summary: Officers made contact with the complainant in response to an alleged child endangerment.

raw_content:
Case P23 012023 Printed on November 6, 2023
Status Approved
Report Type Patrol
Primary Officer Josh Keyes
Investigator None
Records Technician
Reported At 10/05/23 15:42
Incident Date 10/05/23 15:42
Incident Code ENDW : ENDANGERING WELFARE
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
Zone 2
Beat Southwest
Court None
Ereferral County None
Summary Of Incident
Disposition P- PENDING
Disposition Date/Time 10/05/23 18:42
Disposition Comments
GD 4303.
Review for Gang Activity None
Dispatch Information
CFS # CFS2023-28969
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
Incident Code ENDW : ENDANGERING WELFARE
Occurred Between 10/05/23 15:42:47 and
Assigned 15:48:17 Enroute 16:53:48 On Scene 16:53:48 Completed 16:53:48
Reporters
Name RANDY
Involvement Initial Reporter
Sex
DOB
Address
Report Time 10/05/23 15:42:47
How Reported
From Phone
Contact Phone
Comments
Other Names
Vehicles
Call Details
CFS Responders
Case P23-012023 Page 1 of 2

CFS Command Log Printed on November 6, 2023
CFS # CFS2023-28969
Call Taker Antionette Williams
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
Location Details
Primary Incident Code ENDW : ENDANGERING WELFARE
Mod
Priority 4
Use Caution No
Primary Disposition Report Taken
Beat Southwest
Zone
Ready For Dispatch Yes
Call Time 10/05/23 15:42:47
Completed Time 10/05/23 16:53:48
Reporters
RANDY (Initial Reporter)
Sex
DOB
Address
Report Time 10/05/23 15:42:47
How Reported
From Phone
Contact Phone
Comments
Other Names
Vehicles
Responders
P78 (Primary) P78 - Schoff, Jeremy PCSO (Primary)
P79 P79 - Couch, Javonn PCSO (Primary)
Y42 Y42 - Keyes, Josh PCSO (Primary)
Response Times
Assigned 10/05/23 15:48:17
Enroute 10/05/23 16:53:48 *
Arrived 10/05/23 16:53:48 *
Leaving
Arrived At
Completed 10/05/23 16:53:48
IR / External Agency Numbers
P23-012023 PO: Y42 - Keyes, Josh
Page 1 of 2

doc_type: Police Report


state: AR

facility_name: Youth Home

summary: A resident eloped from the facility after an altercation with a peer. The resident was later returned to the facility by Pulaski County Sheriff’s Deputies.

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: 10/3/2023
Date Received by DCCECE: 10/4/2023
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for DOB: Private placement
client in our PRTF program and resides in Sturgis House. Incident Report date/time:
10/03/2023 9:02am Location of Incident: Siebert School Incident Description: Aggressive to
Peers, Runaway, Threat to Safety Staff Involved: Tyteonia Morgan, Robert Page, Valerie
Alvarez Events Leading: Peer (1) gave client a threatening quote on whiteboard saying "If
you don't stop you will not enjoy the consequences". Staff encouraged client to allow them
to de-escalate the situation. Client seemed accepting to the information. While staff was
helping de-escalate another peer (2), the client went behind staff's back and immediately
started fighting peer (1). 9:02am Personal Restraint: Client and peer were on the floor
fighting. Additional staff were called due to the increased aggressiveness. Staff had to
remove pt's arms from peer's neck. After staff was standing between client and peer, he
quickly calmed down and walked out of the class with staff. 9:03am Personal Restraint End:
Client walked with staff and was not showing any signs of being unsafe. Client was calm
and expressive with staff. 9:18am Other/None: Client was in the D-zone talking with staff.
Staff went in to find out their version of what happened. Pt stated that his peer had written
on the white board a threat about messing with him. This made the Pt mad and asked the
peer what was he going to do about it. Pt said something like you'll find out and PT then
charged at peer , fighting him. 9:33am Other/None: Staff began talking about PT going to
Chestnut for the afternoon since it would not be safe to have the 2 clients together right
now. Pt refused and said we would have to restrain him to get him up there. Another Team
Member went to get help and Pt ran out of the D-Zone and out the side door and eloped.
9:35am Other/None: Pt eloped from the Dzone and exited the school from the back door.
Pt ran across campus and eventually exited campus, running through the woods. Staff
pursued pt and pt continued to run through the woods and then down the road. Staff lost
sight of pt and run protocol was initiated. The Pulaski County Sheriff's Office was notified.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Team members continued to look in the woods and surrounding area for the pt and at
approximately 10:20 am, the pt arrived back to campus via the police. Patient Debriefing
date/time: 10/03/23 10:30am: Client was accepting of the information that he would be
placed on "freeze" for aggression. Staff and client discussed more effective and safe ways to
deal with similar issues in the future. After the client was returned by the Pulaski County
Sheriff's office (report #P23-011913), the client stated that he did not want to go back to the
house so he ran. He stated that he knew he shouldn't run. He was accepting of being placed
on House Restriction. Nursing Assessment date/time: 10-03-23 9:07am: was
observed standing in the hallway, calm and cooperative. AAOx3. Clear coherent speech. He
agreed to walk with this nurse to office for further evaluation. Erythema noted to posterior
neck and (L) ear. He endorsed some soreness of bottom tooth, #24 as he reported hitting
his head on the wall while striking his peer. He reports 6/10 pain and requested orajel.
Orajel administered. This tooth appears pushed back and not aligned with others. Client
reports this is WNL for him except the sensitivity. No further signs of physical markings,
erythema, bruising, abrasions, lacerations, deformities, or protrusions. No current signs of
periorbital edema. Nares Patent without signs of deviated septum. Active and passive ROM
to all extremities. Gait is steady. VS: 140, 67, HR 94. No signs of acute distress. RR 18
breaths/minute, unlabored. No retractions, accessory muscle use, or nasal flaring.
PERRLA. Grip strength bil equal +2. PP bil equal +2. Denies any feelings of weakness,
numbness, or tingling. Interacts and responds appropriately. Posture appears fairly relaxed
although facial expression appears tense. Client appears indifferent and voiced wanting to
return back to class. Guardian was notified by nurse on 10/03/23 at 10:30am Note: Client
was returned to campus by Pulaski County Sheriff's Deputies at 10:20 am.
Interim Action Narrative: Run protocol was initiated and the PCSO was called. Upon his
return, resident was assessed by nursing and placed on house restriction.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist was informed of the provider reported incident
during a visit. 10/4/2023, Licensing Specialist reviewed provider reported incident for
licensing concerns.

doc_type: Notice of Incident


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

raw_content:
Youth Home, Inc.
20400 COLONEL GLENN ROAD
LITTLE ROCK AR 72210

ARKANSAS
Je grcegelonteleny! OF

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

Kendra Rice
Donaghey Plaza

P.O. Box 1437

Little Rock, AR. 72203

Facility Visit Compliance Notice

Facility#: 128

Date of Visit: 10/3/2023

Visit Type(s): Child Record Review Visit
Time: 10:30 AM - 1:55 PM

Visit Comment :
Time of Visit: 10:30 am to 2:00 pm
Census: 42

Licensing Specialist reviewed twelve (12) children files:

Page 1 of 2

All children’s files reviewed complied with the minimum licensing standards.

CCL Staff Signature : Date: 10/3/2023

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Provider Signature : Date: 10/3/2023

Ky
VAL (uc
Yer

V

Your Signature indicates that this form has been reviewed with you; it does not imply your agreement with
it.

Right to Appeal: For more information on how to appeal these findings, refer to the minimum Licensing
Requirements or contact your Licensing Specialist.

Page 2 of 2

doc_type: Compliance Report


summary: Willful failure of a mandated reporter to notify child abuse authorities of known child maltreatment contrary to Arkansas state statute 27-18-201. The complaint was UNFOUNDED by Licensing.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 10/1/2023
Date Received by DCCECE: 10/5/2023
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Willful failure of a mandated reporter to notify child abuse authorities of
known child maltreatment contrary to Arkansas state statute 27-18-201
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 10/6/2023- Program Coordinator spoke to the reporter and gather
more information about the complaint. The reporter stated that the resident returned home
from a weekend pass with her non-custodial parent and was reportedly acting "strange".
RN "Donald" reportedly drug tested the resident and she came back positive for marijuana.
The reporter suspected that the non-custodial parent provided the resident with the
marijuana as he has a known history of substance abuse. The reporter states that the facility
failed to call the child abuse hotline and instead stated that they will be doing their own
investigation internally. The family has filed a police report with the Pulaski Co. Sheriff's
office for the facility staff's failure to notify the child abuse hotline in a timely manner. The
incident occurred on 10/1/2023 and it is reported that no call to the child abuse hotline has
been made by the facility as of 10/6/2023. 10/9/2023, Licensing Specialist requested
nursing notes for 10/1/2023. Licensing Specialist inquired of lab results had been received.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Lab results received. Resident tested negative for marijuana and positive for nicotine.
10/20/2023, Licensing Specialist staffed complaint with Program Manager.


summary: Officers were dispatched to the facility in response to a welfare concern.

raw_content:
Case P23 011188 Printed on November 6, 2023
Status Approved
Report Type Patrol
Primary Officer Michael Jenkins
Investigator None
Records Technician
Reported At 09/15/23 16:10
Incident Date 09/15/23 16:10
Incident Code WELF : WELFARE CONCERN
Location 20400 COLONEL GLENN RD, LITTLE ROCK
Zone 2
Beat Southwest
Court None
Ereferral County None
Summary Of Incident
Disposition P- PENDING
Disposition Date/Time 09/15/23 17:13
Disposition Comments
APPROVED L36 JDW
Review for Gang Activity None
Dispatch Information
CFS # CFS2023-27004
Location 20400 COLONEL GLENN RD, LITTLE ROCK
Incident Code WELF : WELFARE CONCERN
Occurred Between 09/15/23 16:10:32 and
Assigned 16:18:09 Enroute 16:18:42 On Scene 16:34:42 Completed 16:48:59
Reporters
Name JAMES
Involvement Initial Reporter
Sex
DOB
Address
Report Time 09/15/23 16:10:32
How Reported
From Phone
Contact Phone
Comments
Other Names
Vehicles
Call Details
CFS Responders
P77 (Primary) P77 - Jenkins, Michael PCSO (Primary)
Case P23-011188 Page 1 of 2

CFS Command Log Printed on November 6, 2023
CFS # CFS2023-27004
Call Taker Antionette Williams
Location 20400 COLONEL GLENN RD, LITTLE ROCK
Location Details MAIN BUILDING
Primary Incident Code WELF : WELFARE CONCERN
Mod
Priority 2
Use Caution No
Primary Disposition Report Taken
Beat Southwest
Zone
Ready For Dispatch Yes
Call Time 09/15/23 16:10:32
Completed Time 09/15/23 16:48:59
Reporters
JAMES (Initial Reporter)
Sex
DOB
Address
Report Time 09/15/23 16:10:32
How Reported
From Phone
Contact Phone (207) 632-3400
Comments
Other Names
Vehicles
Responders
P77 (Primary) P77 - Jenkins, Michael PCSO (Primary)
Response Times
Assigned 09/15/23 16:18:09
Enroute 09/15/23 16:18:42
Arrived 09/15/23 16:34:42
Leaving
Arrived At
Completed 09/15/23 16:48:59
IR / External Agency Numbers
P23-011188 PO: P77 - Jenkins, Michael
Command Log Filter: All Commands | Details: Hidden | Units: All Units | Revised Entries: Shown
Page 1 of 2

09/15/23 16:10:32 | Williams, Antionette | New CFS
09/15/23 16:12:01 | Williams, Antionette | CALLER ADV THAT HE WANTS TO KNOW IS HIS SON ALIVE
09/15/23 16:13:11 | Lewallen, Caleb | Waiting
09/15/23 16:14:32 | Williams, Antionette |
09/15/23 16:15:22 | Lewallen, Caleb | Waiting
09/15/23 16:16:08 | Williams, Antionette | CALLER WANTS TO BE NOTIFIED AFTER CHECK UP
09/15/23 16:18:09 | Lewallen, Caleb | P77 | Dispatch
09/15/23 16:18:42 | Lewallen, Caleb | P77 | Enroute
09/15/23 16:34:42 | Lewallen, Caleb | P77 | On Scene
09/15/23 16:39:56 | Lewallen, Caleb | P77 | Check Status (Time (minutes): 15)
09/15/23 16:48:59 | Lewallen, Caleb | P77 | Available
CLQ
Requested At
Sent To
Status
Received At
Location ,
Accuracy
Page 2 of 2


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

raw_content:
Case P23-011062 Printed on September 20, 2023
Status Approved
Report Type Patrol
Primary Officer Corey Browder
Investigator None
Records Technician
Reported At 09/12/23 23:17
Incident Date 09/12/23 23:17
Incident Code ASTA : ASSIST AMBULANCE
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
Zone 2
Beat Southwest
Court None
Ereferral County None
Summary Of Incident
Disposition P- PENDING
Disposition Date/Time 09/13/23 00:47
Disposition Comments
****Approved 9/13/2023 JMM4805*****
Review for Gang Activity None
Asst Officers
P78 - Schoff, Jeremy
Primary Narrative By Corey Browder, 09/13/23 00:41
Assist Agency
On 09/12/2023 at approximately 2317 hours I, Deputy Browder, was dispatched to 20400 Colonel Glenn Rd in
reference to an assist MEMS with a juvenile.

Prior to arrival, I was advised that was actively being restrained.

Upon arrival, was located asleep in his bed unrestrained. I was advised he was restrained several hours ago and
had since been unrestrained.

MEMS responded to the scene and transported without incident.

Nothing further
Case P23-011062 Page 1 of 1


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

Youth Home, Inc. Kendra Rice
20400 COLONEL GLENN ROAD Donaghey Plaza
LITTLE ROCK AR 72210 P.O. Box 1437

Little Rock, AR. 72203
Facility Visit Compliance Notice

Facility#: 128

Date of Visit: 9/6/2023

Visit Type(s): Subsequent Building and Grounds
Time: 9:30 AM - 0:38 AM

Visit Comment :
Time of visit: 9:30 am to 10:15 am

Census: 8

Licensing Specialist completed buildings and grounds at the Chestnut House. The following areas were
observed: comfort room, seclusion room, staff bathroom, bedrooms, bathrooms, storage closet, game room,
visitation/therapy room, laundry room, library, and dining area.

Licensing Specialist was escorted by Mr. |]. PRTF Lead Unit Manager. No residents were present
during the walkthrough. Mr. J informed Licensing Specialist that two (2) residents were at the house
i). One resident was unable to attend school due to behavioral problems and the other resident being
ill.

Walking to the building, Licensing Specialist observed the grounds near the house. Leaves were falling from
the trees and the grounds were maintained. Licensing Specialist observed parked cars and facility vans on the
parking lot.

Walking into Chestnut House, Licensing Specialist observed new flooring (wood panel like design)
throughout the house. The flooring has been repaired, base boards have been replaced, and walls were painted.

Page 1 of 2

Emergency escape plans were posted by each exit door. There was a total of three (3) fire extinguishers
located in the house. Residents’ rights are posted in the dining room area. A water fountain is in the common
area. Phones are located at the staff desk area and the milieu. The game room will be located by the
therapy/visitation room. Two (2) cabinets are placed by the milieu for residents to check out their belongings.

A date has not been determined when residents will move back into Chestnut. Mr. [J informed
Licensing Specialist that he would keep Licensing updated on the move.

CCL Staff Signature : Date: 9/6/2023
| MAL
A ae
Provider Signature : Date: 9/6/2023

Your Signature indicates that this form has been reviewed with you; it does not imply your agreement with
it.

Right to Appeal: For more information on how to appeal these findings, refer to the minimum Licensing
Requirements or contact your Licensing Specialist.

Page 2 of 2


summary: A resident eloped from the facility by running into the woods as she and staff members returned to the house after dinner.

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: 9/5/2023
Date Received by DCCECE:9/6/2023
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for DOB: Private
Placement client in our PRTF program and resides in Rose House Incident Report
date/time: 09/05/2023 5:15pm Location of Incident: Rose Incident Description: Attempted
Runaway Staff Involved: Michael Stanfield, Chastity Robinson, Brayjana Pettigrew, Robert
Smith-nurse, Meredith Reddin-nurse Events Leading: After eating dinner client returned to
the house with staff. Once staff attempted to open the door, client stated "Are you going to
chase me?" Staff replied "yes". Client then sprinted into the woods, staff attempted to go
after her, but she was too fast. The Pulaski County sheriff was contacted. The sheriff was
able to find client, then contacted staff to return her to the facility. Nursing Assessment
date/time: 09/05/2023 6:20pm: Nurse assessed pt upon return. Pt tells nurse that she ran
b/c she has been having 'unwanted thoughts to harm self 'and 'impulsive thoughts'. Denies
plan to harm self, denies SI/HI at this time. Upon nurses assessment, pt has superficial cuts
on R shoulder and on L shin. Pt says that these are from running through the woods. Denies
any other pain/injuries. No further injury/deformity noted upon assessment. Pt is oriented
to situation, person. Resp even, unlabored. Full ROM in all extremities. No further needs at
this time. Guardian was notified by nurse on 09/06/2023 at 5:28pm
Interim Action Narrative: The police were called and resident was returned. Resident was
assessed by nursing and placed on safety precautions.
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing Specialist reviewed provider reported incident for licensing
concerns. Licensing Specialist received documentation for this incident. Licensing
Specialist will inquire about safety precautions. 9/7/2023, Licensing Specialist informed
resident was placed on close observation, run risk, freeze, and house restriction.


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

raw_content:
Case P23-010733 Printed on September 20, 2023
Status Approved
Report Type Patrol
Primary Officer Matthew Knobloch
Investigator None
Records Technician
Reported At 09/05/23 17:31
Incident Date 09/05/23 17:31
Incident Code RUNJ : RUNAWAY JUVENILE
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
Zone 2
Beat Southwest
Court None
Ereferral County None
Summary Of Incident
Disposition EC-Exceptionally Cleared
Disposition Date/Time 09/09/23 08:54
Review for Gang Activity None
Primary Narrative By Matthew Knobloch, 09/05/23 18:49
Runaway Juvenile
On 9/5/2023, at approximately 1731 hours I, Deputy Knobloch, was dispatched to 20400 Colonel Glenn Rd, Little Rock,
AR 72210 in regards to a runaway juvenile.

Dispatch advised me that a white female wearing gray pants and a black hoodie had ran away from the youth home
and was headed east down Colonel Glenn Rd. I then canvassed the area in an attempt to locate the juvenile. I then
observed a female matching the description given walking through a field at Colonel Glenn Rd and Burlingame Rd.

Upon making contact with the female she stated her name was , and that she had ran away from the
youth home because she has felt trapped and just needed to get away. Youth Home worker Chastity Robinson then
arrived on scene with other coworkers and transported back to 20400 Colonel Glenn. I then spoke with
workers at the youth home and discovered that suffers from Major Depressive Disorder, ADHD, and other
behavioral issues.

The Youth Home was provided a report number, parents were contacted via the employees, and no further
action was taken.
Case P23-010733 Page 1 of 1


summary: A resident was accused of going into other residents’ rooms and touching them inappropriately. The complaint was UNFOUNDED by Licensing.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 8/29/2023
Date Received by DCCECE:9/7/2023
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Dual
Report Description: Incident Report for DOB: Private placement
client in our PRTF program and resides in Hickory House Incident Report date/time:
08/29/2023 1:15pm Location of Incident: Siebert School Incident Description: Hotline Call
Staff Involved: Events Leading: Pt has been accused of going into
the room of other peers and and touching them inappropriately. One case being
yesterday morning 8/28/2023. A hotline report has been filed and awaiting confirmation on
whether accepted or not. Reference number for report is Guardian was notified
on 08/29/23 We were informed today, 09/07/23 at 11:17am from AR State Police that the
hotline call had been accepted.
Interim Action Narrative: AR hotline called and call accepted. Residents were placed on 6 ft.
peer limit from the accused.
Maltreatment Narrative: Residents and accused resident entering their
bedrooms and touching them inappropriately.
Licensing Narrative: Licensing Specialist reviewed complaint for licensing concerns.
Licensing Specialist will inquire about witness statements, safety plan, late reporting,
and/or nursing notes. Licensing Specialist will follow-up on the assign investigator.
9/8/2023, Licensing Specialist informed residents involved were placed on 6 ft. peer limit
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

with the accused. One resident attempted to tell staff but staff did not understand that it was
touching. Staff member received disciplinary action. Licensing Specialist informed that
resident bedroom was moved and resident is no longer in class with . It was
reported that there are no witness statements. 9/11/2023, Licensing Specialist inquired
about the referral number provided. Licensing Specialist provided with referral numbers.
9/12/2023, Licensing Specialist informed of investigator. Licensing Specialist reached out
to investigator for permission to contact the facility. 9/13/2023, Licensing Specialist
received permission to contact the facility. 9/14/2023, Licensing Specialist informed by
Investigator Wilson that resident had been interviewed but not due to him having
covid. Licensing Specialist inquired again about late reporting. Licensing Specialist
received an email with correspondence on when the hotline was submitted and accepted.
10/5/2023, Licensing Specialist followed-up with Investigator Wilson for an update.
Licensing Specialist informed that referral is still pending. 10/16/2023, Licensing Specialist
followed-up with Investigator Wilson for an update. 10/19/2023, Licensing Specialist
informed referral found unsubstantiated.


summary: A resident was touched inappropriately by her peer while walking toward class. The complaint was UNFOUNDED by Licensing.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Date of Incident: 8/17/2023
Date Received by DCCECE:8/17/2023
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Maltreatment
Report Description: Report Alleged Victim:
Private Placement Alleged Offender: Private Placement
Incident Date: 8/17/2023 PT was walking in line from the recreational class. PT was
walking by the d-zone toward her designated class, while waiting to enter the classroom, her
peer touched her inappropriately. The date of the report was 8/17/2023 at 12:13 PM.
Call was accepted for investigation.
Interim Action Narrative: AR called and call accepted. Residents were placed on
peer limit and AV was moved to a different classroom.
Maltreatment Narrative: A peer touched resident inappropriately.
Licensing Narrative: Licensing Specialist reviewed complaint for licensing concerns.
Licensing Specialist will inquire about safety precautions. Licensing Specialist will follow-
up on investigator and referral #. Licensing Specialist informed there is camera footage.
8/21/2023, Licensing Specialist reached out to facility to schedule a time to review camera
footage. Licensing Specialist will pick up flashdrive with camera footage on 8/22/2023.
Licensing Specialist inquired about the investigator. 8/22/2023, Licensing Specialist picked
up flashdrive and will contact investigator for permission to contact the facility. 8/23/2023,
Licensing Specialist received permission to contact facility regarding incident. Flashdrive
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

was given to IT to scan for viruses. 8/29/2023, Licensing Specialist received flashdrive from
IT. 9/1/2023, Licensing Specialist unable to review camera footage on flashdrive due to not
having permission. Licensing Specialist will follow-up with IT. IT was unable to resolve the
issue, Licensing Specialist will have IT to look into the issue on 9/5/2023. 9/6/2023,
Licensing Specialist reviewed camera footage. 9/18/2023, Licensing Specialist reached out
to Investigator Pifer for an update. 9/21/2023, Licensing Specialist contacted Investigator
Pifer for an update via telephone. The phone rung and went silent. Licensing Specialist
send an email. Investigator Pifer informed Licensing Specialist that referral is still open.
9/29/2023, Licensing Specialist reached out to Investigator Pifer for the status on this
referral. Investigator Pifer informed Licensing Specialist that case was closed,
unsubstantiated.

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: 9/6/2023
Home Visit Date: 9/6/2023
Purpose of Visit: Complaint Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Time of visit: 11:45 am to 12:30 pm
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Census: 36
Licensing received a complaint on 8/17/2023 for ELS Case #015570.
Licensing Specialist reviewed camera footage for reported complaint on 9/6/2023. The alleged incident took
place at the school.
Licensing Specialist observed residents and staff walking through a door. Residents were observed lined up
against a wall with staff standing on the opposite side. Licensing Specialist observed a staff member walk out
a room with residents walking behind. After the group of residents exited the room the other residents entered.
Before entering the room, Licensing Specialist observed what appeared a peer touching resident on her back
area. When the group was entering the room, Licensing Specialist observed two (2) staff members walk down
the hall and one staff member standing by the door while residents walked through the door.
Licensing Specialist is not prepared to leave a finding at this time.
Provider Comments:
CCL Staff Signature : Date: 11/1/2023
Provider Signature : Date: 11/1/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


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: 8/15/2023
Home Visit Date: 8/15/2023
Purpose of Visit: Subsequent Building and Grounds
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Time of visit: 11:00 am to 12:30 pm
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Census: 35
Licensing Specialist completed buildings and grounds and observed the following houses: Hickory/Chestnut,
Sturgis, Rose, and Mabee. The following areas were observed: bedrooms, bathrooms, common area, kitchen
area for staff, laundry rooms, family rooms, seclusion rooms, game rooms, and milieus.
Licensing Specialist was escorted by Jon Pulliam, PRTF Director. Licensing Specialist observed parked cars
and nicely cut grass walking the grounds. Licensing Specialist observed that the gazebo has been painted and
picnic tables have been added to the area. Residents were observed working in the garden by the school.
All bedrooms and bathrooms were organized and clean. Licensing Specialist observed some tie dye hats that
the residents created in the bedrooms. Licensing Specialist observed new game tables in all the houses in the
common or game rooms. Grievance boxes were located on the walls for the residents in the houses. Water
fountains were observed for residents to have drinking water. Clients’ rights, escape plans, and fire
extinguishers were located on walls in the houses. Smoke detectors were observed by the entrance doors, in
the common areas, and in the hallways by the bedrooms.
Licensing Specialist and Mr. Pulliam walked through the Chestnut House. Licensing Specialist observed
contractors working on the house. Licensing Specialist observed the common area furniture outside of the
house on the parking lot. The flooring was pulled up, baseboards were removed, and toilets were not in the
bathrooms. Licensing Specialist observed where the plumbing was repaired on the outside of the building.
Provider Comments:
CCL Staff Signature : Date: 8/17/2023
Provider Signature : Date: 8/17/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident was taken to Arkansas Children’s Hospital for evaluation after she complained of leaking from her bruised tailbone.

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: 8/1/2023
Date Received by DCCECE: 8/2/2023
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for DOB: Private
Placement client in our PRTF program and resides in Rose House Incident Report
date/time: 08/01/23 12:25pm Location of Incident: Rose House Incident Description:
Medical Emergency (Trip to ER/Urgent Care) Staff Involved: Tiffany Phillips-Peters,
Elizabeth Larson-nurse Events Leading: Pt was transported by staff to Baptist Urgent Care
for them to examine her bruised tailbone as she was experiencing leaking from the area,
which was also producing an odor. Baptist Urgent Care advised staff that pt needed to be
taken to the Emergency Room to ensure proper drainage and further assessment. Pt was
then taken to Arkansas Children's Hospital Emergency Room. Nursing Assessment
date/time: 08/01/23 3:45pm: Was seen at this time- returned from ER with diagnosis of
Diagnosis- Pilonidal Cyst. Pt calm, NADN. Laying down resting quietly in bed in room. Pt
states that she is felling better and is concerned with dressing changes at this time. Notified
her of new orders and asked if there was anything she needed at this time. No needs voiced
currently. Has a dressing 4x4 gauze/cover sponge/tape applied to tailbone to collect
drainage. New orders for by mouth three times a day x10 days-
(+Consent), Change dressings as needed 4x4 dry gauze/ cover
sponge/ tape(will need to be changed frequently as it is draining large amounts) Follow up
with ACH ER if symptoms worsen Follow up with Surgery Clinic- Pediatric Surgery 501-
364-4000 (need to make appointment asap) Guardian was notified on 08/01/23 at 3:23pm by
nurse.
Interim Action Narrative: Resident was taken to urgent care for further evaluation. Resident
referred to emergency room for treatment.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed provider reported incident for licensing
concerns. 8/3/2023, Licensing Specialist inquired about follow-up appointment for resident.
Licensing Specialist informed resident is scheduled to discharge on 8/5/2023. A call was
made to expedite the resident's surgery appointment. No call had been returned to the
nurse charge.


summary: A resident was sent to Arkansas Children’s Hospital for assessment after injuring herself by falling off her bed.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 7/28/2023
Date Received by DCCECE: 8/2/2023
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for DOB: 7 Private
placement client in our PRTF program and resides in Rose House Incident Report
date/time: 07/28/23 8:15am Location of Incident: Rose House Incident Description:
Medical Emergency (Trip to ER/Urgent Care), Patient Injury Staff Involved:
-nurse Events Leading: Pt fell off her bed on Saturday. She was
taken to urgent care yesterday, 7/27, where the LPN examined her and said it was swollen,
bruised, and needed to be x-rayed. We were sent to another urgent care to get the x-ray but
was told we had to go somewhere else. Due to it almost being 7pm, staff decided to take her
the next day. She was taken to another urgent care where they said the "x-ray tech was
limited" and they couldn't do it there. It was finally decided that she go to the ER. She was
x-rayed and examined, it was not fractured, just badly bruised. Nursing Assessment
date/time: 07/28/23 1:12pm: Patient presents at nurse station after returning from Arkansas
Children's Hospital. Per collaborative report with staff and nurses patient was sent to urgent
care yesterday and the treating practitioner endorsed that the patient lower back was tender
and discoloration noted and advised having an x-ray to be performed of the coxxyx but they
did not have access to x-ray at this site. Staff attempted yesterday to visit alternate site and
was informed they would not be able to se her for an x-ray then. Patient was taken to a third
urgent care site and was informed they would not be able to assist with x-ray also and orders
were received by youthhome practitioner to transport the patient or AR Children's hospital
for evaluation. Diagnosis was provided From AR children ER and X-rays were
unremarkable. Provider at AR Children's advised ice or heat therapy for 15 minutes 3-4
times a day, use of a donut pillow while sitting, and Alternate Tylenol and Ibuprofen for
pain as needed. Patient is to follow up with PCP if not improving after 1 week. Pt
complaints of current pain and Tylenol provided. Pt instructed to reduce activity and not
push herself and rest her injury as needed. Guardian was notified on 07/28/23 at 1:30pm by
the nurse.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Interim Action Narrative: Resident was taken to urgent care for further evaluation and the
emergency room for x-ray.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed provider reported incident for licensing
concerns. 8/3/2023, Licensing Specialist inquired about late entry. Licensing Specialist
informed late reporting was an oversight. Licensing Specialist informed that it was an
oversight from the facility of late reporting. Facility will be cited for R110.17.

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: 8/4/2023
Home Visit Date: 8/4/2023
Purpose of Visit: Self Report Visit
Regulations Out of Compliance:
Regulation Number: 1. 110. 17
Regulation Description: The agency shall notify the Licensing Unit by the next business day of serious injuries
requiring emergency medical treatment, agency vehicle accidents, arrests, elopements, suicide attempts, or
deaths, and maintain documentation of the incident and notification.
Findings Description: Facility failed to notify Licensing by the next business day of a provider reported incident.
Action Due Date:
Action Due Description:
Comply Date:
Sub Regulation Description:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Regulations Not Correctable:
Narrative:
No in-person licensing visit completed on 8/4/2023.
Licensing received a provider reported incident on 8/2/2023 for ELS Case #015347.
Per provider reported incident, resident was taken to urgent care on 7/27/2023 and x-rayed on 7/28/2023.
Facility is being cited for R110.17; failure to notify Licensing Unit by the next business day of serious injury
requiring emergency medical treatment.
Provider Comments:
CCL Staff Signature : Date: 8/17/2023
Provider Signature : Date: 8/17/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: Licensing conducted an annual review of policies and procedures at the facility.

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: 7/13/2023
Home Visit Date: 7/13/2023
Purpose of Visit: Special Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Time of Visit: 2:00 pm to 3:45 pm
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Census: 40
Licensing Specialist conducted an annual review of policies and procedures for Youth Home PRTF. Adria
Riley, UR & Records Compliance Director, assisted Licensing Specialist with the review.
Policies and procedures for Youth Home PRTF complied with minimum licensing standards.
Provider Comments:
CCL Staff Signature : Date: 8/17/2023
Provider Signature : Date: 8/17/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: Licensing visited the facility to conduct a buildings and grounds walkthrough and to review personnel files and children’s records. No deficiencies cited.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: 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: 6/14/2023
Home Visit Date: 6/14/2023
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: 10:00 am to 11:00 am
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 3

Census: 42
Licensing Specialist completed buildings and grounds on the PRTF’s.
Walking the grounds, Licensing Specialist heard and observed residents playing basketball. The grounds were
wet due to the rain and well-kept with no debris.
Licensing Specialist was escorted by Jon Pulliam, PRTF Lead Unit Manager. Licensing Specialist observed
the following houses: Sturgis, Chestnut, Rose, and Mabee. Licensing Specialist observed the following areas
of the houses: bedrooms, bathrooms, day areas, hallway, laundry, game rooms, milieu, and dining area.
Sturgis House: Ratio 1:1, other residents were out playing basketball and sitting under the pavilion. Licensing
Specialist could smell the aroma of the house being recently cleaned. Chestnut House: Residents were out
playing basketball and sitting under the pavilion. Housekeeping was cleaning the house during the
walkthrough. Licensing Specialist observed the Summer Daily Schedule posted on the wall.
Rose House: Ratio 3:12. Residents were present during the walkthrough. Some residents were in the game
room and day area watching television. Mabee House: Ratio 3:12. Residents were present during the
walkthrough. Some residents were watching television in the day area and talking with staff. Licensing
Specialist observed one resident in her bedroom laying down.
Licensing Specialist observed the emergency escape plans and children’s rights posted on the walls in
different locations of the houses. Fire extinguishers were observed on the walls behind a case. All bedrooms
were clean and organized. The bathrooms were clean with running water.
Mr. Pulliam informed Licensing Specialist that Chestnut House will be moving to Hickory House on July 5th,
2023, while the house (Chestnut) is being repaired. Residents at Hickory House have moved to Cartwright
House.
Provider Comments:
CCL Staff Signature : Date: 8/17/2023
Provider Signature : Date: 8/17/2023
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

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: 6/14/2023
Home Visit Date: 6/14/2023
Purpose of Visit: Personnel Records
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Time of Visit: 12:30 pm to 1:45 pm
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Census: 42
Licensing Specialists reviewed five (5) personnel files:
(Qualified Behavioral Health Provider) 6/5/2023
(Qualified Behavioral Health Provider) 6/5/2023
(Registered Nurse) 6/5/2023
(Therapist) 6/12/2023
(Qualified Behavioral Health Provider) 6/5/2023
Licensing Specialist was informed that personnel recently went through orientation. Licensing Specialist
reviewed the following minimum licensing standards: 103 Central Registry and Criminal Record Checks and
part of 105 Staff Qualifications.
Personnel files reviewed complied with the minimum licensing standards.
Provider Comments:
CCL Staff Signature : Date: 8/17/2023
Provider Signature : Date: 8/17/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: 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: 6/14/2023
Home Visit Date: 6/14/2023
Purpose of Visit: Children’s Records
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Time of Visit: 11:00 am to 12:30 pm
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Census: 42
Licensing Specialist reviewed eight (8) children files:
All children’s files reviewed complied with the minimum licensing standards.
Provider Comments:
CCL Staff Signature : Date: 8/17/2023
Provider Signature : Date: 8/17/2023
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 disturbance. Facility staff advised that a resident caused a disturbance in the van earlier. Staff requested that the resident be taken to Children’s Hospital and assessed for acute care.

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 P23-006686 - UNAPPROVED DRAFT Printed on June 20, 2023

Status Pending
Report Type Patrol
Primary Officer David Guarno
Investigator None
Records Technician
Reported At 06/07/23 16:56
Incident Date 06/07/23 16:56
Incident Code DIST : DISTURBANCE
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
2
Southwest
None
Ereferral County None
Summary Of Incident

Disposition P- PENDING
Disposition Date/Time 06/07/23 18:30
Review for Gang Activity None

Primary Narrative By David Guarno, 06/07/23 18:52
DISTURBANCE

On 6/7/2023, at 16:56 hours, | was dispatched to 20400 Colonel Glenn in reference to a disturbance.

Upon arriving on scene, Youth Home Staff advised this deputy that . _ had caused a disturbance on the
van earlier. | was advised that had gotten into an argument with another resident, resulting in

ripping the plexiglass light fixture off of the ceiling while also threatening to assault the student physically.

had also advised that she was going to jump out of the van into oncoming traffic. Staff requested that be

taken to Children's Hospital and assessed for placement in an acute long term care facility.

MEMS was requested for an evaluation on MEMS unit 803 responded and transported to
Childrens for further evaluation.

| then departed the scene without incident.

Case P23-006686 Page 1 of 1


summary: A resident was sent to Arkansas Children’s Hospital for evaluation of continued complaints of headaches and topical pain to her head following an altercation with a peer.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 5/31/2023
Date Received by DCCECE: 6/2/2023
Facility Name: Youth Home, Inc.
Facility Number: 128
Facility Type:
Incident Type: Licensing
Report Description: Incident Report for DOB: 1 008 Private
Placement client in our IRT program and resides in Mabee House Incident Report
date/time: 05/31/23 3:10pm Location: Mabee House Incident Description: Medical
Emergency (Trip to ER/Urgent Care) Staff Involved: Anthony White, Joseph Davis Events
Leading: After incident on 5/29 (See IR), including a face to face assessment from Nursing
that concluded she was not concussed, client convinced her mother that she had a
concussion. APRN ordered client to be seen by the Emergency Department. Nursing
Assessment date/time: 05/31/23 10:30am: Assessed Pt at this time for continual complaints
of headaches and topical pain to her head. Pt has voiced multiple times to peers staff, and
mother that she feels like she has a concussion from altercation on Monday were she
received head injury. Pt states she has felt "nauseous at times" but no actual vomiting. Pt
neuro checks completed at this time. A,A,Ox4, PERRLA, Recent and Remote memory
intact, Gait WNL. Notified Provider of findings, Provider advised that is she was still
symptomatic to send to ER for further evaluation 2nd Nursing Assessment date and time:
05/31/23 2:30pm: Client returned from ACH ER around 8:40pm on 05/31 with diagnosis of
No concussion was detected. Client is alert and oriented, calm and cooperative.
Client denies blurry/double vision, steady gait, answers questions appropriately. Client
states she does have a headache 5/10, but adds that it is probably because she is "using too
much ice for my head". States she does get dizzy at times, while playing outdoors,
encouraged to take frequent breaks/rest and get plenty of fluids. Client states she is not
angry with peers at this time. No other needs identified now, will continue to monitor.
Guardian was notified on 05/31/23 at 11:10am, 3:30pm: was sent to ACH ER
instead of Urgent Care for evaluation incase of the need for a CAT Scan, that procedure
would only be available at the ER. Notified Mother at 1110am that with the continual
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

multiple complaints that the provider would like to send her for evaluation and to be
medically cleared. Notified Mother at 330p that was being transported at this time
to ACH ER for evaluation and to keep her phone on and near incase they called her for
information/consents Guardian was notified on return from the ER on 05/31/23
at 1:50pm
Interim Action Narrative: Resident was assessed by nursing. APRN ordered for resident to
be evaluated at the emergency room.
Maltreatment Narrative:
Licensing Narrative: 6/2/2023, Licensing Specialist received documentation for provider
reported incident. 6/6/2023, Licensing Specialist reviewed provider reported incident for
licensing concerns.


summary: Officers were dispatched to the facility in response to a medical emergency. Dispatch advised that a juvenile female had been hitting her head on the wall and was going in and out of consciousness.

raw_content:
Case P23-006285 Printed on June 20, 2023
Status Approved
Report Type Patrol
Primary Officer Dylan Burke
Investigator None
Records Technician
Reported At 05/28/23 18:34
Incident Date 05/28/23 18:34
Incident Code MEDI : MEDICAL EMERGENCY
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
Zone 2
Beat Southwest
Court None
Ereferral County None
Summary Of Incident
Disposition P- PENDING
Disposition Date/Time 05/28/23 19:50
Disposition Comments
GD 4303.
Review for Gang Activity Not Applicable
Primary Narrative By Dylan Burke, 05/28/23 18:37
Medical Emergency
On 5/28/2023 (Sunday), at approximately 1837 hours, I was dispatched to the Youth Home for a medical emergency.
Dispatch advised that a 17 year old female has been hitting her head on the wall, and is going in and out of
consciousness.

On arrival, I observed MEMS unit 428 traveling eastbound on Colonel Glenn Road away from the scene. I made
contact with a firefighter from the West Pulaski Fire Department, who advised that is being transported by
MEMS to Children’s Hospital in Little Rock for having a seizure.
Case P23-006285 Page 1 of 1


summary: Officers were dispatched to the facility in response to a battery called in by a facility staff member.

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 P23-005494 - UNAPPROVED DRAFT Printed on May 17, 2023

Status
Report Type Patrol
Primary Officer Kaylon Jones
Investigator None
Records Technician
Reported At 05/09/23 14:38
Incident Date 05/09/23 14:38
Incident Code BATT : BATTERY
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
1
Southwest
None
Ereferral County None
Summary Of Incident

Disposition CA- Cleared by Arrest
Disposition Date/Time 05/09/23 16:09
Disposition Comments

GD 4303.
Review for Gang Activity Not Applicable

Primary Narrative By Kaylon Jones, 05/09/23 16:24
Battery

On Tuesday May 9, 2023, | Deputy Jones, was dispatched to 20400 Colonel Glenn for a battery that was called in by
one of the youth home staff members.

Upon arrival | made contact with Kaitlyn Davis who stated that had heard she was going to be put ona
special status that wouldn't allow her to play games with the other students. then said "| am out of here" and
made her way towards the door. Two male employees blocked her exit and she then went to try bite them. That is
when Mrs. Davis then grabbed hold of to try and restrain her. turned and punched Mrs. Davis in the face
multiple times and then attempted to bite her. Mrs. Davis was able to avoid being bitten but was grabbed by the collar
of her shirt and was then scratched by in the eye.

Mrs. Davis had mentioned her vision being blurry but had refused medical and advised Deputies that was being
transported by MEMS to Methodist Hospital for care and would return to the youth home.

| made contact with the Juvenile Intake Officer and told Deputy Clark what had occurred. | was advised | could cite
out and she was given a court date of July 11, 2023 at 0900 hours.

| then wrote my ADR which was able to sign. | also had Mrs. Davis fill out a witness statement and | then gave a
report number to the youth home staff for their records.

Case P23-005494 Page 1 of 1


summary: Officers were dispatched to the facility in response to an active fight in progress. Dispatch advised that there were four juveniles fighting at two different locations, and staff was not able to get them under control.

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 P23-006323 Printed on June 20, 2023

Approved
Report Type Patrol
Primary Officer Steven Bass
Investigator None
Records Technician
Reported At 05/29/23 18:51
Incident Date 05/29/23 18:51
Incident Code BATT : BATTERY
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
2
Southwest
None
Ereferral County None
Summary Of Incident

Disposition CA- Cleared by Arrest
Disposition Date/Time 05/29/23 20:49
Review for Gang Activity Not Applicable

Asst Officers
P91 - Tucker, Bradley

Primary Narrative By Steven Bass, 05/29/23 21:20
Battery 2nd

On 5-29-2023 at 1855 hours |, Deputy Bass, responded to the Youth Home located at 20400 Col Glenn Rd in reference
to an active fight in progress. Dispatch advised that there were four juveniles fighting at two different locations, and that
staff was not able to get them under control. Deputies Browning, Cawthon, Tucker, and | responded code to the Youth
Home.

Deputies Browning and Cawthon arrived first, and began handling the situation at the main building. Deputy Browning
advised Deputy Tucker and | to head to the "Rose House" at this location. Upon arrival, Deputy Tucker and |, made
contact with a worker at the facility, Michael Stanfield, and two juveniles,

Stanfield advised that were in a minor physical altercation, pushing one another, and throwing
water and ice cubes. Stanfield stated that when he went to physically separate the two juveniles to prevent the situation
from escalating, kicked him in his groin.

Deputy Tucker snoke with who stated that she and had been arguing about tearing up each others
property. stated that they threw water and ice cubes at one another, and had been pushing each other.
Deputy Tucker advised that there were no physical marks on to suggest a major physical altercation had
taken place.

| spoke with ' stated that . had been tearing up hers, and other juvenile's property, and she
threw water and ice at stated that they started pushing one another, when Stanfield physically
separated them.

Stanfield advised that he wanted to file charges against . Stanfield advised that the right side of his scrotum was

red, and starting to bruise. Stanfield showed me his inner thighs, and | observed redness/swelling on both his right and
left inner thigh. Stanfield refused medical attention. | photographed Stanfield to add to the report.

Case P23-006323 Page 1 of 2

| contacted the on-call Juvenile Intake Officer. | advised him of my charges, and the situation with the . Juvenile
Intake advised to issue a court date of 7-20-2023 at 0900 hours at Pulaski County juvenile Court. | completed an ADR
with the charge of Battery 2nd - Certain Victims. | explained the court date to and Staff, and had a staff member
sign the ADR. | provided copy of the ADR to staff, to be placed with her file at the Youth Home.

Case P23-006323 Page 2 of 2

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

Case P23-006330 - UNAPPROVED DRAFT Printed on June 20, 2023

Status
Report Type Patrol
Primary Officer Marvin Cawthon
Investigator None
Records Technician
Reported At 05/29/23 18:51
Incident Date 05/29/23 18:51
Incident Code FIGHT : FIGHT
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72206
2
Southwest
None
Ereferral County None
Summary Of Incident

Disposition P- PENDING
Disposition Date/Time 05/29/23 18:51
Review for Gang Activity None

Primary Narrative By Marvin Cawthon, 05/29/23 23:07
Fight

On May 29, 2023, |, Deputy M. Cawthon Jr., was dispatched to 20400 Colonel Glenn Road in reference to a fight that
broke out at the youth home. Upon arrival, | spoke with Mr. Terrence McDaniel and Ms. Ebony Galmore who stated
several of the girls in the home had a fiaht and thev had to separate them all in order to aain control at the home. The
girls involved in the fight were

All of which admitted to hitting someone. However, only suffered from
minor injuries and were cleared by the on staff nurse, Ms. Ebony Galmore. | spoke with Mr. McDaniel and he advised
they have methods to separating the girls and sending off the instigators and All of

the girls appeared to be under control at the time and | allowed the staff to handle the situation in house due to their
protocols. The staff also stated they would notify the parents of all the girls about the incident.

Supporting Narrative By Marvin Cawthon, 06/02/23 22:04

Follow up information

On 05/29/23 at approximately 18:51 hours, | arrived to a disturbance involving several juveniles. | spoke with each
individual juvenile and got their story. | did not see any major or life threatening injuries on any of the juveniles and | did
not witness any of them causing harm to anyone. | spoke with the staff members and was advised that there were
steps in place for placement of juveniles in these situations and that the two instigators and _._ 2...

would be transported this same evening because they started both fights. | did not witness any of the fights
and they were misdemeanors that did not occur in my presence. Each individual juvenile admitted to participating ina
fight in some way or another. | simply assisted the staff with keeping them under control and reporting the incident for
documentation purposes.

Case P23-006330 Page 1 of 1


summary: Officers were dispatched to the facility in response to a disturbance. A staff member advised that he was struck on the face by a resident.

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 P23-004604 Printed on May 17, 2023

Approved
Report Type Patrol
Primary Officer David Guarno
Investigator None
Records Technician
Reported At 04/18/23 15:05
Incident Date 04/18/23 15:05
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 04/18/23 16:01
Disposition Comments

kdb 1719
Review for Gang Activity None

Primary Narrative By David Guarno, 04/18/23 16:11
DISTURBANCE

On 4/18/2023, at 15:05 hours | was dispatched to 20400 Colonel Glenn in reference to a disturbance. Upon arrival, |
met with the caller, Christian Spratt. C. Spratt advised that he was attempting to calm down an angry student, later
identified as when he was struck on the right side of his face. He advised that was attempting
to get away from his grasp and turned toward him, striking him on the right side of his face with a closed fist.

C. Spratt advised that Youth Home had already made arrangements to have transported to an Acute Care
facilitv in Maumelle and requested | standby during this transaction. It was also requested that | not speak with
as he was currently calm and sleeping and staff did not want to see him get worked up again.

It should be noted that Youth Home staff specifically stated they wished not to press criminal charges against
and that they had already made all arrangements for alternative treatment.

MEMS unit 338 arrived and transported per the request of Youth Home Staff.

Case P23-004604 Page 1 of 1


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

raw_content:
Case P23-004505 Printed on May 17, 2023
Status Approved
Report Type Patrol
Primary Officer Dalton Griesemer
Investigator None
Records Technician
Reported At 04/16/23 13:11
Incident Date 04/16/23 13:11
Incident Code ASTA : ASSIST AMBULANCE
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
Zone 1
Beat Southwest
Court None
Ereferral County None
Disposition P- PENDING
Disposition Date/Time 04/16/23 15:19
Disposition Comments
Approved 04/16/2023 JH2579
Review for Gang Activity Not Applicable
Primary Narrative By Dalton Griesemer, 04/16/23 15:23
Assist Medical
On April 16, 2023 at approximately 1333 hours, I responded to 20400 Colonel Glenn Road in regards to assist
ambulance.

Upon my arrival I stood by while MEMS spoke with a patient who they believed would be combative.
The patient left with MEMS without Issue and I notified dispatch I was available for calls.

Case P23-004505 Page 1 of 1


summary: Multiple deficiencies were noted in the Inspection of Care conducted on 4/12/2023. A Corrective Action Plan was submitted and approved.

raw_content:
Inspection of Care Summary
Facility Tour:
Upon arrival at the 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 Unit Manager. AFMC staff was given the completed and signed consent form listing approval for
access to the AFMC portal.
A tour of the facility was completed with the Unit Manager. Several staff members were observed
interacting calmly with clients throughout the facility. All clients were in class at the school building.
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 had trash scattered throughout the dormitory. Otherwise, there were no concerns
noted.
• Chestnut House had trash scattered throughout the dormitory. Otherwise, there were no concerns
noted.
• Rose House was clean and well organized. The Carpet in dormitory had recently been replaced
with new vinyl flooring two months ago when AFMC was on site. New vinyl flooring was noted
to be separating from the subfloor and “bubbling” throughout the building. In the day room the
floor has separated to the point the door was hard to open as the vinyl flooring was blocking the
door. This was noted as a trip hazard. Facility staff had called the company that had installed the
flooring before AFMC staff left.
• Mabee House was clean and well organized. No concerns noted.
• School was in session. The school building was noted to be extremely clean, and classrooms were
very well organized. AFMC staff noted one classroom had a staff member that was sitting in the
back of the class eating food from an outside restaurant. This was pointed out to the Unit
Manager who reported it to the supervisor. The Unit Manager stated they do not allow staff to eat
outside food in front of the clients as this can trigger behaviors in the clients since they are not
allowed to have food in the classroom or from outside restaurants. No other issues noted during
the tour of this building.
• Cafeteria was noted to be extremely clean. No concerns noted.
• Gymnasium was noted to be a very large space and was clean and well organized.
• The outside grounds were noted to be clean and well-manicured. AFMC staff did observe two
large trash cans behind the Rose House that had been knocked over with trash and food items
scattered across the grounds. This appeared to be from wild animals knocking over the cans.
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 The provider lacked evidence that all
221.804; CFR 42 in the use of nonphysical intervention direct care staff are trained in the use
482.130, 483.376 skills, such as de-escalation on an of nonphysical intervention skills,
annual basis. such as de-escalation, mediation
conflict resolution, active listening,
and verbal and observational
methods, to prevent emergency safety
situations on an annual basis.
Medicaid IP Sec. 2: HR records did not indicate that all The provider lacked evidence that all
221.804; CFR 42 direct care personnel have ongoing direct care personnel have ongoing
482.130, 483.376 education, training, and demonstrated education, training, and demonstrated
knowledge of techniques to identify knowledge of techniques to identify
Youth Home, Incorporated Final IOC Report 2 | P ag e

staff and resident behaviors that may staff and resident behaviors, events
trigger an emergency safety situation and environmental factors that may
semi-annually. trigger emergency safety situations
Medicaid IP Sec. 2; There is no documentation in the HR The provider lacked evidence that all
CFR 42 482.130, records that all direct care personnel direct care personnel are trained, as
483.376 are trained in facility's Restraint and well as demonstrate competency, in
Seclusion policy. facility's Restraint and Seclusion
policy and appropriate procedures to
be used in Restraint and Seclusion
interventions.
Personnel Records- Licenses, Certifications, Training:
There was a total of 29 personnel records requested, seven (26%) professional staff and 22 (26%)
paraprofessional staff. During the review of the personnel records, the following deficiencies were noted:
Personnel Rule Credential Outcome Reviewer Notes
Record Validated
Number
SR013583 Medicaid IP Sec. 2: Restraint and Failed The last completed annual training
221.804; 42 CFR Seclusion was completed on 10/06/2021 and
482.130, 483.376 Training (CPI) the six-month refresher was last
completed on 04/20/2022.
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. The following is a summary of findings and noted
deficiencies.
Client/Guardian Interviews:
No active FFS Medicaid clients currently admitted at the time of IOC. Therefore, no client interviews
were conducted.
Clinical Record Review Deficiencies:
No active FFS Medicaid clients currently admitted at the time of IOC. Therefore, no clinical records
reviewed.
Program Activity/Service Milieu Observation:
During the facility tour, staff and clients were observed in the classroom setting. 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. The tour of the medication room was completed with the medication nurse. An
open vial of TB skin test was observed in medication refrigerator in nurse's station that was not labeled
with date of opening and with nurse's initials.
Youth Home, Incorporated Final IOC Report 3 | P ag e

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: 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: Robbie Lagrone
Record Visit Date: 4/10/2023
Home Visit Date: 4/10/2023
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: 12:30 pm to 1:45 pm
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Census: 40
Licensing Specialist completed buildings and grounds on the following houses: Sturgis, Rose, Mabee, and
Chestnut. All residents were at school during this visit.
All grounds were clean and free of debris. All houses were freshly cleaned. Licensing Specialist could smell
the aroma of cleaning fragrances. Licensing Specialist observed the following areas of each house: milieu,
bedrooms, bathrooms, and day areas. The bedrooms were organized, and the bathrooms were cleaned.
Fire extinguishers were in metal cases but visible. Licensing Specialist observed clients’ rights and the
evacuation plans in the Sturgis and Rose houses. Clients’ rights and evacuation plan were not visible at
Chestnut and Mabee houses. Mr. Jon Pulliam (PRTF Lead Unit Manager) informed Licensing Specialist that
when maintenance touched up the paint, the rights nor plan were put back in place. Mr. Pulliam requested the
documentation during the buildings and grounds visit to be placed back on the walls.
Licensing Specialist was informed by Mr. Pulliam that the facility’s last tornado drill was on 3/31/2023.
Provider Comments:
CCL Staff Signature : Date: 4/10/2023
Provider Signature : Date: 4/10/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident was reported to have forcefully and inappropriately touched a peer multiple times.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 4/4/2023
Date Received by DCCECE: 4/5/2023
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Dual
Report Description: Incident Report for
placement client in our PRTF program and resides in Mabee House Incident Report
date/time: 04/04/2023 9:30am Location of Incident: Siebert School Incident Description:
Call Staff Involved: Contrell Alexander Events Leading: Pt is alleged offender for
report put in that she forcefully touched a peer twice on one occasion and once on
another occasion during the weekend and on Friday during tornado. the report was done via
AR mandate reporter portal. the state police accepted the report, Confirmation number
Operator Brooke.
Interim Action Narrative: was called and call was accepted.
Residents were placed on Peer Limit.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed complaint. Licensing Specialist will
inquire about the assigned investigator. Licensing Specialist will contact investigator for
permission to reach out to the facility. 4/10/2023, Licensing Specialist contacted the
investigator for permission to reach out to the facility. Licensing Specialist granted
permission to contact facility. Licensing Specialist spoke with Mr. White, Unit Manager,
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

about the incident and safety plan for the residents. 4/13/2023, Licensing Specialist
provided with name of resident's therapist, Penny Dedmon. 4/17/2023, Licensing Specialist
reached out to the therapists of the residents.

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 4/4/2023
Date Received by DCCECE: 4/5/2023
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Dual
Report Description: Incident Report for
Placement client on our PRTF program and resides in Mabee House Incident Report
date/time: 04/04/2023 9:00am Location of Incident: Siebert School Incident Description:
Call Staff Involved: Contrell Alexander Events Leading: pt reported that she was
inappropriately touched by a peer at the house in the chest area and on the van during an
outing on the weekend. a report was put in place online via AR mandate reporter
portal and was accepted by the state police. confirmation number Operator
Brooke. Incident Report for placement client in
our PRTF program and resides in Mabee House Incident Report date/time: 04/04/2023
9:30am Location of Incident: Siebert School Incident Description: Call Staff
Involved: Contrell Alexander Events Leading: Pt is alleged offender for report put in
that she forcefully touched a peer twice on one occasion and once on another occasion
during the weekend and on Friday during tornado. the report was done via AR mandate
reporter portal. the state police accepted the report, Confirmation number Operator
Brooke.
Interim Action Narrative: was called and call was accepted.
Residents placed on Peer Limit.
Maltreatment Narrative: pt reported that she was inappropriately touched by a peer at the
house in the chest area and on the van during an outing on the weekend. a report
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

was put in place online via AR mandate reporter portal and was accepted by the state police.
confirmation number Operator Brooke. Incident Report for
placement client in our PRTF program and resides in Mabee House
Incident Report date/time: 04/04/2023 9:30am Location of Incident: Siebert School
Incident Description: Call Staff Involved: Contrell Alexander Events Leading: Pt is
alleged offender for report put in that she forcefully touched a peer twice on one
occasion and once on another occasion during the weekend and on Friday during tornado.
the report was done via AR mandate reporter portal. the state police accepted the report,
Confirmation number Operator Brooke.
Licensing Narrative: Licensing Specialist reviewed the complaint. Licensing Specialist will
inquire about the assigned investigator. Licensing Specialist will contact investigator for
permission to reach out to the facility. 4/10/2023, Licensing Specialist contacted the
investigator for permission to reach out to the facility. Licensing Specialist granted
permission to contact facility. Licensing Specialist spoke with Mr. White, Unit Manager,
about the incident and safety plan for the residents. 4/13/2023, Licensing Specialist
provided with name of resident's therapist, Mitzi Griffin. 5/2/2023, Licensing Specialist left
a voicemail for the therapist (Penny Dedmon) of the other involved resident. 5/3/2023,
Licensing Specialist received a statement from therapist via email. 5/30/2023, Licensing
Specialist emailed investigator for an update. Licensing Specialist informed case found
unsubstantiated.

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: 4/10/2023
Home Visit Date: 4/10/2023
Purpose of Visit: Complaint Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Time of visit: 1:45 pm to 2:30 pm
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Census: 40
Licensing Specialist received a complaint of maltreatment on 4/4/2023.
Licensing Specialist spoke with Mr. Anthony White (Unit Manager for Mabee House). Mr. White informed
Licensing Specialist that there is no camera footage of these reported incidents. The allegation of resident
being touched at the house happened on 3/31/2023 when the residents had to take shelter because of the
tornado. The allegation of being touched while on an outing, there are no cameras on the vans.
Mr. White informed Licensing Specialist that the residents are on Peer Limit Precaution. Residents are to stay
six (6) feet apart, no contact, and no communication with one another.
Licensing Specialist is not prepared to leave a finding at this time.
Provider Comments:
CCL Staff Signature : Date: 4/10/2023
Provider Signature : Date: 4/10/2023
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 disturbance.

raw_content:
Case P23-003982 Printed on April 17, 2023
Status Approved
Report Type Patrol
Primary Officer Matthew Knobloch
Investigator None
Records Technician
Reported At 04/03/23 18:52
Incident Date 04/03/23 18:52
Incident Code SUICTHRT : SUICIDE THREATS
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
Zone 2
Beat Southwest
Court None
Ereferral County None
Disposition P- PENDING
Disposition Date/Time 04/03/23 22:34
Review for Gang Activity None
Primary Narrative By Matthew Knobloch, 04/03/23 22:54
Suicide Threats
On 4/3/2023, at approximately 1853 hours I, Deputy Knobloch, was dispatched to the Youth Home located a 20400
Colonel Glenn Rd, Little Rock AR, 72210 in regards to a disturbance.

Upon arrival, I made contact with employees Chastity Robinson and Michael Stanfield. Ms. Robinson stated that
juvenile had become irate and started trying to destroy items. Ms. Robinson stated that she and Mr.
Stanfield then physically restrained and placed her inside of a seclusion room. Ms. Robinson and Mr. Stanfield
both stated that neither of them were injured and that was not able to break any of the items. Ms. Robinson also
stated that had threatened to kill herself.

Ms. Robinson advised me that she believes should be sent to the hospital. I then requested MEMS to my
location to evaluate . It was at this time I made contact with father over the phone and
advised him of the situation. MEMS unit 340 then arrived on scene and placed into the rear of the ambulance. I
then escorted MEMS and to Children’s Hospital without incident.

No further action was taken.

Case P23-003982 Page 1 of 1


summary: A resident was sent to Arkansas Children’s Hospital for assessment after injuring his hand by punching a van panel.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 4/2/2023
Date Received by DCCECE: 4/3/2023
Facility Name: Youth Home, Inc.
Facility Number: 128
Facility Type: Residential
Incident Type: Licensing
Report Description: Incident Report for DOB: placement
client from in our PRTF program and resides in Sturgis House
Incident Report date/time: 04/02/2023 2:10pm Location of Incident: Outdoors off Youth
Home campus Incident Description: Self Injury(Not Suicidal), Medical Emergency (Trip to
ER/Urgent Care) Staff Involved: Gregory Nesdahl-nurse, Broderick Parker Events Leading:
We arrived at our location for community outing and staff noticed there was a lot of people
at the park. We informed the PTs that staff will assess the situation before we exit the van.
PT begin to tell staff what he thought was best for us so. PT would not listen to staff
information and immediately became visibly upset and verbally aggressive. I used CPI de-
escalation procedures and PT did not calm down. PT wanted to leave but his peers were
already engaged in activities. PT became more aggressive and threaten to harm staff. Pt
then begin to punch the panel on the inside of the van and visible harmed his right hand.
PT walked off and I continued to de-escalate and get him calm. After more conversation he
finally calmed down and got in the van so that we could get him medical attention. The shift
was informed of the situation and prepped the nurse for our arrival back to the house.
Nursing assessment date/time: 04/02/2023 2:15pm: Patient presents at Sturgis outside
main entry door with staff sitting on bench chair. Patient reported by staff to have punched
the van dashboard while coming back from outing event. Pt reports pain 8/10 to right hand
at Digit 5 and 4 knuckle area. Abrasions, redness, and edema noted at metacarpophalangeal
joints at 4 and 5. Patient able to slightly perform some range of movement with pain noted.
Cap refill is brisk at distal fingers of right hand. Orders received for transport to ACH for
evaluation. 2nd Nursing assessment date/time: 04/02/2023 6:10pm: Patient returned from
ACH on 4/2/23 at 4:45pm and no FX on xray. Patient is cooperative and calm. Pt refused
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

ice pack treatment. Pt received PRN for pain. Pt is in good sprits. Nurse contacted the
guardian on 04/02/2023 at 2:54pm
Interim Action Narrative: Staff provided verbal de-escalation. Resident was transported
back to the facility to be assessed by the nurse. He was transported to AR Children's
Hospital for further evaluation.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed provider reported incident. It was
reported that resident went to AR Children's Hospital for further evaluation. No fracture
noted on x-ray. No licensing concerns noted.


summary: A resident was sent to Arkansas Children’s Hospital for evaluation after complaining of breathing problems.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 4/1/2023
Date Received by DCCECE: 4/3/2023
Facility Name: Youth Home, Inc.
Facility Number: 128
Facility Type: Residential
Incident Type: Licensing
Report Description: Incident Report for DOB:
client in our PRTF program who resides in Sturgis House Incident Report date/time:
04/01/2023 1:35pm Location of Incident: Sturgis House Incident Description: Medical
Emergency(Trip to ER/Urgent Care) Staff Involved: Gregory Nesdahl-nurse, Broderick
Parker Events Leading: Received notification from Sturgis house that patient was having
breathing problems and rapid breathing. Patient presents in his bed supine position upon
assessment with rapid breathes. Nursing Assessment date/time: 04/01/2023 1:35pm:
Patient presents in his bedroom supine position short rapid breathing, patient endorses
tightness in chest and throat. Patient disoriented upon assessment to age city that he lives
in. Patient blood pressure at 1:40pm 145/107, 134/97 with pulse at 108. Respirations 28 per
minute. On call notified and orders received to have transported to ACH for evaluation.
Contact made with (mother) on 4/1/23 at 2:38pm by phone conversation
and understanding of event.
Interim Action Narrative: Resident assessed by the nurse. Order received for further
evaluation at AR Children's Hospital. Resident was 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 outcome of ACH visit. Resident was diagnosed with
panic attack.


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

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: 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: 3/31/2023
Home Visit Date: 3/31/2023
Purpose of Visit: Special Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Time of Visit: 9:00 am to 11:30 am
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Census: 41
Licensing Specialist attended CPI Training at the facility to ensure that staff members are being trained
according to the facility’s policy on physical restraints. Also, to ensure that the facility’s policy on physical
restraints complies with the minimum licensing standards.
Provider Comments:
CCL Staff Signature : Date: 3/31/2023
Provider Signature : Date: 3/31/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: Technical assistance was provided to the facility regarding the current law on mandated reporting, R102.3.h and R110.9.

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:
Record Visit Date: 3/29/2023
Home Visit Date: 3/29/2023
Purpose of Visit: Technical Assistance Request Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Number: 1. 110. 9
Regulation Description: Any owner/operator, employee, foster parent, or volunteer in a child welfare agency
shall immediately notify the Child Abuse Hotline if he or she has reasonable cause to suspect that a child has
been subjected to child maltreatment, died as a result of child maltreatment or if they observe a child being
subjected to conditions or circumstances that would reasonably result in child maltreatment.
Findings Description:
Action Due Date:
Action Due Description:
Comply Date:
Sub Regulation Description:
Regulation Number: 1. 102. 3 .h
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Regulation Description: The following policies of the agency shall be current and available to all employees of
the agency and the Licensing Specialist:
Findings Description:
Action Due Date:
Action Due Description:
Comply Date:
Sub Regulation Description:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Review of the agency’s current mandated reporter policy determined that it does not comply with the current
law in the state of Arkansas nor the Minimum Licensing Standards.
Technical assistance was provided to the agency regarding the current law on mandated reporting, R102.3.h,
and R110.9.
Please ensure that your current mandated reporter policy is updated to comply with A.C.A. 12-18-402 and the
Minimum Licensing Standards by 4/12/2023and provide a copy to the Licensing Unit for review. Once the
needed changes have been made, please ensure that all staff are retrained on the new policywithin two weeks
of the new policy going into effect.
Provider Comments:
CCL Staff Signature : Date: 3/29/2023
Provider Signature : Date: 3/29/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident was sent to Arkansas Children’s Hospital for assessment after injuring her hand by hitting a wall.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 3/15/2023
Date Received by DCCECE: 3/16/2023
Facility Name: Youth Home, Inc.
Facility Number: 128
Facility Type: Residential
Incident Type: Licensing
Report Description: Incident Report for DOB:
client in our PRTF program who resides in Mabee House Incident Report
date/time: 03/15/23 2:10pm Location of Incident: Mabee Incident Description: Self Injury
(Not Suicidal), Aggressive to Adults, Attempted Runaway, Threat to Safety, Medical
Emergency (Trip to ER/Urgent Care), Patient Injury Staff Involved: Jacqueline Wheeler,
Contrell Alexander, Christian Spratt, Erika Henthorne, Joseph Davis-nurse, Anthony Mask
Events Leading: The nurse came to assess Pt hand following an incident from earlier. After
verbal support and instructions to care for her hand, Pt began demanding juice, kicking the
door and hitting the wall. Pt alternated between the front and the kitchen door and was
unable to kick it open. Pt was yelling No as staff attempted to reason with her. Pt eventually
headed to the emergency exit door and had to be restrained. 2:10pm Personal Restraint: Pt
was placed in restraint at this time. Pt struggled with staff and was yelling let me go. Staff
continued to offer verbal support. Pt complained of pain on her hand. Pt responded well to
staff's verbal de-escalation and began to relax and stopped struggling. 2:15pm Personal
Restraint End: Pt was visibly calm. Nurse explained to Pt that we need to assure she was
safe in order to assess her hand. Pt allowed the nurse to assess her hand. Pt was released at
this time. Patient Debriefing date/time: 03/15/2023 3:15pm: Time was spent validating the
Pt feelings. Pt understood the possible dangers that could occur if she was allowed to leave
the premises without consent. Staff discussed what was causing her verbal and physical
aggression and ways she could cope with it in a positive manner. UM Debriefing date/time:
03/15/23 3:00pm Injuries to client: Right hand 3rd-5th digit knuckles noted to be bruised
and swollen. Limited ROM with mild/moderate pain. Follow-up to injury: Client sent to
Arkansas Children's Hospital Nursing Assessment date/time: 03/15/2023 2:20pm: Came to
Mabee house to assess right hand injury. Client having changes in mood and behavior.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Client demanding to go out the front door. Client was encouraged to calm down. Client
feeding off peer limit peer. Client began kicking the front door and hitting the wall with her
right hand. Client then ran to restricted area and personal restraint was initiated.
Encouraged client to relax, refused and continued to struggle with staff. Client was able to
calm down and was released from restraint. Encouraged client to take good care of her
hands because she will have them for life. Right hand 3-5th digit knuckles noted to be
bruised and swollen. Limited ROM with mild/moderate pain, complains of numbness to
5th digit, capillary refill >3 seconds. Client not stable enough to go to urgent care with
single staff supervision. Client shared that she wanted to kill herself. Encouraged client to
make good choices, to give her future self a chance. Client voiced suicidal ideation once
again, and the call was made to transfer to acute. Will continue to monitor. Client left for
ACH ER, possible transfer to acute from there. Guardian was contacted by nurse on
03/15/23 at 2:54pm and 2:56pm: Guardian informed of need for emergency room prior to
acute admission for treatment/evaluation of right hand injury.
Interim Action Narrative: Resident was assessed by nursing and transferred to AR
Children's Hospital emergency room for further evaluation. Due to resident's voicing
suicidal ideation she was admitted to acute care after evaluation.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist will inquire about camera footage and placement
of resident. Licensing Specialist informed that resident was placed in acute care at
Methodist. 3/20/2023, Licensing Specialist reviewed camera footage.


summary: A resident injured her hand in an incident where she hit a wall and door and tied a sweatshirt around her neck in an effort to self-harm.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 3/14/2023
Date Received by DCCECE: 3/15/2023
Facility Name: Youth Home, Inc.
Facility Number: 128
Facility Type: Residential
Incident Type: Licensing
Report Description: Incident Report for DOB:
client in our PRTF program resides in Mabee Incident Date/Time: 03/14/2023
4:04pm Location: Mabee Incident Description: Suicidal, Attempted Runaway, Threat to
Safety Staff Involved: Anthony White, Ben Malone, Kelton Johnson, Terrence McDaniel,
Matthew Chrysler-nurse, Joseph Davis-nurse, Carlos Shavers Events Leading: Client upset
about freeze status. Came charging up the hallway into the milieu yelling that she was
"tired of this shit." Client attempted to kick the front door open. Staff approached offering
verbal support. Yelling and swearing continued. After a therapist entered the unit, client
successfully kicked the front door open. 4:02pm Personal Restraint: Client placed in
personal restraint. Client physically resisted against restraint as she was escorted to the
seclusion area for safe supervision while de-escalating. 4:03pm Personal Restraint End:
restraint ended as seclusion area was reached. Client attempted to use her legs to climb up
against walls to push off. 4:04pm Locked Seclusion: Client placed in locked seclusion. Client
observed to strike the wall of the seclusion room with significant force with her fist. Staff
offered verbal support. Client produced pen that had fallen off staff's lanyard during
restraint. 4:05pm Locked Seclusion End: Locked seclusion ended as client began gesturing
with pen with her back to staff as though she was self harming. Staff asked for the pen, and
client refused. staff immediately entered seclusion room. 4:06pm Personal Restraint: Client
placed in restraint as pen was retrieved. 4:07pm Personal Restraint End: Restraint ended as
staff attempted to resume seclusion. 4:08pm Locked Seclusion: Locked seclusion began at
this time. Staff attempted to offer verbal support. Client observed to remove her sweatshirt
and tie it around her neck. 4:09pm Locked Seclusion End: Locked seclusion ended at this
time as staff immediately entered to remove the sweatshirt and maintain safety. Auxilliary
staff alerted to retrieve a different shirt for client at this time. 4:10pm Unlocked Seclusion:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Client placed in unlocked seclusion at this time as she attempted to force her way out this
area without permission and de-escalation. Staff used their bodies to prevent her from
leaving the seclusion room while providing verbal support. During this time client is
observed to strike the wall of the seclusion room door with her fist. Client observed to say "I
don't fucking care." and "I don't want to fucking be here." 4:13pm Unlocked Seclusion
End: Client was able to force her way out of the seclusion room, and she agreed to sit with
staff and talk. Unlocked Seclusion ended at this time. Patient Debriefing date/time:
03/14/2023 4:20pm: Client was given an option of talking to staff are going back to
seclusion. Client chose to come out and talk with staff. Client was angry but willing to
accept her consequences. Client said that she was not angry at staff anymore. Nursing
Assessment date/time: 03/14/2023 4:15pm: Client reportedly in personal restraint. Upon my
arrival, client was in seclusion room struggling with staff. Client agreed to sit and process
with staff. Client began to calm down as she was processing with staff. Complains of right
hand injury, 3rd-5th digits knuckles noted to be swollen, bruised and reddened. Client
struck the wall with her right hand. Denies numbness/tingling, has full/active ROM,
capillary refill <3 seconds. Ice pack refused, PRN OTC pain relief refused. Client denies
other pain/injury from this incident. Client has no other obvious injury from this incident.
Client was offered icepack and PRN medications again, refused. Encouraged client to use
medication/icepack for pain/swelling. No other needs identified now, will continue to
monitor. 2nd Nursing Assessment date/time: 03/14/2023 4:16pm: Client refused PRN OTC
medication and icepack. Will continue to monitor. Guardian was notified on 03/14/23 at
4:20pm and 4:40pm. Was able to get a hold of her mother on the 2nd call. first call voicemail
left.
Interim Action Narrative: Resident was assessed by nursing. She refused OTC medication
and the ice pack.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist will schedule to review camera footage and
inquire about safety precautions. 3/16/2023, Licensing Specialist informed that resident was
evaluated at AR Children's Hospital and transferred to Methodist Acute. Licensing
Specialist reviewed camera footage.