remaining citations, and, as a result, those citations are final and not subject to review.

Citation 10: The correction order stated that one of two files reviewed for requirements governing program services did not meet requirements (resident file numbered 3). The emergency plan was not reviewed with the resident at least once every six months.

Request for Reconsideration. Your submitted information and documentation to support your belief that the program was in compliance with the applicable law at the time the citation was issued. Specifically, you indicate in the request for reconsideration that the program’s emergency plan is reviewed monthly, with all residents in shelter, on a day chosen at random. During the review, the program provides a mock emergency drill, and a debrief occurs with each resident during which the emergency plan is reviewed. Resident file numbered 3 was a client in the program from January 2022 through August 2022, and the resident reviewed the emergency plan during each month from January through August 2022. You provide emergency procedures reporting forms from February through August 2022.

Reconsideration Determination. Pursuant to Minnesota Rules, part 2960.0080, subpart 14, the license holder must develop a written emergency plan that specifies actions by staff and residents required for the protection of all persons in the case of an emergency, such as a fire, natural disaster, serious illness, severe weather, disappearance of a resident, or other situation that may require a law enforcement response or other emergency response. The plan must be developed with the advice of the local fire and emergency response authorities. The plan must specify responsibilities assumed by the license holder for assisting a new resident who requires emergency care or special assistance to a resident in emergencies. The license holder must review the plan with staff and residents at least once every six months. The license holder must keep documentation showing compliance with the emergency plan and the semiannual review.

During the licensing review, the licensor requested information from the program and provided 24 hours after the onsite review was conducted to provide any further documents. The program did not provide documentation at the time of the licensing review or within the 24-hour period that demonstrated compliance. There is therefore sufficient evidence to support the violation, and it is affirmed.

Citation 16: The correction order stated that one file reviewed for requirements governing shelter discharge documentation did not meet requirements (resident file numbered 3). A transition services plan was not completed.

Request for Reconsideration. Your submitted information and documentation to support your belief that the program was in compliance with the applicable law at the time the citation was issued. Specifically, you indicate in the request for reconsideration that a transition plan for resident file numbered 3 was completed, but you acknowledge that not all necessary information had been included. You indicate the program now provides additional details, that the transition services plan has been integrated into a database, that the program is working to update language in the transition services plan, and that staff have been retrained staff on how to accurately complete a transition services plan. You provide a copy of the resident’s transition plan dated December 22, 2021, a screenshot of a blank transition services plan from the program’s database, and training certificates.

Reconsideration Determination. Pursuant to Minnesota Rules, parts 2960.0520, subpart 2, item C, if a resident remains in shelter for more than ten days, the license holder must follow the discharge requirements of part 2960.0190, subparts 1, item A; and 2, and must note the name and address of the party the resident was released to following discharge.

Pursuant to Minnesota Rules, parts 2960.0190, subpart 1, items A, prior to the resident’s release from the program, the license holder, in conjunction with the placing agency, must develop a transition services plan for the resident. The plan must recommend ways to meet the resident’s needs and identify resources that are available in the community to address the resident’s continuing needs after release from the facility. The plan must consider the environment into which the resident will return and recommend how the resident may deal with issues and potential challenges within that environment. The plan must be developed with input from the resident, the resident’s family members, if appropriate, the providing school district, and the person who will provide support services to the resident upon release. A copy of the plan must be given to the resident and to the school, or to the residential treatment facility that the resident will attend or is placed in after the release. Pursuant to item B, the transition plan must include at least the elements in subitems (1) to (7): (1) housing, recreation, and leisure arrangements; (2) appropriate educational, vocational rehabilitation, or training services; (3) a budget plan and a description of the resident’s financial and employment status; (4) transportation needs; (5) treatment services; (6) health services; and (7) personal safety needs.

Although you have now taken steps to improve the transition services plan, you acknowledge in your reconsideration request that the transition services plan for resident file number 3 did not contain all required information. There is therefore sufficient evidence to support the violation because the transition services plan did not document all the information required by Minnesota Rules, part 2960.0190, subpart 1, item A. The violation is affirmed and revised to include item B as additional authority for the citation.

Disposition: The Commissioner has reviewed the request for reconsideration and all of the information submitted in response to the correction order. The Commissioner finds there is sufficient evidence to support citations 10 and 16, and they are affirmed with the revision that Minnesota Rules, part 2960.0190, subpart 1, item B is added as additional authority for citation 16. This is a final agency decision.

Sincerely,

Frances Simon Standing, Attorney

Legal Counsel’s Office

Office of Inspector General

PO Box 64242 • Saint Paul, Minnesota • 55164-0242 • An Equal Opportunity and Veteran Friendly Employer
https://mn.gov/dhs/general-public/licensing/