summary: Multiple deficiencies were noted in the recertification/complaint survey completed on 6/7/2025. A Corrective Action Plan was submitted and approved.

raw_content:
PRINTED: 06/20/2025
DEPARTMENT OF HEALTH AND HUMAN SERVICES Approved 6/30/25 BBM
FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A.BUILDING
C
04L115 B.WING 06/06/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1521 ALBERT ST
WOODRIDGE OF FORREST CITY, LLC
FORREST CITY, AR 72335
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETION
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
N 000 Initial Comments N 000
Note: The CMS-2567 (Statement of Deficiencies)
is an official, legal document. All information must
remain unchanged except for entering the plan of
correction, correction dates, and the signature
space. Any discrepancy in the original deficiency
citation(s) will be reported to the Dallas Regional
Office (RO) for referral to the Office of the
Inspector General (OIG) for possible fraud. If
information is inadvertently changed by the
provider/supplier, the State Survey Agency (SA)
should be notified immediately.
Complaint #N/A (AR00036313) was in
compliance.
Complaint #N/A (AR00038422) was in
compliance.
Complaint #N/A (AR00038874) was not in
compliance with deficiencies cited at N128 and
N142
The facility was not in compliance with §483,
Subpart G - Conditions of Participation for
Psychiatric Residential Treatment Center.
N 128 PROTECTION OF RESIDENTS N 128 The Resident affected was assessed by Nursing and
CFR(s): 483.356(a)(3) an Order was received by the Physician for further
evaluation of Resident at local Medical center. Staff
Restraint or seclusion must not result in harm or involved were suspended immediately and remain
injury to the resident and must be used only- suspended pending investigation results. Results from
internal investigation yield one Staff member not
returning. The likelihood for this deficiency affecting
This ELEMENT is not met as evidenced by:
other Residents being affected was greatly reduced
Based on observations, interviews, and record
and minimized due to the organization’s response.
and video review, the facility failed to prevent
The Chief Executive Officer oversees the
injury during an Emergency Safety Intervention implementation of this corrective action plan. A
(ESI) for one (Client #3) of three clients reviewed mandated facility-wide retraining for all Mental
for injuries. Health Technicians, Nurses, Dietary Staff,
Maintenance Staff, Clinical staff, and Administrative
The findings include: staff on verbal de-escalation and proper physical
interventions was conducted by the Handle with Care
Instructor June 18th 2025. Retraining included
modeling verbal de-escalation, proper physical
intervention, and scenario based participation. All
attendees signed acknowledgement and attestation of
training on proper Handle with Care technique. The
Director of Quality and Risk Management is the
custodian of the training log. Training records will be
audited weekly by the Quality Risk Director until
100% training compliance is reached for existing
staff. This training is already part of the new hire
orientation process. The ongoing standard six-month

PRINTED: 06/20/2025
DEPARTMENT OF HEALTH AND HUMAN SERVICES
FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
Handle with Care refreshers will also continue as
scheduled, conducted by the Handle with Care
Instructor and tracked by the Director of Quality and
Risk Management. Compliance rate and upcoming
trainings will be reviewed in the monthly Committee
of the Whole meeting and reported to the Governing
Board for oversight. For Staff who could not attend
the training, individual training will be provided,
documented, and attestations will be signed. All
training will be completed by July 6th, 2025.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that
other safeguards provide sufficient protection to the patients . (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days
following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14
days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued
program participation.
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 67P111 Facility ID: 3012 If continuation sheet Page 1 of 16

PRINTED: 06/20/2025
DEPARTMENT OF HEALTH AND HUMAN SERVICES
FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING
C
04L115 B. WING 06/06/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1521 ALBERT ST
WOODRIDGE OF FORREST CITY, LLC
FORREST CITY, AR 72335
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETION
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
N 128 Continued From page 1 N 128
Review of Client #3's " Master Treatment Plan "
dated 05/06/2025, revealed Client #3 had
diagnoses which included major depressive
disorder which was recurrent and severe without
psychosis, generalized anxiety disorder, history of
post-traumatic stress disorder, and history of
trauma.
Review of an ESI dated 05/23/25 and completed
by Registered Nurse (RN) #1, revealed that Client
#3 was placed in a physical restraint at 7: 11 PM
and was released at 7:15 PM, due to the resident
being out of control and uncooperative with staff .
ESI documentation included check marks under
the section that listed interventions attempted
before restraints were implemented as,
emphasized need for self-control, attempted to
redirect, and allowed patient other ways to vent
anger.
Review of the " Client Debrief Form" contained in
the ESI packet revealed Client #3 reported that
staff gave no warnings before the restraint was
initiated. While in restraint the client reported that
staff "just broke my arm."
Review of a " Body Check Form " contained in
the ESI packet under the comment section dated
05/23/2025 at 7:17 PM, signed by RN #1,
revealed that per staff, Client #3 was placed in a
personal restraint due to being uncooperative with
staff and slamming the bedroom door in another
resident's face. Client #3 was sent to the
emergency department for an X-ray of the left
wrist. A body assessment was completed by RN
#1, that included a body diagram, which indicated
a bruise on Client #3's upper area of both arms,
and bruising on the left hand and wrist. The ESI
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 67P111 Facility ID: 3012 If continuation sheet Page 2 of 18

PRINTED: 06/20/2025
DEPARTMENT OF HEALTH AND HUMAN SERVICES
FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING
C
04L115 B. WING 06/06/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1521 ALBERT ST
WOODRIDGE OF FORREST CITY, LLC
FORREST CITY, AR 72335
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETION
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
N 128 Continued From page 2 N 128
included Client #3 ' s complaints of pain and
inability to move their left hand.
Review of a " Nurse's Note " dated 05/23/2025
at 7:16 PM, revealed Client #3 reported that
Mental Health Technician (MHT) #1 shoved Client
#3 inside the bedroom causing the client's wrist
and hand to go backwards. Client #3 was unable
to move the upper left extremity, and bruising was
noted to the entire wrist and hand. Review of an
additional " Nurse's Note " timed 7:30 PM,
indicated the client was transferred to the
emergency department for evaluation and
treatment. Both nurse ' s notes were signed by
RN #1.
Review of a " Nurse's Note " signed by RN #1,
dated 05/24/2025 at 12:20 AM, indicated Client
#3 returned from the hospital with a splint to the
upper left extremity.
Review of a handwritten witness statement by
MHT #1, dated 05/23/2025, contained within the
" Facility Investigation Packet " revealed Client
#3 had called MHT #1 a derogatory name after
she stepped on a bug that Client #3 was trying to
put in a "container and save." Client #3 then went
into the bedroom and slammed the door and was
banging their hands on the clothes shelf. MHT #1
reported she told Client #3 to come out of the
bedroom, but Client #3 was " resisting staff Client
#3 finally came out and was placed in a primary
restraint technique (PRT). Client #3 stated their
wrist was hurting but staff had their arms and put
them in a PRT with one hand so the client
wouldn't say the staff was holding them too tight. "
Review of a " witness statement, " of the incident
transcribed and written by the Quality and Risk
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 67P111 Facility ID: 3012 If continuation sheet Page 3 of 18

PRINTED: 06/20/2025
DEPARTMENT OF HEALTH AND HUMAN SERVICES
FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING
C
04L115 B. WING 06/06/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1521 ALBERT ST
WOODRIDGE OF FORREST CITY, LLC
FORREST CITY, AR 72335
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETION
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
N 128 Continued From page 3 N 128
Manager and signed by the resident on
05/26/2025, revealed Client #3 reported finding a
bug then MHT #1 stepped on it and both Client #3
and MHT #1 began calling each other derogatory
names. Client #3 went into their bedroom and
slammed the door, then MHT #1 came into the
room, slammed the door, screamed, "Don't slam
this [expletive] door!" Client #3 stated, "I won't
slam this [expletive] door in a sassy way." The
client reported being shoved into the " cubby "
by MHT #1, and then being put into a PRT and
taken out into the hallway. Client #3 stated they
asked MHT #1, "Could you release the pressure
on my left arm because I think you broke it."
Review of video footage dated 05/23/2025, time
stamped beginning at 7:11:47 PM and ending at
7:16:22 PM, revealed the following events:
At 7:11:49 Client #1 was seen noticing something
on the floor by the double doors, turned and went
quickly back to their bedroom, returned five
seconds later with a red container and went back
to the door and was seen bending down. MHT #1
arrived at the door and stepped in front of Client
#3. Client #3 went back to their room and shut the
door at 7:12:15. One second later, MHT #1 was
seen aggressively pushing past Client #4 who
was standing in the doorway. Client #4 continued
to look into the open doorway and then the door
closed again at 7:12:26 PM. One second later,
Client #3 was seen coming out of the room with
MHT #1 holding the client's left upper extremity
around the biceps area with her left hand. MHT
#1's arm was hooked under the client's right
armpit which resulted in the right arm being held
behind the client's back. MHT #1 then forcefully
put Client #3 against the hallway wall pulling the
client's elbows at an approximate 90-degree
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 67P111 Facility ID: 3012 If continuation sheet Page 4 of 18

PRINTED: 06/20/2025
DEPARTMENT OF HEALTH AND HUMAN SERVICES
FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING
C
04L115 B. WING 06/06/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1521 ALBERT ST
WOODRIDGE OF FORREST CITY, LLC
FORREST CITY, AR 72335
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETION
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
N 128 Continued From page 4 N 128
angle to the client's body up and behind the
client's back, forcing the client up on their tiptoes.
MHT #1 was seen leaning on Client #3 with her
upper body into the client's upper body area
pressing Client #3's chest against the wall. Client
#3 was seen having to turn their head to the side
with cheek against the wall. This hold was
maintained for 23 seconds then MHT #1
repositioned her arms and continued to hold the
client's arms behind their back, Client #3
remained against the wall and on their tiptoes.
Client #3 and MHT #1 were seen having a verbal
exchange, but the video did not have audio. At
7:13:26 PM, MHT #2 entered the hallway,
approached the client, and took over the restraint
by placing his arms under the client's armpits and
pulling the elbows up and behind the client, lifting
the client back up on their tiptoes. MHT #2
interlaced his own fingers together while pulling
Client #3's elbows toward each other behind the
client's back. MHT #2 leaned his upper body into
the back of the client's upper body resulting in the
client's chest being pushed against the wall. RN
#1 arrived at 7:14:24. MHT #2 readjusted his
position standing more upright. MHT #2 stepped
back maintaining the physical hold but no longer
leaned on Client #3 and lowered the client
enough that Client #3's feet were in a flat position
on the floor. At 7:16:09 Client #3 was released
from the physical restraint. RN #1 looked at Client
#3's arm and the client was seen exiting the
hallway at 7:16:27 PM. Client #3 was not seen
struggling at any time during the physical restraint
hold which was referred to as a PRT by the staff.
During a telephone interview on 06/04/2025 at
10:23 AM, MHT #1 reported that Client #3 had
gone to their room and slammed the door after
she had stepped on a bug that Client #3 was
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 67P111 Facility ID: 3012 If continuation sheet Page 5 of 18

PRINTED: 06/20/2025
DEPARTMENT OF HEALTH AND HUMAN SERVICES
FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING
C
04L115 B. WING 06/06/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1521 ALBERT ST
WOODRIDGE OF FORREST CITY, LLC
FORREST CITY, AR 72335
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETION
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
N 128 Continued From page 5 N 128
trying to put into a container. MHT #1 reported
that she heard small plastic blocks hit the floor.
She went into the room and escorted Client #3
out into the hall and placed the client in a PRT.
MHT #1 reported that Client #3 was hitting the
bookshelves with their fists. MHT #1 reported that
the client had told her in the hallway that she had
hurt the client ' s wrist, but she did not report the
complaint to MHT #2 who took over the restraint
later in the hallway. MHT #1 stated she did not
come in on her next scheduled day, "Because I
figured I'd be suspended."
During a phone interview on 06/04/2025 at 10:54
AM, MHT #2 reported that on 05/23/2025 he
responded to the restraint of Client #3 and
relieved MHT #1 because the staff and the client
were arguing. Client #3 stated to MHT #1 "I'm
going press charges on you." MHT #2 stated that
the resident was hurting and crying and when the
nurse arrived MHT #2 stated the client was
released from the PRT. MHT #2 described the
client's wrist as "bent up and purple."
During an interview on 06/04/2025 at 3:00 PM,
Client #4 reported that Client #3 had been hurt
and described the incident stating that Client #3
had got mad when MHT #1 had stomped on a
bug that Client #3 had wanted to catch. Client #4
reported that Client #3 had gone into the
bedroom and slammed the door and was behind
the door when MHT #1 pushed the door open
and it hit Client #3 and hurt their arm. Then, MHT
#1 had brought Client #3 out into the hall and put
them in a PRT. Client #4 stated Client #3's arm
was broken.
During an interview on 06/04/2025 at 3:30 PM,
Client #3 reported that on 05/23/2025, they had a
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 67P111 Facility ID: 3012 If continuation sheet Page 6 of 18

PRINTED: 06/20/2025
DEPARTMENT OF HEALTH AND HUMAN SERVICES
FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING
C
04L115 B. WING 06/06/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1521 ALBERT ST
WOODRIDGE OF FORREST CITY, LLC
FORREST CITY, AR 72335
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETION
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
N 128 Continued From page 6 N 128
verbal confrontation with MHT #1 and went to the
bedroom and slammed the door after MHT #1
stomped on a bug that the client had wanted to
catch. Client #3 stated that MHT #1 came into the
bedroom, slammed the door and started
screaming and cursing. Client #3 reported turning
toward the cubby to get a " fidget " out to "calm
myself down. As I turned, she pushed me from
behind and my hand hit the cubby and went numb
and then she put me in a PRT." Client #3
reported that their hand and wrist bent backwards
when it hit the cubby. Client #3 reported that MHT
#1 took them out into the hallway and continued
the PRT. Client #3 stated " I felt a ' pop ' and it
felt like it shifted, and the bones rubbed together.
At first, it was numb but then she was putting
pressure on it, and it started hurting really bad. I
told her she had broken it." Client #3 reported that
MHT #2 took over the PRT and "put so much
pressure on my arm that I was on my toes and
then I had a bruise on my arm." Client #3
indicated to this surveyor the upper bicep area as
being where the bruise was located. Client
reported, "Then the nurse came, and they let me
go, on my way to the quiet room my hand was
purple."
During an interview on 06/04/2025 at 4:16 PM,
Client #1 reported witnessing the incident and
stated he heard Client #3 in their room with MHT
#1 saying, "I didn't do anything, why did you put
me in a PRT?" Client #1 stated that Client #3 was
saying, "Stop! Stop! Stop! I feel like my arm is
broken!"
During a phone interview on 06/05/2025 at 7:36
AM, MHT #3 reported being present during the
incident on 05/23/2025, and revealed that Client
#3 was fighting with MHT #1 as she was bringing
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 67P111 Facility ID: 3012 If continuation sheet Page 7 of 18

PRINTED: 06/20/2025
DEPARTMENT OF HEALTH AND HUMAN SERVICES
FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING
C
04L115 B. WING 06/06/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1521 ALBERT ST
WOODRIDGE OF FORREST CITY, LLC
FORREST CITY, AR 72335
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETION
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
N 128 Continued From page 7 N 128
the client out into the hallway and was screaming,
"My arm, my arm- you broke my arm!"
During an interview on 06/05/2025 at 3:25 PM,
the Director of Nursing (DON) reported that
unless the client was a danger to self or others,
interventions such as offering coping skills ,
redirection, or removing the audience should be
attempted by staff prior to placing a resident in a
physical restraint. The DON also reported that
staff were taught to call the nurses before putting
clients in a physical hold.
During an interview on 06/05/2025 at 3:45 PM,
the Chief Executive Officer (CEO) stated that
staff should not put a resident in a physical
restraint unless the resident was a harm to self or
others. Staff were to give clients alternatives and
try the coping skills that have been identified as
effective for them. Some have "fidgets" that help
them calm down and when restraints are used it
should be the least restrictive method.
Review of an " Emergency Department Physician
Documentation " dated 05/23/2025, revealed
Client #3 had diagnoses of a break in the larger
wrist bone, about an inch below the wrist joint and
a fracture of both radial and ulnar bones.
Review of a facility policy titled, "Behavioral
Management-General" revised 03/2025, revealed
that restraints are used only in the case of
emergency, when there is imminent risk of harm
to the client or others and when non-physical
interventions would or have been ineffective .
"These techniques are used only after less
restrictive methods have been tried and failed
and all other means of verbal de-escalation
techniques have been expended." The policy
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 67P111 Facility ID: 3012 If continuation sheet Page 8 of 18

PRINTED: 06/20/2025
DEPARTMENT OF HEALTH AND HUMAN SERVICES
FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING
C
04L115 B. WING 06/06/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1521 ALBERT ST
WOODRIDGE OF FORREST CITY, LLC
FORREST CITY, AR 72335
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETION
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
N 128 Continued From page 8 N 128
indicated if restraints are used, they are to be
used in the least restrictive manner and are to be
discontinued at the earliest time possible.
N 142 ORDERS FOR USE OF RESTRAINT OR N 142
SECLUSION
CFR(s): 483.358(c)
A physician or other licensed practitioner
permitted by the state and the facility to order
restraint or seclusion must order the least
restrictive emergency safety intervention that is
most likely to be effective in resolving the
emergency safety situation based on consultation
with staff.
This ELEMENT is not met as evidenced by:
Based on observations, interviews and record
review, the facility failed to ensure that the least
restrictive interventions were implemented prior to
physically restraining one (Client #3) of three
case mix clients reviewed for restraints.
The findings include:
Review of Client #3's "Master Treatment Plan,"
dated 05/06/2025, revealed Client #3 had
diagnoses which included major depressive
disorder which was recurrent and severe without
psychosis, generalized anxiety disorder, history of
post-traumatic stress disorder, and history of
trauma.
Review of an "Emergency Safety Intervention
Justification" packet (ESI) dated 05/23/25, and
completed by Registered Nurse (RN) #1,
indicated Client #3 was placed in a physical
restraint at 7:11 PM, and was released at 7:15
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 67P111 Facility ID: 3012 If continuation sheet Page 9 of 18

PRINTED: 06/20/2025
DEPARTMENT OF HEALTH AND HUMAN SERVICES
FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING
C
04L115 B. WING 06/06/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1521 ALBERT ST
WOODRIDGE OF FORREST CITY, LLC
FORREST CITY, AR 72335
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETION
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
N 142 Continued From page 9 N 142
PM, due to "resident out of control" and
"uncooperative with staff." ESI documentation
included check marks under the section that
listed interventions attempted before restraint as:
emphasized need for self-control, attempted to
redirect, and allowed patient other ways to vent
anger.
Review of the "Client Debrief Form" contained in
the ESI packet revealed Client #3 reported that
the staff gave no warnings before initiating
restraint.
Review of the "Staff Debrief Form" contained in
the ESI packet signed by Mental Health
Technician (MHT) #1 revealed the measure taken
to de-escalate the situation prior to implementing
the restraint was, processed with patient.
Review of a "Body Check Form" contained in the
ESI packet under the comment section dated
05/23/2025 at 7:17 PM, signed by RN #1
indicated that per staff, Client #3 was placed in a
personal restraint due to being uncooperative with
staff and slamming the bedroom door in another
resident's face.
Review of a handwritten "Witness Statement," by
MHT #1 dated 05/23/2025, located within the
facility investigation packet, indicated Client #3
called MHT #1 a derogatory name after she
stepped on a bug that Client #3 was trying to put
in a "container and save." Client #3 then went into
the bedroom and slammed the door and was
banging hands on the clothes shelf. MHT #1
reported she told Client #3 to come out of the
bedroom, but Client #3 was "resisting staff " but
finally came out and was placed in a primary
restraint technique (PRT).
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 67P111 Facility ID: 3012 If continuation sheet Page 10 of 18

PRINTED: 06/20/2025
DEPARTMENT OF HEALTH AND HUMAN SERVICES
FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING
C
04L115 B. WING 06/06/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1521 ALBERT ST
WOODRIDGE OF FORREST CITY, LLC
FORREST CITY, AR 72335
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETION
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
N 142 Continued From page 10 N 142
Review of a "Witness Statement" transcribed and
written by the Quality and Risk Manager due to
resident's injury received on 05/23/2025 during an
Emergency Safety Intervention and signed by the
resident on 05/26/2025, revealed Client #3
reported finding a bug but MHT #1 stepped on it
and both Client #3 and MHT #1 began calling
each other derogatory names. Client #3 went into
the bedroom and slammed the door, then MHT
#1 came into the room, slammed the door,
screamed "don't slam this [expletive] door!" Client
#3 stated, "I won't slam this [expletive] door in a
sassy way. " The client reported being shoved
into the cubby by MHT #1 and then being put into
a PRT and taken out into the hallway. Client #3
stated having asked MHT #1 "could you release
the pressure on my left arm because I think you
broke it."
Review of video footage dated 05/23/2025 time
stamped beginning at 7:11:47 PM and ending at
7:16:22 PM, revealed the following events:
At 7:11:49 Client #1 was seen noticing something
on the floor by the double doors, turned and went
quickly back to the bedroom, returned five
seconds later with a red container and went back
to the door and was seen bending down. MHT #1
arrived at the door and stepped in front of Client
#3 and appeared to step on something. Client #3
went back to the room and shut the door at
7:12:15 PM. One second later, MHT #1 was seen
aggressively pushing past Client #4 who stood in
the doorway. Client #4 continued to look into the
open doorway and then the door closed again at
7:12:26 PM. One second later, Client #3 was
seen coming out of the room with MHT #1 holding
the client's left upper extremity around the bicep
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 67P111 Facility ID: 3012 If continuation sheet Page 11 of 18

PRINTED: 06/20/2025
DEPARTMENT OF HEALTH AND HUMAN SERVICES
FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING
C
04L115 B. WING 06/06/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1521 ALBERT ST
WOODRIDGE OF FORREST CITY, LLC
FORREST CITY, AR 72335
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETION
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
N 142 Continued From page 11 N 142
area with her left hand. MHT #1's arm was
hooked under the client's right armpit which
resulted in Client #3 ' s right arm being held
behind the client's back. MHT #1 then forcefully
put Client #3 against the hallway wall, pulled the
client's elbows at an approximate 90-degree
angle to the client's body, up and behind the
client's back, forcing the client up on their tiptoes.
MHT #1 was seen leaning on Client #3 with her
upper body into the client's upper body area
pressing Client #3's chest against the wall and
the client was seen having to turn their head to
the side with cheek against the wall. This hold
was maintained for 23 seconds, then MHT #1
repositioned her arms and continued to hold
Client #3's arms behind the client ' s back and the
client remained against the wall and on their
tiptoes. Client #3 and MHT #1 were seen having
a verbal exchange, but the video did not have
audio. At 7:13:26 PM, MHT #2 entered the
hallway, approached Client #3 and took over the
restraint by placing his arms under the client's
armpits and pulling the elbows up and behind the
client, lifting the client back up on tiptoes. MHT #2
interlaced his fingers together while pulling Client
#3's elbows toward each other behind the client's
back. MHT #2 was leaning his upper body into
the back of the client's upper body resulting in
Client #3 ' s chest being pushed against the wall.
RN #1 arrived and at 7:14:24 PM, MHT #2
readjusted his position stood more upright,
stepped back to maintain the physical hold, but
no longer leaned on Client #3 and lowered Client
#3 enough that the client's feet were in a flat
position on the floor. At 7:16:09 PM, Client #3
was released from the physical restraint, RN #1
looked at Client #3's arm and client was seen
exiting the hallway at 7:16:27 PM. Client #3 was
not seen struggling at any time during the
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 67P111 Facility ID: 3012 If continuation sheet Page 12 of 18

PRINTED: 06/20/2025
DEPARTMENT OF HEALTH AND HUMAN SERVICES
FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING
C
04L115 B. WING 06/06/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1521 ALBERT ST
WOODRIDGE OF FORREST CITY, LLC
FORREST CITY, AR 72335
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETION
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
N 142 Continued From page 12 N 142
physical restraint hold which was referred to as a
PRT by the staff.
On 06/04/2025 during a telephone interview
which began at 10:23 AM, MHT #1 reported that
Client #3 had gone to the room and slammed the
door after she had stepped on a bug that the
client was trying to put into a container. MHT #1
reported that she heard small plastic blocks hit
the floor, and she went into the room and
escorted Client #3 out and placed the client in a
PRT.
On 06/04/2025 during a phone interview which
began at 10:54 AM, MHT#2 reported that he had
responded on 05/23/2025, to the restraint of
Client #3 that was already in progress. He had
relieved MHT #1 because the staff and the client
were arguing and Client #3 had stated to MHT #1
"I'm gonna press charges on you." MHT #2 stated
that the resident was hurting and crying and when
the nurse arrived, the client was released from
the PRT. MHT #2 described Client #3's wrist as
"bent up and purple."
During an interview on 06/04/2025 at 3:00 PM,
Client #4 reported that Client #3 had been hurt by
staff and described the incident. Client #4 stated
Client #3 had gotten mad when MHT #1 had
stomped on a bug that Client #3 had wanted to
catch. Client #4 reported that Client #3 had gone
into the bedroom and slammed the door and was
behind the door, then MHT #1 had pushed the
door open, and it hit Client #3 and hurt the client's
arm. Then MHT #1 had brought Client #3 out and
put them in a PRT. Client #4 stated Client #3's
arm was broken.
During an interview on 06/04/2025 at 3:30 PM,
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 67P111 Facility ID: 3012 If continuation sheet Page 13 of 18

PRINTED: 06/20/2025
DEPARTMENT OF HEALTH AND HUMAN SERVICES
FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING
C
04L115 B. WING 06/06/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1521 ALBERT ST
WOODRIDGE OF FORREST CITY, LLC
FORREST CITY, AR 72335
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETION
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
N 142 Continued From page 13 N 142
Client #3 reported that on 05/23/2025, they had a
verbal confrontation with MHT #1 and went to the
bedroom and slammed the door after MHT #1
stomped on a bug that the client had wanted to
catch. Client #3 stated MHT #1 came into the
bedroom slammed the door and started
screaming and cursing. Client #3 reported turning
toward the cubby to get a fidget out to "calm
myself down, as I turned, she pushed me from
behind, my hand hit my cubby, bent backwards
and went numb, and then she put me in a PRT."
Client #3 reported that MHT #1 took them out to
the hallway and continued the PRT in the hall
where the client felt a "pop" and stated it "felt like
it shifted, and the bones rubbed together. At first
it was numb, but then she put pressure on it, and
it started hurting really bad. I told her she had
broken it." Client #3 reported that MHT #2 took
over the PRT and "put so much pressure I was
on my toes and had a bruise on my arm." Client
#3 then indicated to this surveyor the upper
biceps area as being where the bruise was
located. Client #3 stated, "Then the nurse came,
and they let me go; on my way to the quiet room
my hand was purple. "
During an interview on 06/04/2025 at 4:16 PM,
Client #1 reported witnessing the incident. Client
#1 stated they heard Client #3 in the room with
MHT #1 saying, "I didn't do anything why did you
put me in a PRT?" Client #1 stated that Client #3
was saying, "Stop! Stop! Stop! I feel that my arm
is broken!"
On 06/05/2025 during a phone interview which
began at 7:36 AM, MHT #3 reported being
present during the incident on 05/23/2025. MHT
#3 stated Client #3 was fighting with MHT #1 as
she was bringing the client out into the hallway.
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 67P111 Facility ID: 3012 If continuation sheet Page 14 of 18

PRINTED: 06/20/2025
DEPARTMENT OF HEALTH AND HUMAN SERVICES
FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING
C
04L115 B. WING 06/06/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1521 ALBERT ST
WOODRIDGE OF FORREST CITY, LLC
FORREST CITY, AR 72335
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETION
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
N 142 Continued From page 14 N 142
Client #3 was screaming, "My arm- you broke my
arm!"
During an interview on 06/05/2025 at 1:29 PM,
RN #2 reported that staff were taught to give at
least three verbal prompts and try to de-escalate
the behavior before a client was placed in a
physical restraint.
During an interview on 06/05/2025 at 3:25 PM,
the Director of Nursing (DON) reported that
unless the client was a danger to self or others,
interventions such as offering coping skills ,
redirection, or removing the audience should be
attempted by staff prior to placing a resident in a
physical restraint. The DON stated that staff were
taught to call the nurses before putting clients in a
physical hold.
During an interview on 06/05/2025 at 3:45 PM,
the Chief Executive Officer (CEO) stated that
staff should not put a resident in a physical
restraint unless the resident was a harm to self or
others. The CEO stated staff gave clients
alternatives and the coping skills that have been
identified to work for them. Some have "fidgets"
that help them calm down and when a restraint
was used it should be the least restrictive
method.
Review of a facility policy titled, "Behavioral
Management-General" with a revision date of
03/2025, revealed that restraint is used only in the
case of emergency, when there is imminent risk
of harm to the resident or others and when
non-physical interventions would or have been
ineffective. These techniques are used only after
less restrictive methods of interventions have
been tried and failed and all other means of
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 67P111 Facility ID: 3012 If continuation sheet Page 15 of 18

PRINTED: 06/20/2025
DEPARTMENT OF HEALTH AND HUMAN SERVICES
FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING
C
04L115 B. WING 06/06/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1521 ALBERT ST
WOODRIDGE OF FORREST CITY, LLC
FORREST CITY, AR 72335
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETION
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
The Resident affected was assessed by Nursing and
N 142 Continued From page 15 N 142 an Order was received by the Physician for further
evaluation of Resident at local Medical center. Staff
verbal de-escalation have been expended. If
involved were suspended immediately and remain
restraint is used it is to be used in the least suspended pending investigation results. Results from
restrictive manner possible and discontinued at internal investigation yield one Staff member not
the earliest possible time. returning. The likelihood for this deficiency affecting
other Residents being affected was greatly reduced
and minimized due to the organization’s response.
The Chief Executive Officer oversees the
implementation of this corrective action plan. A
mandated facility-wide retraining for all Mental
Health Technicians, Nurses, Dietary Staff,
Maintenance Staff, Clinical staff, and Administrative
staff on verbal de-escalation and proper physical
interventions was conducted by the Handle with Care
Instructor June 18th, 2025. Retraining included
modeling verbal de-escalation, proper physical
intervention, and scenario-based participation. All
attendees signed acknowledging receipt of training
and attestation of understanding. and attestation of
understanding. For Staff who could not attend the
training, individual training will be provided,
documented, and attestations will be signed. All
training will be completed by July 6th, 2025. The
Director of Quality and Risk Management will be the
custodian of the training log. Training records will be
audited weekly by the Quality Risk Director until
100% training compliance is reached for existing
staff. This training is already part of the new hire
orientation process. The Director of Quality and Risk
Management will continue to review and document
all physical interventions with special emphasis on
physical interventions where a Resident injury was
reported. Observations will be reviewed with the
interdisciplinary Safety committee daily (Monday –
Friday) comprised of the Director of Nursing,
Program Director, Handle with Care Instructor,
Clinical Director, Director of Quality and Risk
Management, and Chief Executive Officer. Proper
reporting to Guardians, Abuse/Neglect hotline, and
other child protective entities will continue to be
notified in accordance with Arkansan and Resident’s
corresponding State guidelines. Cumulative data will
be reviewed in the Committee of the Whole monthly
and reported to the Governing Board for oversight.
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 67P111 Facility ID: 3012 If continuation sheet Page 16 of 18

PRINTED: 06/20/2025
DEPARTMENT OF HEALTH AND HUMAN SERVICES
FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 67P111 Facility ID: 3012 If continuation sheet Page 17 of 18

Division of Provider Services
& Quality Assurance
P.O. Box 8059, Slot S404
Little Rock, AR 72203-8059
June 30, 2025
Charlotte Lockhart, Administrator
Woodridge Of Forrest City, Llc
1521 Albert St
Forrest City, AR 72335
Dear Administrator:
On June 6, 2025, we conducted a Complaint Investigation survey at your facility. You have alleged that
the deficiencies cited on that survey have been corrected. We are accepting your allegation of
compliance and have approved your plan of correction and presume that you will achieve substantial
correction by July 6, 2025.
We will be conducting a revisit of your facility to verify that substantial correction has been achieved
and maintained.
If you have any questions, please contact your reviewer: Breanna Marengo at 501-320-6280 or email
to: breanna.marengo@dhs.arkansas.gov.
Sincerely,
for Jeff Rosenbaum
Breanna Marengo, RN QA Reviewer
DPSQA/Office of Long Term Care
Survey & Certification Section
bbm
Charlotte Lockhart - Woodridge Of Forrest City, Llc -- -- (AOLTC-14) Page 1

doc_type: Recertification Survey


state: AR

facility_name: Perimeter Behavioral of Forrest City

summary: A resident was transported to the emergency room due to a persistent cough.

raw_content:
R
Notice of Incident
Case Number: 030401
Date of Incident: 6/7/2025
Date Received: 6/10/2025
Facility Name: Woodridge Northwest LLC
Report Description: Resident, , was sent to the by order of Physician due to
persistent cough. COVID and flu tests negative. Resident returned from
same day at 1422 (2:22 pm). . Resident isolated
for first 48 hours after first dose of antibiotics and released by the Provider. Resident on antibiotics
for 8 ? 10 days. , Guardian, notified 06/07/2025, at approximately 0852 (8:52 am cst).
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

doc_type: Notice of Incident


summary: Staff reported sexual activity involving resident and peers.

raw_content:
R
Notice of Incident
Case Number: 030404
Date of Incident: 6/7/2025
Date Received: 6/10/2025
Facility Name: Woodridge Northwest LLC
Report Description: Staff reported sexual activity involving
Resident and peers. Resident admits sexual activity of kissing and hugging a peer, both clothed.
Resident also admits to being the ?look out? for peers during the sexual activity. Residents separated
for the night. Residents remain separated. Sexual safety plan developed by Therapist. Sleeping
arrangements have been changed. Witness statements collected from Staff and two Residents, one
peer refused to write a statement. .
Camera review conducted by Safety team. All Resident?s interviewed by Safety team during morning
Safety meeting. , notified 06/08/2025, at approximately 0247 (2:47 am
cst).
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

R
Notice of Incident
Case Number: 030405
Date of Incident: 6/7/2025
Date Received: 6/10/2025
Facility Name: Woodridge Northwest LLC
Report Description: Staff reported sexual activity involving Resident
and peers. Resident denies engaging in sexual activity. Resident admits to being a ?look out? for
peers during the sexual activity. Residents separated for the night. Residents remain separated.
Sexual safety plan developed by Therapist. Sleeping arrangements have been changed. Witness
statements collected from Staff and two peers. Resident refused to write a statement.
Camera review conducted by Safety team. All
Resident?s interviewed by Safety team during morning Safety meeting.
notified 06/08/2025, at approximately 1812 (6:18 pm cst).
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was transported for evaluation of persistent itching and swelling to left lower extremity.

raw_content:
R
Notice of Incident
Case Number: 030403
Date of Incident: 6/7/2025
Date Received: 6/10/2025
Facility Name: Woodridge Northwest LLC
Report Description: Resident, , was sent to by order of Physician for
further evaluation of left lower extremity due to persistent itching and swelling from possible bug
bite, approximately 2-3 inches in diameter.Resident returned from same
day at 2305 (11:05 pm).
notified 06/07/2025, at approximately 1416 (2:16 pm
cst).
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was transported for evaluation after the back of his head hit a wall when a peer kicked him in the nose.

raw_content:
R
Notice of Incident
Case Number: 030402
Date of Incident: 6/6/2025
Date Received: 6/10/2025
Facility Name: Woodridge Northwest LLC
Report Description: Resident, , was stooped down to the floor with his back and
head against the wall when Peer kicked him in the nose. The back of his head hit the wall. No break
in skin noted to the back of his head or nose. Small amount of bleeding noted from nose. Pupils
equal round and reactive to light. Resident taken to for further
evaluation per order of Physician. Resident returned from same day at
2305 (11:05 pm). . Resident on peer
restriction until released by Provider. Peer who assaulted Resident placed on assault precautions.
, Guardian, notified 06/06/2025, at approximately 2126 (9:26 pm cst).
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: An x-ray was ordered after a resident complained of pain from landing wrong on his leg while playing ball.

raw_content:
R
Notice of Incident
Case Number: 030219
Date of Incident: 6/3/2025
Date Received: 6/3/2025
Facility Name: Woodridge Northwest LLC
Report Description: Resident, returned from the gym limping
and stated ?I came down on my ankle wrong playing ball. Can I have some ibuprofen?? Slight
swelling noted to ankle area. No increased redness or warmth. Ibuprofen 200 mg by mouth for
complaint of pain to left ankle. Pain rated 6/10 (ten being the highest). Icepack applied for fifteen
minutes. Physician notified and order for x-ray received and processed. Resident returned from
same day at 2248 (10:48 pm). Resident does have a boot on injured foot
and will need orthopedic appointment.
Resident on activity restriction until further evaluation.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent for evaluation after admitting to swallowing staples from the binding of a book.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 030068
Date of Incident: 5/27/2025
Date Received: 5/27/2025
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, admitted to swallowing
staples from the binding of a book. Upon assessment, Resident refused to cooperate.
Physician notified and orders received to send Resident out to
for further evaluation. Resident alert and oriented to person, place, time, and situation. No
visible injuries noted. Resident returned to facility with at 1240 (12:40 pm) from
No restrictions on discharge instructions.
Resident should have no difficulty passing the staples per
.
Interim Action Narrative:
Narrative:
Licensing Narrative: 6.12.25- Uploaded documentation
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent for evaluation after an altercation with a peer resulted in an existing wound reopening.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 030066
Date of Incident: 5/26/2025
Date Received: 5/27/2025
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, , sent to
after a physical altercation with peer resulting in an existing
wound reopening. Resident has mild swelling to right and healing abrasion to knuckle on
right hand. No other injuries noted. Resident returned to facility with transportation at 1327
(1:27 pm) from
Interim Action Narrative:
Narrative:
Licensing Narrative: 5.28.25- uploaded SORF and awaiting discharge paperwork and
nurses notes 6.12.25- requested discharge paperwork
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident complained of pain to the right thumb after hitting a peer. The resident was sent for evaluation.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 030067
Date of Incident: 5/26/2025
Date Received: 5/27/2025
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, , sent to
of right hand after hitting a peer resulting in thumb pain. Resident has mild
swelling to right hand and complaint of pain. No other injuries noted. Resident returned to
facility at 1418 (2:18 pm) from
Interim Action Narrative:
Narrative:
Licensing Narrative: 5.28.25- uploaded SORF awaiting discharge paperwork and nurses
notes
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humanservices.arkansas.gov


summary: A resident was sent for an x-ray of the right hand after punching a television.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 030069
Date of Incident: 5/26/2025
Date Received: 5/27/2025
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident, sent to
x-ray of right hand after punching a television. Pain reported 3/10 (10
being the highest) and redness noted. PRN . Icepack also
applied to affected area. Resident stated he punched the television because he was mad at
Staff. Plexi glass was removed from dayroom by Staff. Resident has mild swelling to right
hand. No other injuries noted. Resident returned to facility with at 1505 (3:05 pm).
Interim Action Narrative:
Narrative:
Licensing Narrative: 5.28.25- inquired about plexiglass replacement and if resident was
placed on any precautions Facility replied: It was replaced and he was placed on
precautions.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov