summary: A resident complained of pain and swelling to nose and mouth after an Emergency Safety Intervention (ESI). The facility was provided technical assistance for 905.9, ensuring that staff use the minimal force and time necessary during the course of a restraint hold.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 018475
Date of Incident: 1/8/2024
Date Received by DCCECE: 1/9/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Serious injury requiring outside medical attention Residents
Name/DOB: Date/Time of incident: 1/8/23-
09:38 Please give a description of the incident: Resident complained of pain to nose and
mouth and swelling after ESI for physical aggression toward staff and attempted property
destruction. Corrective Actions Taken: Staff was seen by APRN and sent to the Forrest City
Medical Center. After assessment and x-ray Its was determined that there was a fracture to
his nose but the age of the fracture was undetermined it appeared that fracture was aged.
Additional Information: None currently. Guardian Notified:
Interim Action Narrative: Resident was assessed by the APRN and evaluated at FCMC.
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns. Program Coordinator will inquire about camera footage. Program
Coordinator reviewed camera footage and received documentation.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

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: Perimeter Behavioral of Forrest City
Facility Number: 142
Licensee Address: 603 KITTLE ROAD
FORREST CITY AR 72335
Licensing Specialist: Kendra Rice
Person In Charge: Charlotte Lockhart
Record Visit Date: 1/10/2024
Home Visit Date: 1/10/2024
Purpose of Visit: Self Report Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Time of visit: 12:00 pm to 1:30 pm
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Census: 58
Licensing received a provider reported incident on 1/9/2024 for ELS Case #018475.
Program Coordinator reviewed camera footage for the provider reported incident with Mr. Cliff Williams,
Program Director. Nurse Kim provided documentation for this provider reported incident.
Resident was observed sitting at a table in the cafeteria with a staff member. The other residents were sitting
at tables away from the resident or walking around the cafeteria putting their trash away. Program Coordinator
observed resident throw a water bottle at the wall and walked out of the cafeteria.
Once in the hall, resident was observed kicking a door. A staff member was observed walking on the hall
behind the resident, ratio 1:1. The staff member appeared to be communicating with the resident who
continued to kick the door. Another staff member was observed entering the hall. Program Coordinator
observed the resident jumping toward the exit sign on the ceiling. A staff member was observed blocking the
resident from hitting the exit sign.
Resident was placed in a restraint and struggled with the staff member. Another staff member was observed
assisting the first staff member. One staff member was observed on the upper part of the resident’s body and
another staff member had the resident’s legs. Resident was observed trying to get out of the restraint.
Program Coordinator observed another staff member enter the hall to assist, ratio 3:1. Once the third staff
member arrived, staff members were observed repositioning the restraint. The nurse was observed entering the
hall while resident was still in a restraint. Program Coordinator was unable to determine how the resident
injured his nose.
Provider Comments:
CCL Staff Signature : Date: 3/1/2024
Provider Signature : Date: 3/1/2024
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


state: AR

facility_name: Perimeter Behavioral of Forrest City

summary: Caller advised that he needs to make a report on one of the residents.

raw_content:
CFS - Unit Response Times Printed on January 5, 2024

CFS #

Call Taker
Location
Location Deta
Primary Incid
Mod

Priority

Use Caution

Primary Dispasition

Beat
Zone
Call Time

Completed Time

Reporters

Sex

DOB
Address
Report Time
How Reported
From Phone

CFS2400611
ALENA BAILEY

1521 ALBERT ST, FORREST CITY, AR 72335 (WOODRIDGE BEHAVIORAL CENTER)
Is

nt Code DISTURBANCE : Disturbance
Report Needed
2

No
Handled By Officer / Deputy

Forrest City Police Department
01/03/24 15:44:23
01/03/24 16:07:46

DAVIS, MARCUS (Initial Reporter)

01/03/24 15:44:23

Contact Phone (312) 286-0965

Comments

Other Names

Vehicles

Responders
543 (Primary)

Response Tim

543 - ALBERT, TANESHA — FCPD (Primary)

es

Assigned 01/03/24 15:46:16 *

Enroute
Arrived
Leaving
Arrived At

01/03/24 15:46:16
01/03/24 15:51:33

Completed 01/03/24 16:07:46

IR / External Agency Numbers

Officer Addenda

Unit Response Times

Non Unit Speaine Times
01/03/24 15:44123 | New CFS

01/03/24 15:45+52 | CALLER ADVISED THAT HE NEEDS TO MAKE A REPORT ON ONE OF THE RESIDENCE

01/03/24 16:07

40 | EVENT #2401030010

Page 1 of 2

01/04/24 17:20:20 | Complete
543

01/03/24 15:44:16 | Enroute
01/03/24 15:51:33 | On Scene
01/03/24 16:07:46 | Complete

eo
Page 2 of 2

CFS - Command Log ; Printed on January 5, 2024
CFS # CFS2400611

Call Taker ALENA BAILEY

Location

Location Detajls

1521 ALBERT ST, FORREST CITY, AR 72335 (WOODRIDGE BEHAVIORAL CENTER)

Primary Incident Code DISTURBANCE : Disturbance

Mod
Priority
Use Caution

Primary Dispasition

Beat
Zone
Call Time

Completed Time

Reporters

Report Needed

2

No

Handled By Officer / Deputy

Forrest City Police Department
01/03/24 15:44:23
01/03/24 16:07:46

DAVIS, MARCUS (Initial Reporter)

Sex

DOB
Address
Report Time

How Reported

From Phone

01/03/24 15:44:23

Contact Phone (312) 286-0965

Comments

Other Names

Vehicles

Responders,
543 (Primary)

543 - ALBERT, TANESHA —_FCPD (Primary)

Response Times

Assigned 0
fe)
fe)

Enroute
Arrived
Leaving
Arrived At

(03/24 15:46:16

oar 15:46:16 *
103/24 15:51:33

Completed 0/1/03/24 16:07:46

IR / External Agency Numbers

Officer Addenda

Command Log Filter: All Commands | Details: Hidden | Units: All Units | Revised Entries: Shown

01/03/24 15:
01/03/24 15:
RESIDENCE

4:23 | BAILEY, ALENA | New CFS
5:52 | BAILEY, ALENA | CALLER ADVISED THAT HE NEEDS TO MAKE A REPORT ON ONE OF THE

01/03/24 15:46:16 | BAILEY, ALENA | 543 | Enroute

Page 1 of 2

01/03/24 15:51:33 | BAILEY, ALENA | 543 | On Scene
01/03/24 16:07:40 | BAILEY, ALENA | EVENT #2401030010
01/03/24 16:07:46 | BAILEY, ALENA | 543 | Complete
01/04/24 17:20:20 | BAILEY, ALENA | Complete

CLQ

Requested At
Sent To
Status
Received At
Location ;
Accuracy

-_

Page 2 of 2

doc_type: Police Report


summary: A resident was sent to the emergency room after falling in the gym while playing and injuring 3rd digit.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 018351
Date of Incident: 1/2/2024
Date Received by DCCECE: 1/3/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Serious injury requiring outside medical attention Residents
Name/DOB: State: Date/Time of incident: 1-2-24/13:34
Please give a description of the incident: Resident was sent to the ER after falling in the
gym while playing and injuring 3rd digit. Corrective Actions Taken: Nurse assessed
and he was sent to Forrest City Medical Center for medical examination and x-ray after
consultation with the APRN. Diagnosed with non-displaced hairline fracture of the
epiphysis of the middle phalanx. Sent back to the facility for continuance of care. Additional
Information: None currently. Guardian Notified: Parent/Legal Guardian
Interim Action Narrative: Resident was assessed by the nurse and sent to FCMC for further
evaluation.
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

doc_type: Notice of Incident


summary: A resident was sent to Forrest City Medical Center after falling and hitting his head.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 019521
Date of Incident: 1/1/2024
Date Received by DCCECE: 1/3/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident fell out and hit his head for an unknown reason.
Nurse assessed and came too but was lethargic. The Nurse consulted
with APRN who advised that resident be sent to the Forrest City Medical Center for
evaluation. was diagnosed with adult syncope referred to neurologist within 2-3
days to rule out seizure.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 3/1/2024- This incident was sent by the provider to the specialist via
email on 1/3/2024, but never put into ELS. The report has been put into ELS by the PRLU
for documentation purposes.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A staff member advised that a resident fainted and was unresponsive.

raw_content:
CFS - Unit Response Times

Printed on January 5, 2024

CFS # CFS2400100
Call Taker KATELYN JACKSON
Location 1521 ALBERT ST, FORREST CITY, AR 72335 (WOODRIDGE BEHAVIORAL CENTER)

Location Detajls
Primary Incident Code MED : Medical Call

Mod
Priority 1
Use Caution No
Primary Dispasition Handled By Officer / Deputy
Beat
Zone Forrest City Police Department
Call Time 01/01/24 09:36:47
Completed Time 01/01/24 09:38:34
Reporters

UNK 911 (Initial Reporter)
Sex

DOB
Address
Report Time | 01/01/24 09:36:47
How Reported
From Phone | (870) 970-3500
Contact Phone

Comments

Other Names

Vehicles

Responders

CALL1 FCFD (Primary)
FCBAT1 FCEFD, Battalion Chief FCFD (Primary)
FCE1 (Primary) FCFD, Engine CO 1 FCFD (Primary)

Response Times
Assigned oboiza 09:45:57

Enroute 01/01/24 09:47:55
Arrived 01/01/24 09:50:18
Leaving

Arrived At
Completed 0/1/01/24 09:38:34

IR/ External Agency Numbers
FCFD 202400003

Officer Addenda

Unit Response Times

Non Unit Spécific Times
Page 1 of 2

01/01/24 09:36
01/01/24 09:37
01/01/24 09:38
SAID SHE WO
01/01/24 09:38
01/01/24 09:45
01/01/24 09:47

CALL1

47 | New CFS

43 | MALE FAINTED - ADV HE WAS UNRESPONSIVE

a | FEMALE ADV THE MALE WAS RESPONDING AND TO DISREGARD EMS AND FIRE - SHE
LD CALL BACK IF THEY NEEDED TO GET EMS ON SCENE

334 | Complete

453 | CALLED BACK - MALE FAINTED AND IS UNRESPONSIVE - HR 70 BP 114/78
305 | EMS ENROUTE

01/01/24 09:45157 | Assign

01/01/24 10:10
FCBAT1

350 | Complete

01/01/24 09:48104 | Enroute

01/01/24 09:50
01/01/24 09:55
01/01/24 10:07

FCE1

333 | On Scene
45 | Clear Alarms
30 | Available

01/01/24 09:47155 | Enroute

01/01/24 09:50
01/01/24 09:55
01/01/24 10:10

18 | On Scene
31 | Clear Alarms
02 | Available

—__— > —oAvW SSS

Page 2 of 2

CES - Command Log Printed on January 5, 2024

CFS #
Call Taker
Location

Location Detajls

CFS2400100
KATELYN JACKSON
1521 ALBERT ST, FORREST CITY, AR 72335 (WOODRIDGE BEHAVIORAL CENTER)

Primary Incident Code MED : Medical Call

Mod
Priority
Use Caution

Primary Dispasition

Beat
Zone
Call Time

Completed Time

Reporters

a
No
Handled By Officer / Deputy

Forrest City Police Department
01/01/24 09:36:47
01/01/24 09:38:34

UNK 911 (Initial Reporter)

Sex

DOB
Address
Report Time

How Reported

From Phone

Contact Phone

Comments

Other Names

Vehicles

Responders

CALL1
FCBAT1

FCE1 (Primary)

Response T

01/01/24 09:36:47

(870) 970-3500

FCFD (Primary)
FCFD (Primary)
FCFD (Primary)

FCFD, Battalion Chief
FCFD, Engine CO 1

mes

Enroute 0

01/24 09:47:55

Assigned ooze 09:45:57
i
i

Arrived
Leaving
Arrived At

0

(01/24 09:50:18

Completed 0/1/01/24 09:38:34

IR / aoa
FCFD 202409003

Agency Numbers

Officer Addenda

Command Log Filter: All Commands | Details: Hidden | Units: All Units | Revised Entries: Shown
01/01/24 09:36:47 | JACKSON, KATELYN | New CFS

Page 1 of 2

01/01/24 09:3

7143 | JACKSON, KATELYN | MALE FAINTED - ADV HE WAS UNRESPONSIVE

01/01/24 09:38)21 | JACKSON, KATELYN | FEMALE ADV THE MALE WAS RESPONDING AND TO DISREGARD

EMS AND FIR

01/01/24 09:3

8/34 | JACKSON, KATELYN | Complete

- SHE SAID SHE WOULD CALL BACK IF THEY NEEDED TO GET EMS ON SCENE

01/01/24 09:45|}53 | JACKSON, KATELYN | CALLED BACK - MALE FAINTED AND IS UNRESPONSIVE - HR 70 BP

114/78
01/01/24 09:4
01/01/24 09:4
01/01/24 09:4

01/01/24 09:48

01/01/24 09:5

5157 | JACKSON, KATELYN | CALL1 | Assign
7105 | JACKSON, KATELYN | EMS ENROUTE
dee | FCFD, Engine CO 1 | FCE1 | Enroute

04 | FCFD, Battalion Chief | FCBAT1 | Enroute
O18 | FCFD, Engine CO 1| FCE1| On Scene

01/01/24 09:50:33 | FCFD, Battalion Chief | FCBAT1 | On Scene

01/01/24 09:5
01/01/24 09:5:
01/01/24 10:0
01/01/24 10:1
01/01/24 10:1

CLQ

Requested A
Sent To
Status
Received At
Location
Accuracy

5:31 | JACKSON, KATELYN | FCE1 | Clear Alarms
:45 | JACKSON, KATELYN | FCBAT1 | Clear Alarms
:30 | FCFD, Battalion Chief | FCBAT1 | Available
9:02 | FCFD, Engine CO 1| FCE1 | Available

G:50 | JACKSON, KATELYN | CALL1 | Complete

t

Page 2 of 2


summary: A resident was sent to Forrest City Medical Center for assessment after injuring his hand in an altercation with a peer.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 019709
Date of Incident: 12/30/2023
Date Received: 1/3/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident had pain and swelling in right hand and nose, bruise also noted on
his nose from altercation with another peer the night before. Nurse assessed and he was sent
to Forrest City Medical Center for medical examination and x-ray after consultation with the APRN.
diagnosed with buckle fracture displaced of the 5th metacarpal metaphysis. Sent back to the
facility for continuance of care all residents involved separated and allowed to process with staff.
Interim Action Narrative: Resident was assessed by the nurse and sent to FCMC for further
evaluation.
Maltreatment Narrative:
Licensing Narrative: Provider reported incident was sent to licensing via email on 1/3/2024 but
was not entered into ELS. Program Coordinator entered provider reported incident into ELS for
documentation purposes.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for assessment after he punched a wall with a previously injured hand.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 019708
Date of Incident: 12/30/2023
Date Received: 1/3/2024
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident sent back out to the ER for punching wall with already injured hand
due to still being angry about altercation. Nurse assessed and he was sent to Forrest City
Medical Center for medical examination and x-ray after consultation with the APRN.
diagnosed with a metacarpal buckle fracture. Sent back to the facility for continuance of care all
residents involved separated and allowed to process with staff. Also placed of assault precaution and
self-harm precaution.
Interim Action Narrative: Resident sent to the ER and placed on safety precautions.
Maltreatment Narrative:
Licensing Narrative: Licensing informed of provider reported incident on 1/3/2024 but was ont
entered into ELS. Program Coordinator entered provider reported incident into ELS for
documentation purposes.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Officers were dispatched to the facility in response to a report that a juvenile resident attacked a staff member.

raw_content:
CES - Unit R¢sponse Times Printed on January 5, 2024

CFS # CFS2355563
Call Taker ALLISON LAWS
Location 1521 ALBERT ST, FORREST CITY, AR 72335 (WOODRIDGE BEHAVIORAL CENTER)

Location Details
Primary Incident Code ASSAULT : Assault/Battery

Mod Emergency Fire/Medical
Priority 1
Use Caution No
Primary Disposition Handled By Officer / Deputy
Beat
Zone Forrest City Police Department
Call Time 12/29/23 18:20:19
Completed Time 12/29/23 18:49:37

Reporters

LADARIUS MURPHY (initial Reporter)
Sex

DOB

Address
Report Time | 12/29/23 18:20:19
How Reported
From Phone
Contact Phone (501) 762-4146
Comments

Other Names
Vehicles

Responders

512 (Primary) 512 - HAWKINS, FCPD (Primary)
NATHANIEL
514 514 - JAMES, JOHN FCPD (Primary)

Response Times
Assigned ee 18:21:50 *

Enroute 12/29/23 18:21:50
Arrived 12/29/23 18:27:49
Leaving

Arrived At
Completed 12/29/23 18:49:37

IR/ Exerna Agency Numbers
FCPD202313116 -

Officer Addenda

Unit Response Times

Non Unit Specific Times

Page 1 of 2

12/29/23 18:20
12/29/23 18:23
EMS

12/29/23 18:45

512

12/29/23 18:21
12/29/23 18:29
12/29/23 18:39

512, 514

19 | New CFS
20 | ADVISED ONE OF THE JUVENILES ATTACKED HIM. CALLER SAID HE DOES NOT NEED

25 | 2312290006
50 | Enroute

12 | On Scene
11 | Clear Alarms

12/29/23 18:49|37 | Complete

514

12/29/23 18:21}56 | Enroute

12/29/23 18:27
12/29/23 18:39

49 | On Scene
19 | Clear Alarms

er  SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS

Page 2 of 2

CFS #
Call Taker
Location

Location Details

CFS - Comm

And Log Printed on January 5, 2024

CFS2355563
ALLISON LAWS

1521 ALBERT ST, FORREST CITY, AR 72335 (WOODRIDGE BEHAVIORAL CENTER)

Primary Incident Code ASSAULT : Assault/Battery

Mod
Priority
Use Caution

Primary Disposition

Beat
Zone
Call Time

Completed Time

Reporters

Emergency Fire/Medical

1

No

Handled By Officer / Deputy

Forrest City Police Department
12/29/23 18:20:19
12/29/23 18:49:37

LADARIUS MURPHY (Initial Reporter)

Sex

DOB
Address
Report Time

How Reported

From Phone

12/29/23 18:20:19

Contact Phone (501) 762-4146

Comments

Other Names

Vehicles

Responders
512 (Primary)

512 - HAWKINS,
NATHANIEL

FCPD (Primary)

514 514 - JAMES, JOHN FCPD (Primary)
Response Times

Assigned 12/29/23 18:21:50 *

Enroute 12/29/23 18:21:50

Arrived 12/29/23 18:27:49

Leaving

Arrived At

Completed 12/29/23 18:49:37

IR/ —
FCPD202313}

A

gency Numbers
16

Officer Addenda

Command Log Filter: All Commands | Details: Hidden | Units: All Units | Revised Entries: Shown

12/29/23 18:20

:19 | LAWS, ALLISON | New CFS

Page 1 of 2

12/29/23 18:21:
12/29/23 18:21)
12/29/23 18:23:
DOES NOTN

0 | LAWS, ALLISON | 512 | Enroute
6 | LAWS, ALLISON | 514 | Enroute

D EMS

12/29/23 18:27:49 | LAWS, ALLISON | 514 | On Scene
12/29/23 18:29112 | LAWS, ALLISON | 512 | On Scene

12/29/23 18:39]11 | FREEMAN, MARLA | 512 | Clear Alarms
12/29/23 18:39]19 | FREEMAN, MARLA | 514 | Clear Alarms

12/29/23 18:45
12/29/23 18:49

CLQ

Requested At
Sent To
Status
Received At
Location
Accuracy

25 | LAWS, ALLISON | 2312290006
37 | LAWS, ALLISON | 512, 514 | Complete

0 | LAWS, ALLISON | ADVISED ONE OF THE JUVENILES ATTACKED HIM. CALLER SAID HE

Page 2 of 2

FORREST CITY Pee 1 Incident
POLICE DEPARTMENT

Incident #

225 N. ROSSER ST. _ — Saree 0008
FORREST CITY, AR. 72335 pO [PPS] criminas Report |" 4

Crime / Incident (Primary, Secondary, Tertiary)
5-13-203 BATTERY 3RD DEGREE

3

Occurred
On or Fron 12/29/2023
12/29/2023
12/29/2023

Time Day
Fri
18:45 Fri
Fri

Location of Incident 1521 ALBERT AV, FORREST CITY, AR
Cross Street 1521 ALBERT AVE Rona

. Dispo "V" = Victim "RP" = Reporting Party "W" = Witness "S" = Suspect "O" = Other
Last, First, Middle (Firm if Business) Race Age HT
v MURPHY, LADARUIS B 27 | 6-03 200

Address DL Number

_—__
Age HT WT Ha Ey
16

DOB DL Number State

AR
_
nano ™ “= ee ee
DL Number

i fr | _
ar _ ™_ a ee ee =
“ _ Pe | _ “

Continuation PropertyList
Attached LL] | attaches  [_]| Property Damages $0.00
Press Domestic Violence

UCR

Gang Related N Victim Senior Citizen CL]
a
Solvability County vas

Points Oo Code ST FRA Disposition A

Report Complete/Ready for Review [XJ

Assigned To

Officer ID JAMES, JOHN 569

Printed By/On: 461 / 01/24/2024 10:23:44

Se ea ae ean ANIMA

City, State, Zip Code
FORREST CITY AR 72335

Last, First, Middle (Firm if Business)

City, State, Zip Code

Address

Work Phone
(870)

S
2

1 &
Uv
x
fe)
5
)

5

Home Phone

Address Work Phone

City, State, Zip Code

Connecting Case #

CAD/CFS Event# 2312290006

<iHi-r-or<cron

222222222222

Date

Reviewed By Approved Date
Sgt. Steven Mansel 12/30/2023

FORREST CITY Page 2 Incident conta
POLICE DEPARTMENT Narrative newert® 9312290006
Crime / Incident (Primary) Attempt | Type

Pas axreernoose ET commen [7

On December 29, 2023, I Officer James was dispatched to Perimeter Behavioral
Center for a aggravated assault report. Upon arrival I made contact with Mr.
Ladarius Murphey. Murphey is one of the workers at Perimeter. Murphey stated
that he was in the dayroom and the resident ( walked out of
the dayroom and walked down the whole way without permission. Murphey then
started to stop from _ leaving the dayroom. Murphey then proceeded to put
GS ip the ESI lock. then started to swing on Murphey. While
swinging on Murphey. struck Murphey with his right fist to the right

cheek of the face. I then begin to investigate on Murphey face there was no
visible injuries, and I ask Murphey did he want me to call EMS to check him out
Murphey stated" No "he will be ok. There were no more injuries from the
incident. Murphey was also advised if he wanted to press charges to come to the
police department to fill out an affidavit.

Reviewed By Approved Date
Sgt. Steven Mansel YES 12/30/2023

IMO

Officer ID

JAMES, JOHN 569

Printed By/On: 461 / 01/24/2024 10:23:45

CrimeStar® Law Enforcement Records Management System
Licensed to: FORREST CITY AR POLICE DEPARTMENT


summary: A resident was sent to Forrest City Medical Center for assessment after complaining of right hand pain and swelling.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 019715
Date of Incident: 12/27/2023
Date Received: 12/28/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident came to the nurses? station due to right hand pain and swelling.
Source of injury was not specified. Staff was seen by APRN and sent to the Forrest City Medical
Center. After assessment and x-ray was diagnosed with Linear lucency through the ulnar
aspect of the epiphysis of the proximal phalanx of the thumb with tenderness possibly an artifactual
fracture. After care at the hospital sent back to the facility for continuance of care.
Interim Action Narrative: Resident assessed by APRN and sent to FCMC for further evaluation.
Maltreatment Narrative:
Licensing Narrative: Provider reported incident sent to licensing via email on 12/28/2023 but
not entered into ELS by facility. Program Coordinator entered provider reported incident into ELS
for documentation purposes.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for assessment after complaining of stomach pain and no bowel movements.

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: 019717
Date of Incident: 12/27/2023
Date Received: 12/28/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident complained of stomach pain and expressed to nurse that he was not
having bowel movements for the past week. Staff was seen by APRN and sent to the Forrest City
Medical Center. After assessment he was given a fleet enema for the hospital and diagnosed with
child constipation. He was sent back to the facility for continuance of care.
Interim Action Narrative: Resident assessed by APRN and sent to FCMC for further evaluation.
Maltreatment Narrative:
Licensing Narrative: Provider reported incident sent to licensing on 12/28/2024 but was not
entered into ELS by the facility. Program Coordinator entered provider reported incident into ELS
for documentation purposes.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for assessment after complaining of pain from punching a wall.

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: 019718
Date of Incident: 12/28/2023
Date Received: 12/28/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident complained of pain in his right hand after punching a wall. Staff was
seen by APRN and sent to the Forrest City Medical Center. After assessment and x-ray it is a
Boxer?s fracture to the right hand. Resident sent back to the facility for continuance of care after
hand was cared for at hospital.
Interim Action Narrative: Resident was assessed by APRN and sent to FCMC for further
evaluation.
Maltreatment Narrative:
Licensing Narrative: Provider reported incident sent to licensing via email on 12/28/2023 but
not entered into ELS. Program Coordinator entered provider reported incident into ELS for
documentation purposes.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for assessment after complaining of left wrist pain.

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: 12/13/2023
Date Received by DCCECE: 12/14/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Serious injury requiring outside medical attention Residents
Name/DOB: Date/Time of incident: 12/13/23-16:24
Please give a description of the incident: Resident complained of pain in his left wrist/hand.
Source or injury or pain was not disclosed by resident after being prompted and asked by
staff. Corrective Actions Taken: Staff was seen by APRN and sent to the Forrest City
Medical Center. After assessment and X-Ray there was not any injury found only swelling
and redness observed sent back to the facility for continuance of care. Additional
Information: None currently. Guardian Notified:
Interim Action Narrative: Resident was assessed by the APRN and referred to FCMC.
:
Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident eloped from the facility after he was involved in a physical altercation with a peer. Upon being returned by police, the resident fainted and was transported to Forrest City Medical Center.

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: 12/12/2023
Date Received by DCCECE: 12/13/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: AWOL/Elopement Serious injury requiring outside medical attention
Residents Name/DOB: Date/Time of incident:
12/12/23-12:53 Please give a description of the incident: Resident eloped from the facility
when a physical altercation between two other peers took place in the gym. Upon return by
the police, the resident faint and had to be held up to walk. Was transported to the ER for
assessment by paramedic ambulance. Corrective Actions Taken: Staff pursued resident by
foot until he made it over the fence and into the woods. The police were called @13:00
resident was returned to the facility by 13:22. The resident was examined by the medical
staff at Forrest City Medical Center and it was found that resident had acute bronchitis
prescribed Tylenol as needed and sent back to the facility for continued treatment. Resident
placed on Elopement Precautions and Unit Restriction. Additional Information: None
currently. Guardian Notified:
Interim Action Narrative: Staff pursued by resident by foot. The police were called. Resident
was assessed by the nurse and transported to the ER by the paramedics. Resident placed on
elopement precautions and unit restriction.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing Specialist reviewed provider reported incident for licensing
concerns. 12/18/2023, Program Coordinator inquired if a police report was filed. Program
Coordinator informed the police returned the resident to the facility but did not mention if a
police report was filed.


summary: Officers were dispatched in response to a report that a resident jumped the fence and ran away from the facility.

raw_content:
CES - Unit R@sponse Times Printed on January 5, 2024

CFS # CFS2352822
Call Taker ALLISON LAWS
Location 1521 ALBERT ST, FORREST CITY, AR 72335 (WOODRIDGE BEHAVIORAL CENTER)

Location Details
Primary Incident Code RUNAWAY : Runaway

Mod Report Needed

Priority 1

Use Caution No

Primary Disposition Handled By Officer / Deputy

Beat ‘

Zone Forrest City Police Department

Call Time 12/12/23 13:03:31

Completed Time 12/12/23 13:40:08
Reporters

AMBER (Initial Reporter)

Sex

DOB

Address

Report Time | 12/12/23 13:03:31
How Reported

From Phone
Contact Phone
Comments

Other Names

Vehicles

Responders
CALL1 FCFD
CALL2 FCFED
FCMARSHALL (Primary) FD2 - Sharp, Jeremy FCFD
511 511 - MANSEL, STEVEN FCPD (Primary)
519 (Primary) 513 - KEYS, PHILLIP FCPD (Primary)

Response Times
Assigned ipa 13:04:01 * — - a

Enroute /12/23 13:04:01
Arrived /12/23 13:05:32
Leaving = 1/2/12/23 13:21:22
Arrived At

Completed 1/2/12/23 13:40:08

FCFD 202301776

iR/ 202504 Agency Numbers
FCPD202312578

Officer Addenda

Page 1 of 2

Unit Response Times

Non Unit Specific Times

12/12/23 oe | New CFS

12/12/23 13:05]29 | 513 IN THE PERIMETER

12/12/23 13:07124 | CALLER ADVISED THAT THEY HAVE ONE THAT HAS JUMPED THE FENCE AND IS
RUNNING LOQGSE IN THE COMMUNITY

12/12/23 13:13}23 | ADVISED TO ASK FD FOR THE DRONE

12/12/23 13:14150 | ADVISED MR ZACKARY JUMPER AND HE ADVISED 10-4 TO PUT HIM OUT THERE
12/12/23 13:15|20 | SUBJECT WILL BE WEARING ALL RED WITH A RED/BLK AND JACKET

12/12/23 13:16}21 | ENTRY REVISED - SUBJECT WILL BE WEARING ALL RED/BLK AND RED JACKET
12/12/23 13:16}35 | ENTRY REVISED - SUBJECT WILL BE WEARING ALL RED WITH A RED/BLK AND RED
JACKET
12/12/23 13:19159 | 511 ADVISED SUBJECT IS IN CUSTODY

12/12/23 13:20t35 | SCENIC AND SPRINGWAY

12/12/23 13:21f15 | 511 ADVISED TO CALL EMS ,

12/12/23 13:21:27 | 23443 BEGINNING MILAGE

12/12/23 13:22:01 | ENDING MILAGE IS SAME AS BEGINNING

12/12/23 13:22:50 | 511 ADVISED THAT THE JUVENILE ADVISED HE WAS JUMPED BY A GROUP OF OTHER
JUVENILES AND WAS HIT IN THE HEAD

12/12/23 13:23:04 | WILL BE BACK ON ALBERT ST

12/12/23 13:31:57 | 513 ADVISED EMS IS 97

510, 511, 513
12/12/23 13:40:00 | Enroute

511
12/12/23 13:34:16 | On Scene

513

12/12/23 13:04:01 | Enroute
12/12/23 13:05:32 | On Scene
12/12/23 13:13:40 | Clear Alarms

CALL1
12/12/23 13:18:09 | Assign

CALL1, FCMARSHALL
12/12/23 aa | Complete

:11 | Assign
:20 | Assign
:31 | Assign

L

12/12/23 13:14:04 | Enroute
12/12/23 13:21:11 | On Scene
12/12/23 13:21:22 | Leaving Scene
12/12/23 13:26:54 | Clear Alarms

Page 2 of 2

SFS - Command Log Printed on January 5, 2024

CFS #
Call Taker
Location
Location Details

Primary Incident Code RUNAWAY : Runaway

Mod
Priority
Use Caution

CFS2352822
ALLISON LAWS
1521 ALBERT ST, FORREST CITY, AR 72335 (WOODRIDGE BEHAVIORAL CENTER)

Report Needed
uh
No

Primary Disposition | Handled By Officer / Deputy

Beat
Zone
Call Time

Forrest City Police Department
12/12/23 13:03:31

Completed Time 12/12/23 13:40:08

Reporters

AMBER (Initial Reporter)

Sex

DOB
Address
Report Time

How Reported

From Phone

12/12/23 13:03:31

Contact Phone

Comments

Other Names

Vehicles

Responders

CALL1
CALL2

FCFD
FCFD

FCMARSHALL (Primary) FD2 - Sharp, Jeremy FCFD

511

511 - MANSEL, STEVEN FCPD (Primary)

519 (Primary) 513 - KEYS, PHILLIP FCPD (Primary)

Response mes
Assigned 12/12/23 13:04:01 *

Enroute
Arrived
Leaving
Arrived At

12/23 13:04:01
/12/23 13:05:32
12/23 13:21:22

Completed 1/2/12/23 13:40:08

FCFD 20230

776

IR/ 202504 Agency Numbers

FCPD20231

578

Officer Addenda

ee

Page 1 of 2

12/12/23 13:03:81 | LAWS, ALLISON | New CFS

12/12/23 13:04:01 | LAWS, ALLISON | 513 | Enroute

12/12/23 13:05:29 | BAILEY, ALENA | 513 IN THE PERIMETER

12/12/23 13:05:82 | LAWS, ALLISON | 513 | On Scene

12/12/23 UNNI | BAILEY, ALENA | CALLER ADVISED THAT THEY HAVE ONE THAT HAS JUMPED THE FENCE

Command 3) Filter: All Commands | Details: Hidden | Units: All Units | Revised Entries: Shown

AND IS RUNNING LOOSE IN THE COMMUNITY

12/12/23 13:13:09 | BAILEY, ALENA | CALL1 | Assign

12/12/23 13:13123 | BAILEY, ALENA | ADVISED TO ASK FD FOR THE DRONE

12/12/23 13:13140 | BAILEY, ALENA | 513 | Clear Alarms

12/12/23 13:14}04 | Sharp, Jeremy | FCMARSHALL | Enroute

12/12/23 13:14150 | BAILEY, ALENA | ADVISED MR ZACKARY JUMPER AND HE ADVISED 10-4 TO PUT HIM OUT
THERE

12/12/23 13:15120 | BAILEY, ALENA | SUBJECT WILL BE WEARING ALL RED WITH A RED/BLK AND JACKET
12/12/23 13:16|21 | BAILEY, ALENA | ENTRY REVISED - SUBJECT WILL BE WEARING ALL RED/BLK AND RED
JACKET
12/12/23 13:16135 | BAILEY, ALENA | ENTRY REVISED - SUBJECT WILL BE WEARING ALL RED WITHA
RED/BLK AND/RED JACKET

12/12/23 13:19:59 | BAILEY, ALENA | 511 ADVISED SUBJECT IS INCUSTODY

12/12/23 13:20:35 | BAILEY, ALENA | SCENIC AND SPRINGWAY

12/12/23 13:21}:11 | Sharp, Jeremy | FCMARSHALL | On Scene

12/12/23 13:21/:15 | BAILEY, ALENA | 511 ADVISED TO CALL EMS ,

12/12/23 13:21|:22 | Sharp, Jeremy | FCMARSHALL | Leaving Scene

12/12/23 13:21|:27 | BAILEY, ALENA | 23443 BEGINNING MILAGE

12/12/23 13:24:01 | BAILEY, ALENA | ENDING MILAGE IS SAME AS BEGINNING

12/12/23 13:24:50 | BAILEY, ALENA | 511 ADVISED THAT THE JUVENILE ADVISED HE WAS JUMPED BY A
GROUP OF OJTHER JUVENILES AND WAS HIT IN THE HEAD

12/12/23 13:29:04 | BAILEY, ALENA | WILL BE BACK ON ALBERT ST

12/12/23 13:26:54 | BAILEY, ALENA | FCMARSHALL | Clear Alarms

12/12/23 13:31:57 | BAILEY, ALENA | 513 ADVISED EMS IS 97

12/12/23 13:32:16 | BAILEY, ALENA | 511 | On Scene

12/12/23 13:39:11 | MCCLINTOCK, VICTORIA | CALL2 | Assign

12/12/23 13:39:20 | MCCLINTOCK, VICTORIA | CALL2 | Assign

12/12/23 13:39:31 | MCCLINTOCK, VICTORIA | CALL2 | Assign

12/12/23 13:40:00 | MCCLINTOCK, VICTORIA | 510, 511, 513 | Enroute

12/12/23 13:40:08 | BAILEY, ALENA | CALL1, FCMARSHALL | Complete

CLQ

Requested At
Sent To
Status
Received At
Location ‘
Accuracy

an (Seen ee
Page 2 of 2

FORREST CITY Call For Service
POLICE DERARTMENT Event Detail Page
225 N. ROSSER ST.

Print Date
FORREST CITY, AR| 72335 = 2312120005 01/05/2024

Date 42/12/2023 Time 43:30:21 |DisratcherD4gq [Agency CPD |Souce |
LN I in NE 1

Address
Location 4524 ALBERT

City FORREST CITY County ST FRA
REPORTING PARTY INFORMATION

Phone 870 Requests Contact N
RESPONSE INFORMATION
Officer ID Officer ID

Clear Tim Clear Time
CALL DETAILS
CRIMINAL MISCHIEF

State AR

Total Consumed
Minutes of all
associated Units :

0

Call For Service / Event

Call Type 14

Description :
HAD A JUVEN
Disposition OR OFFENSE REPORT EMD Code

Comments

ILE JUMP THE FENCE

Printed By/On: 412 / 01/05/2024 11:24:16

CrimeStar® Law Enforcement Ri ls Management System
Licensed to; FORREST CITY AR| POLICE DEPARTMENT

FORREST CITY
POLICE DEPARTMENT

225 N. ROSSER ST.
R. 72335

FORREST CITY,
Crime / Incident (Prima
00-00-07 JUVENILE

Location of Incident 1421 ALBERT ST, FORREST CITY, AR

RUNAWAY

, Secondary, Tertiary)

Cross Street 1427 ALBERT

Dispo '"V" = Vict

im
Last, First, Middle} (Firm if Business)

Address

“RP" = Reporting Party

1521 ALBERT ST

City, State, Zip Code
FORREST ©

TY AR 72335

Last, First, Middle (Firm if Business)

WILLIAMS,

CLIFF

"W" = Witness

City, State, Zip Code

FORREST CITY AR 72335

Hee mcs te bl eel cal ine hail Rcd are cenit

Address

City, State, Zip Code

Last, First, Middlg

Address

City, State, Zip Code

Synopsis

<4d-r-or<row

Officer ID

CrimeStar® Law Enforceme:

(Firm if Business)

KEYS, PHILLIP

jt Records Management System

Printed By/On: w norco 11:24:30

Licensed to: FORREST CI

AR POLICE DEPARTMENT

222222222222

565

Page 1

Incident

Incident #
2312120005
Beat Rpt Dist] Ti
— Outside Agency Assist et a |

Attempt[ Occurred | _Date__| Time _| Day _|
CI
CI
C]

County
ST FRA

Age HT WT Hair Eyes | Home Phone
Mw Low |e] | ano fait [ero |
DOB DL Number State Work Phone
Local ID # State # FBI # Cell Phone
i —— ee a en
Race Age HT Hair Eyes | Home Phone
fw | | | fate [aro |r |
AR _ | (870)
Soe eS eS
|

"S$" = Suspect

5

5

ns -
DOB DL Number

hy Work Phone
Local ID # State # Pua | Cell Phone

Continuation
Attached

UCR 29

CL] Property Damage$ $0.00
CADICFS Event # 2312120005

Assigned To Date

Approved Date
12/17/2023

Gang Related N

Pursuit

Solvability
Points

Revie

Sgt. Steven Mansel

FORREST CITY

POLICE D

Crime / Incident (Prima

On December
Health in re
Williams, wh

fence.
come back.

and black ja
bright red a
gathering mo
Street.
injuries.

went over th
Treatment.

Officer ID

CrimeStar® Law Enforcement R

Licensed to: FORREST CITY AR

KEYS, PHILLIP

Printed By/On: 412 / 01/05/2024

Page 2 Incident Cont'd
PARTMENT Narrative

)

00-00-07 JUVENILE RUNAWAY 1

Attempt | Type Seq
LC Outside Agency Assist

2, 2023, I Officer Keys was dispatched to Perimeter Behavioral

erence to a Runaway Juvenile. Upon my arrival I spoke with Cliff
is the Director of this Health Unit. Williams stated

i

fe)

escaped from the building through a hole he made under the safety
eee states he gave chase but could not convince | to stop and

is a 17-year-old white male,
¢ket with some black sweats.

last seen wearing a red
Williams states the jacket is a really
nd you will not miss him. While I was at the main building

e information on | Sgt.Mansel found him on Spring way

was brought back to The Health Unit, and EMS was called for his
has scratches and scrapes to his arms and wrists where he
fence. was transported to Forrest City Medical Center for

Reviewed By
Sgt. Steven Mansel

AMATO

ae
YES

Date
12/17/2023
11:24:30

ecords Management System
POLICE DEPARTMENT


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

raw_content:
521 Visit Compliance Report

Licensee: Perimeter Behavioral of Forrest City

Facility Number: 142

Licensee Address: 603 KITTLE ROAD
FORREST CITY AR 72335

Licensing Specialist: Kendra Rice
Person In Charge: Charlotte Lockhart
Record Visit Date: 12/12/2023

Home Visit Date: 12/12/2023

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: 10:30 am to 11:30 am

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

ARKABMBA SE
DEPARTMENT OF

s7 HUMAN
S a" SERVICES
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437

P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550

Page 1 of 3

Census: 56

Licensing Specialist completed buildings and grounds. The following areas were observed: administration
hall, grounds, education hall, dining room, dayrooms, bathrooms, laundry room, bedrooms, quiet rooms, gym,
and nurse’s station.

Walking into the administration building, Licensing Specialist observed parked cars and the grounds were
maintained. Licensing Specialist was escorted by Mr. Antione Jackson, Clinical Director. Licensing Specialist
observed a Christmas tree and other holiday decorations in the lobby.

The courtyard was clear of safety hazards. Licensing Specialist observed balls lined up on the wall of the
building. Licensing Specialist observed a staff member and resident (ratio 1:1) walking across the courtyard.
The area between the gym and courtyard was free of debris.

Licensing Specialist observed holiday decorations on each hall (100, 200, 300, and 400). Residents had their
holiday art on the walls. Licensing Specialist observed the schedule of holiday activities on each hall. All
bedrooms and bathrooms were organized, and furnishings were in good repair. Licensing Specialist observed
housekeeping on the 100 Hall.

Maintenance was in the laundry room cleaning paint out of the sink. Licensing Specialist observed a wet paint
sign on the door frame. No residents were present on the hall. Licensing Specialist observed the educational
hall, the ratio was 2:1. The other residents were in their classrooms.

Licensing Specialist reviewed the MAR’s on the residents listed below:

All initialed and up to date.
Licensing Specialist was provided a copy of the scheduled activities for the residents.

Provider Comments:

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

CCL Staff Signature :

Provider Signature :

Chuletiy prttoad (@

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

Date: 12/12/2023

Date: 12/12/2023

Page 3 of 3

doc_type: Compliance Report


summary: Officers were dispatched to the facility for a battery report.

raw_content:
FORREST CITY Call For Service
POLICE DEPARTMENT Event Detail Page
225 N. ROSSER ST aR Print Date

FORREST CITY, AR. 72335 2312110006 01/05/2024

CA NR

Address

Location 4624 ALBERT
DRREST CITY

County ST FRA
REPORTING PARTY INFORMATION

row apo
RESPONSE INFORMATION
Cr

State AR

Total Consumed
Minutes of all
associated Units :

0

Call For Service / Event

CALL DETAILS
CallType 08 THEFT Priority O
Disposition ¢ CALL CLEARED EMD Code

Comments

Printed By/On: 412 / 01/05/2024 [11:24:41
CrimeStar® Law Enforcement aon Management System
Licensed to: FORREST CITY AR POLICE DEPARTMENT

FORREST CITY Pee 1 Incident
POLICE DEPARTMENT

225 N. ROSSER ST.
FORREST CITY,
Crime / Incident (Prima
5-13-203 BATTER

Incident #

2312110006

Beat Rpt Dist] Type
at 1 ” Criminal Report

, Secondary, Tertiary)

OO

[On or Fron] 12/11/2023 | 16:21 |
| 16:21 |

[_] [Reported [72/11/2023 | 16:21 | Mon_|

Location of Incident 75

County
ST FRA

| Disco V= Viol "RP" = Reporting Party "W" = Witness "“S" = Suspect "O" = Other
(Firm if Business) Race Age HT Hair Eyes | Home Phone
V | MURPHY, LADARUIS ie | om | “a7 6-03 BLK |BRO i
Address DL Number

Work Phone
learn cola .

City, State, Zip Code Local ID #
FORREST CITY AR 72335
Last, First, Middlg (Firm if Business) Ra Age HT Hair Eyes | Home Phone
B 14 BLK |BRO | (870)
Address DO! DL Number State | Work Phone
AR_ | (870)
=
City, State, Zip Code SSN Local ID # State # FBI # ell Phone
TEXARKANA AR 71854 0
= mi ss = i ee er | wich
Es ee | “i a el el el Be Be Be i
Address DL Number Work Phone
City, State, Zip Code Local ID # Cell Phone

8

Lvs)

ao

5

Synopsis

Continuation PropertyList
Attached  L_ | attached  L_]| ProvertyDamage$ $0.00

Press Domestic Violence
UCR
04D Release LJ Case

Gang Related N Hate Crime LC] Victim Senior Citizen CI
Pursuit [_] | ForceUsed [~ ] Child Abuse [|
Solvabili . as
pala 0} Count’ STFRA| Disposition OR
Connecting Case #
Report Complete/Ready for Review [x] CADI/CFS Event # 2312110006

<H-r-wr<r on

222222222222

Assigned To a C«CO atte: 12/11/2023

Offi Reviewed By Approved Date
icerID JAMES, JOHN 569 Sgt. Steven Mansel 12/12/2023

Printed By/On: 412 / 01/05/2024 11:24:47
CrimeStar® Law Enforcement Records Management System
Licensed to: FORREST CITY AR POLICE DEPARTMENT

FORREST GITY Page 2 Incident cont'a
POLICE DEPARTMENT Narrative Incident 2312110006
Crime / Incident (Primary) Attempt | Type Seq

On 12/11/2023, I Officer James was dispatched to 1521 Albert St for a battery
report. Upon jarrival I met Ladarius Murphy who stated he was one of the group
home teachers. Mr. Murphy stated that one of the other teachers took resident
END sittin utensils in the classroom because he wasn't supposed to
have that kind of utensils in his possession. HE started to get violent with
Mr. Murphy while he was trying to take him to his room. Mr. Murphy stated that

was trying to bite him, and (J used his left fist to punch Murphy in
the left cheek. Murphy stated that he didn't have any injuries at the time.

Murphy also was notified if he wanted to press charges to come to the Police
department.

Reviewed By Approved Date
Officer ID JAMES, JOHN 569 Sgt. Steven Mansel 12/12/2023
cna cnr WN

19:24:47
CrimeStar® Law Enforcement Records Management System
Licensed to: FORREST CITY AR POLICE DEPARTMENT


summary: Officers were dispatched to the facility in response to a report that a resident was attacked by another resident.

raw_content:
sponse Times

Printed on January 5, 2024

CFS # CFS2352722
Call Taker ALENA BAILEY
Location 1521 ALBERT ST, FORREST CITY, AR 72335 (WOODRIDGE BEHAVIORAL CENTER)

Location Details
Primary Incident Code DISTURBANCE : Disturbance

Mod Report Needed

Priority 2

Use Caution No

Primary Disposition Handled By Officer / Deputy

Beat

Zone Forrest City Police Department

Call Time 12/11/23 16:00:31

Completed Time 12/11/23 16:29:31
Reporters

WILLIAMS, CHRIS (Initial Reporter)

Sex

DOB

Address

Report Time | 12/11/23 16:00:31

How Reported

From Phone

Contact Phone (870) 970-3478

Comments

Other Names

Vehicles

Responders'
511 511 - MANSEL, STEVEN FCPD (Primary)
513 (Primary) 512 - FRYER, TAMIKA FCPD (Primary)

Response Tjmes

Assigned 1~/11/23 16:02:45 *
Enroute 12/11/23 16:02:45
Arrived 12/11/23 16:09:39
Leaving
Arrived At
Completed 1/2/11/23 16:29:31

IR/ External Agency Numbers
Officer Addenda
Unit Response Times

Non Unit Specific Times
12/11/23 16:90:31 | New CFS
12/11/23 16:92:38 | CALLER ADVISED THAT ONE OF THE RESIDENTS ATTACKED ANOTHER ONE AND THEY

Page 1 of 2

WOULD LIKE TO DO A REPORT
12/11/23 16:35:54 | 10-19 TO 1803 LINDAUER

511
12/11/23 iezaF | Clear Alarms

12/11/23 16:35:58 | Enroute

12/11/23 16:39:48 | On Scene

12/11/23 16:39:53 | Complete

511,512
12/11/23 16:09:39 | On Scene
12/11/23 16:29131 | Complete

512

12/11/23 cones | Enroute
12/11/23 16:20}42 | Clear Alarms

Page 2 of 2

oO
ep)

oF

CFS#
Call Taker
Location
Location Detai
Primary Incide
Mod
Priority

Use Caution

Primary Disposition

Beat
Zone
Call Time

Completed Time

Reporters

- Comme

nd Log

Printed on January 5, 2024

CFS2352722
ALENA BAILEY

1521 ALBERT ST, FORREST CITY, AR 72335 (WOODRIDGE BEHAVIORAL CENTER)

Is

i Code DISTURBANCE : Disturbance
Report Needed

2

No

Handled By Officer / Deputy

Forrest City Police Department
12/11/23 16:00:31
12/11/23 16:29:31

WILLIAMS, CHRIS (Initial Reporter)

Sex

DOB
Address
Report Time
How Reported
From Phone

12/11/23 16:00:31

Contact Phone (870) 970-3478

Comments

Other Names

Vehicles

Responders

511
513 (Primary)

511 - MANSEL, STEVEN
512 - FRYER, TAMIKA

FCPD (Primary)
FCPD (Primary)

Response Times
Assigned 12/11/23 16:02:45 *

Enroute
Arrived
Leaving
Arrived At

12/11/23 16:02:45
12/11/23 16:09:39

Completed 12/11/23 16:29:31

IR/ External Agency Numbers

Officer Addenda

Command Lo:

12/11/23 16:
12/11/23 16:

ONE AND THE

0:
2

g Filter: All Commands | Details: Hidden | Units: All Units | Revised Entries: Shown
31 | BAILEY, ALENA | New CFS

38 | BAILEY, ALENA | CALLER ADVISED THAT ONE OF THE RESIDENTS ATTACKED ANOTHER
Y WOULD LIKE TO DO A REPORT

a

Page 1 of 2

12/11/23 16:09:39 | BAILEY, ALENA | 511, 512 | On Scene
12/11/23 16:20:42 | BAILEY, ALENA | 512 | Clear Alarms
12/11/23 16:22:58 | BAILEY, ALENA | 511 | Clear Alarms
12/11/23 16:29:81 | LAWS, ALLISON | 511, 512 | Complete
12/11/23 16:35:54 | LAWS, ALLISON | 10-19 TO 1803 LINDAUER
12/11/23 16:35:58 | LAWS, ALLISON | 511 | Enroute

12/11/23 16:39:48 | LAWS, ALLISON | 511 | On Scene

12/11/23 16:39:53 | LAWS, ALLISON | 511 | Complete

12/11/23 i608 | BAILEY, ALENA | 512 | Enroute

CLQ

Requested At
Sent To
Status
Received At
Location \
Accuracy

eee ES
Page 2 of 2


summary: A resident was left unattended for several minutes. The facility was cited 907.2 for the incident.

raw_content:
Division of Childcare & 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
Case Number: 017994
Date of Incident: 12/9/2023
Date Received by DCCECE: 12/11/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Residents Name/DOB: State: Ohio Date/Time
of incident: 12/9/23-15:15 Please give a description of the incident: Resident was left in
room unattended for several minutes. Incident reported by MHT Program Manager
Corrective Actions Taken: was examined by the nurse and the incident was
but not accepted. Staff were sent home pending further investigation and information. The
incident confirmed by staff locating from area that he was left unattended on the 100
Hall. Additional Information: None currently. Guardian Notified:
Interim Action Narrative: Resident was assessed by the nurse, was called, and staff
was sent home pending investigation.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed provider reported incident for licensing
concerns. Licensing Specialist will inquire about camera footage, 12/12/2023, Program
Coordinator visited the facility and was informed there is no camera footage. 12/13/2023,
Program Coordinator received CAA for staff members involved.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident reported that he was punched in the face by his roommate and slapped in the face and hit in the back by staff members. The complaint was UNFOUNDED by Licensing.

raw_content:
Division of Childcare & 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
Case Number: 017993
Date of Incident: 12/9/2023
Date Received by DCCECE: 12/11/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Dual
Report Description: Allegation of sexual/physical abuse Residents Name/DOB:
State: Arkansas Date/Time of incident: 12/9/23-21:30 Please give a
description of the incident: Resident made allegation of abuse against room mate and two
staff members that he was punched in the face by roommate, slapped in the face and hit in
the back by staff. Nurse observed a bruise under eye and swelling. Corrective
Actions Taken: First Aide performed on Staff processed incident with and
was checked and examined by Nurse. APRN was notified and outside medical was
not needed. Staff were suspended pending investigation. was moved away from his
room for that night to avoid further incident with roommate. Allegation of abuse was
and submitted by nurse. Incident reviewed by Safety team and camera was attempted
to be reviewed there was not any camera footage that was found.
came today and interviewed and started their investigation as well.
Additional Information: None currently. Guardian Notified:
Interim Action Narrative: Resident was assessed by the nurse, moved away from his
roommate, and was called.
Maltreatment Narrative: AV is . AO?s are and
, employees at Perimeter Behavioral. PRFC is The AV,
was being unruly tonight. They tried to get him in bed multiple times, and he would
not. The nurse gave him medication to try to help him calm down. The AV was on the side
of his bed, it is cata-cornered. They were trying to get him in the bed, but he kept horse-
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

playing. He wouldn?t get out of the corner; they went to get him out. The AV stated
slapped him in the face, punched him in the back, and the AVs roommate
punched him in the face, leaving a bruise under the AVs left eye.
AV stated it hurt as he screamed and yelled. doesn?t have a discharge date at this
time.
Licensing Narrative: Licensing Specialist reviewed complaint for licensing concerns.
Licensing Specialist will inquire about referral number, investigator, and witness
statements. 12/12/2023, Licensing Specialist visited the facility and received witness
statements. 12/18/2023, Program Coordinator requested permission to contact the facility.
Program Coordinator received permission to contact the facility. 1/10/2024, Program
Coordinator contacted investigator for an update. 1/11/2024, investigator reported case will
be closed unsubstantiated and he is waiting for final approval. Program Coordinator
requested for investigator to informed when approval was finalized. 1/18/2024, investigator
informed Program Coordinator case found unsubstantiated. Program Coordinator spoke
with Program Administrator and Program Manager regarding this case. CEO contacted
Program Coordinator regarding findings. Staff members involved will be retrained in verbal
de-escalation. Program Coordinator requested documentation once training has been
completed. 1/22/2024, training documentation received.


summary: A resident reported that a staff member threw a walkie talkie at him and hit his face after throwing a pen at him. Two lacerations were observed on the resident’s face. The facility was cited 109.1.g and 905.4.g as a result of this incident. The complaint was FOUNDED by Licensing.

raw_content:
Division of Childcare & 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
Case Number: 017992
Date of Incident: 12/8/2023
Date Received by DCCECE: 12/11/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Dual
Report Description: Allegation of sexual/physical abuse Residents Name/DOB:
State: Arkansas Date/Time of incident: 12/8/23-15:30 Please give a
description of the incident: Resident reported to staff that staff member threw a walkie
talkie at him and hit his face after he threw a pen at him. Two lacerations to his face were
observed by the nurse. Corrective Actions Taken: First Aide performed on Staff
processed incident with and was checked and examined by Nurse. APRN
was notified and outside medical was not needed. Staff were suspended pending
investigation. Allegation of abuse was and accepted by nurse. Incident reviewed
by Safety team and camera was attempted to be reviewed there was not any camera footage
that was found. came today and interviewed
and started their investigation as well. Additional Information: None currently. Guardian
Notified: Qunicy Smith DFCS Worker
Interim Action Narrative: Resident was assessed by the nurse and staff member was
suspended.
Maltreatment Narrative: Resident reported to staff that staff member threw a walkie talkie
at him and hit his face after he threw a pen at him. Two lacerations to his face were
observed by the nurse.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing Specialist reviewed complaint for licensing concerns.
Facility reported no camera footage. Licensing Specialist will inquire about referral number,
investigator, and witness statements. 12/12/2023, Licensing Specialist visited the facility
and received witness statements. 12/14/2023, Program Coordinator requested
documentation for staff member involved. 12/18/2023, Program Coordinator requested
permission to contact the facility. Program Coordinator received permission to contact the
facility. 1/16/2024, Program Coordinator contacted investigator for an update. Investigator
reported case found substantiated.


summary: A resident was sent to Forrest City Medical Center for assessment after complaining of chest pain.

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: 12/7/2023
Date Received by DCCECE: 12/8/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Serious injury requiring outside medical attention Residents
Name/DOB: Date/Time of incident: 12/7/23-
09:20 Please give a description of the incident: Resident was brought to the Nurses station
and complained of chest pain. Corrective Actions Taken: Nurse consulted with APRN who
advised that resident be sent to the Forrest City Medical Center for evaluation. Resident
diagnosed with sent back to the facility for
continuance of care and Tylenol as needed. Additional Information: None currently.
Guardian Notified:
Interim Action Narrative: Resident was assessed by the nurse and evaluated at FCMC.
:
Licensing Narrative: Licensing Specialist informed of provider reported incident via email.
12/11/2023, Licensing Specialist reviewed provider reported incident for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for assessment after hurting his ankle during gym time.

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: 12/5/2023
Date Received by DCCECE: 12/6/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Serious injury requiring outside medical attention Residents
Name/DOB: Date/Time of incident: 12/5/23-18:00
Please give a description of the incident: Resident complained of pain to left ankle after
hurting his ankle during gym time and play Corrective Actions Taken: Nurse consulted with
APRN who advised that resident be sent to the Forrest City Medical Center for evaluation.
Resident diagnosed with east to read and RICE therapy recommended for
continued care back at the facility. Additional Information: None currently. Guardian
Notified:
Interim Action Narrative: Resident was assessed and sent to FCMC for an evaluation.
:
Licensing Narrative: Licensing Specialist was informed of provider reported incident via
email. 12/7/2023, Licensing Specialist reviewed provider reported incident for licensing
concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for assessment 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: 12/2/2023
Date Received by DCCECE: 12/6/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Serious injury requiring outside medical attention Residents
Name/DOB: Date/Time of incident: 12/2/23-
10:55 Please give a description of the incident: Resident complained of not being able to
breathe properly and did not know why. Corrective Actions Taken: Nurse consulted with
APRN who advised that resident be sent to the Forrest City Medical Center for evaluation.
Resident diagnosed with cause not known sent back to facility for
continuance of care. No follow-up recommended unless conditions worsens or does not get
better. Additional Information: None currently. Guardian Notified: Guardian
Interim Action Narrative: Resident was assessed by the nurse and sent to FCMC for an
evaluation.
:
Licensing Narrative: Licensing Specialist was informed of provider reported incident via
email. 12/7/2023, Licensing Specialist reviewed provider reported incident for licensing
concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for assessment after complaining of continuing right arm pain.

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: 11/25/2023
Date Received by DCCECE:11/28/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Serious injury requiring outside medical attention Residents
Name/DOB: State: Colorado Date/Time of incident: 11/25/23-13:30
Please give a description of the incident: Resident complained of right arm pain and stated
his arm has been hurting for a few days. Resident did not disclose origin of pain or injury
when prompted multiple times by the nurse. Corrective Actions Taken: Nurse consulted
with APRN who advised that resident be sent to the Forrest City Medical Center for
evaluation. After X-Ray and medical evaluation no significant findings were observed.
Additional Information: None currently. Guardian Notified: Guardian
Interim Action Narrative: Resident was assessed by the nurse and referred to FCMC for an
evaluation.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist informed and reviewed provider reported incident
for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for assessment after complaining of pain 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: 11/25/2023
Date Received by DCCECE:11/28/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Serious injury requiring outside medical attention Residents
Name/DOB: State: Arkansas Date/Time of incident: 11/25/23-13:30
Please give a description of the incident: Resident was involved in a physical altercation
with another peer and complained of right-hand pain after altercation ended. Corrective
Actions Taken: Nurse consulted with APRN who advised that resident be sent to the
Forrest City Medical Center for evaluation. Swelling and redness were also observed.
Results of examination and X-Ray are minimally angulated suspected fracture. Sent back to
facility for continuance of care. Resident placed on assault precautions and activity
restrictions. Additional Information: None currently.
Interim Action Narrative: Resident was assessed by the nurse and referred to FCMC for an
evaluation. Resident was placed on assault precautions and activity restrictions.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist informed and reviewed provider reported incident
for licensing concerns. Licensing Specialist inquired about camera footage. 12/4/2023,
Licensing Specialist followed up with facility regarding camera footage. 12/5/2023,
Licensing Specialist spoke with the CEO regarding this incident. Licensing Specialist was
provided documentation regarding the resident's injury.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for assessment after injuring his wrist while playing with peers.

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: 11/24/2023
Date Received by DCCECE:11/28/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Serious injury requiring outside medical attention Residents
Name/DOB: State: Arkansas Date/Time of incident: 11/24/23-
18:30 Please give a description of the incident: Resident was playing with peers and came
down on his wrist/arm and was brought to the nurses station after injury and reports of
pain. Corrective Actions Taken: Nurse consulted with APRN who advised that resident be
sent to the Forrest City Medical Center for evaluation. Results of examination and X-Ray are
unspecified sprain to right wrist. Resident given pain medications and sent back to the
facility for continuance of care. Additional Information: None currently. Guardian Notified:
Mikayla Curtis DHS Worker
Interim Action Narrative: Resident was assessed by the nurse and referred to FCMC for an
evaluation.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist was informed and reviewed provider reported
incident for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Licensing spoke with the CEO about two incidents that occurred at the facility.

raw_content:
521 Visit Compliance Report

Licensee: Perimeter Behavioral of Forrest City

Facility Number: 142

Licensee Address: 603 KITTLE ROAD
FORREST CITY AR 72335

Licensing Specialist: Kendra Rice
Person In Charge: Charlotte Lockhart
Record Visit Date: 11/21/2023

Home Visit Date: 11/21/2023

Purpose of Visit: Monitor Visit

Regulations Out of Compliance:

Regulations Needing Technical Assistance:

Regulation Not Applicable:

Regulations Not Correctable:

Narrative:

Time of Visit: 10:00 am to 12:15 pm

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

ARKANSAS
) DEPARTMENT OF

> HUMAN
~=a' SERVICES
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437

P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550

Page 1 of 2

Census: 53
Licensing Specialist spoke with Ms. Charlotte Lockhart, CEO, regarding two incidents.

Licensing Specialist reviewed Incident Notification Reports for 10/14/2023 and 11/16/2023. Licensing
Specialist received a copy of the nursing assessment for both incidents.

10/14/2023, the doctor was notified of the incident and the resident was assessed/monitored by nursing staff.
Resident’s vitals were normal, and pain denied at that time.

11/16/2023, staff intervened and cut the zip tie from around the resident’s neck. Resident was assessed by
nursing and vitals were normal. Redness was observed around the resident’s neck area. No swelling, cuts,
abrasions, or bruising note by nursing. The resident was placed on self-harm precautions and line of sight
supervision. Resident reported that he was not trying to harm himself.

Licensing Specialist observed med pass on Station 1. Nurse Jennifer administered the medication for four
residents: JJ and Each resident was called one by one. Nurse Jennifer asked each resident their
name and date of birth. Once she verified their information, Nurse Jennifer popped the medication into a cup,
and poured a cup of water. Two of the residents Nurse Jennifer took their vitals (blood pressure) due to the
medication they are prescribed.

Nurse Jennifer gave each resident their cup of water, took the cup of medication, and she poured the pill into
the resident’s mouth. The resident then drank the water to swallow the pill. Nurse Jennifer checked each
resident’s mouth and under their tongue.

Provider Comments:

CCL Staff Signature : Date: 11/22/2023
|

4 Hi Wad

Provider Signature : Date: 11/22/2023

i ult

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


summary: A resident was sent to Forrest City Medical Center for assessment after complaints of elbow pain following a fight 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: 11/9/2023
Date Received by DCCECE: 12/8/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Serious injury requiring outside medical attention Residents
Name/DOB: Date/Time of incident: 11/9/23-
09:30 Please give a description of the incident: Resident came to the nurses station with
complaints of left elbow pain from fight with another resident. Resident was brough in to
talk to the safety team and placed on assault precautions for fighting with other resident.
Corrective Actions Taken: Nurse consulted with APRN who advised that resident be sent to
the Forrest City Medical Center for evaluation. Results of examination and X-Ray are no
acute findings recommended that resident take Tylenol as needed and sent back to the
facility for continuance of care by nurses. Additional Information: None currently. Guardian
Notified:
Interim Action Narrative: Resident was assessed by the nurse and evaluated at FCMC.
:
Licensing Narrative: Licensing Specialist informed via email and reviewed provider
reported incident for licensing concerns. 12/8/2023, Licensing Specialist reminded facility
to enter provider reported incident into ELS.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for assessment due to complaining of not being able to move his fingers after he punched a wall.

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: 019722
Date of Incident: 11/6/2023
Date Received: 11/7/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Resident came to the nurses station with complaints of not being able to
move his fingers after punching the wall from being angry after he asked to go to the quiet room for
a reason that he did not disclose with staff. Nurse consulted with APRN who advised that resident
be sent to the Forrest City Medical Center for evaluation. Results of examination and X-Ray are
fracture of hand because of self-harm. Resident placed of self-harm precaution and brought to the
Leadership Safety Team for support to investigate what was wrong. Resident who recently admitted
said that he is angry because he is in residential and does not want to be here. Resident given splint
pain medications and sent back to the facility for continuance of care.
Interim Action Narrative: Resident was assessed by the APRN and sent to FCMC for further
evaluation.
Maltreatment Narrative:
Licensing Narrative: Provider reported incident sent to licensing on 11/7/2023 but was not
entered into ELS. Program Coordinator entered provider reported incident into ELS for
documentation purposes.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for assessment after complaining of right ear pain and drainage.

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: 11/4/2023
Date Received by DCCECE:11/6/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Serious injury requiring outside medical attention Residents
Name/DOB: State: Date/Time of incident:
11/4/23-08:30 Please give a description of the incident: Resident was brought to the nursing
station after experience of right ear pain and drainage from the right ear. Corrective Actions
Taken: Resident was assessed and checked by nurse. Nurse consulted with APRN who
advised that resident be sent to the Forrest City Medical Center for evaluation. Results of
examination and X-Ray are Acute suppurative otitis media without spontaneous rupture of
are drum, right ear; other otitis externa, right ear; Prescribed with Amoxicillin and
Ciprofloxacin-dexamethasone and sent back to facility for continued monitoring and care of
nursing staff. Additional Information: None currently. Guardian Notified: Tanya Septkle
DHS Case Manager
Interim Action Narrative: Resident was assessed by the nurse. APRN referred resident to
FCMC for further evaluation.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist informed of provider reported incident.
11/7/2023, Licensing Specialist reviewed provider reported incident for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for assessment after injuring his wrist by falling at the skating rink.

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: 11/3/2023
Date Received by DCCECE:11/6/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Serious injury requiring outside medical attention Residents
Name/DOB: State: Arkansas Date/Time of incident: 11/3/23-
14:30 Please give a description of the incident: While on a High-Level Reward Outing, the
skating rink resident injured his left wrist in an accident when he fell as he was trying to
take his skates off. Corrective Actions Taken: Upon immediate arrival back from the outing,
resident was assessed and checked by nurse. Nurse consulted with APRN who advised that
resident be sent to the Forrest City Medical Center for evaluation at 18:40. Results of
examination and X-Ray are radical fracture of left wrist. Resident put in sling to immobilize
injury for healing; prescribed pediatric acetaminophen and Ibuprofen sent back to facility
for continuance of care by nursing staff. Additional Information: None currently. Guardian
Notified: Grandmother
Interim Action Narrative: Resident was assessed by the nurse. APRN referred resident to
FCMC for further evaluation.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist informed of provider reported incident.
11/7/2023, Licensing Specialist reviewed provider reported incident for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for assessment after injuring his hand during recreational activities.

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: 10/26/2023
Date Received by DCCECE: 10/27/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Serious injury requiring outside medical attention Residents
Name/DOB: State: South Dakota Date/Time of incident:
10/26/23-17:56 Please give a description of the incident: Resident injured right hand/fingers
and complained of pain and this injury took place during recreational activities. Corrective
Actions Taken: Resident was assessed and checked by nurse. Nurse consulted with APRN
who advised that resident be sent to the Forrest City Medical Center for evaluation. Results
of examination and X-Ray are contusion right hand, no findings per X-Ray sent back to
facility for continuance of care. Additional Information: None currently. Guardian Notified:
Father
Interim Action Narrative: Resident was assessed by the nurse and consulted with the
APRN. Resident was referred to FCMC for further evaluation.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed provider reported incident for licensing
concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for assessment after injuring his knee during recreational activities.

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: 10/26/2023
Date Received by DCCECE: 10/27/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Serious injury requiring outside medical attention Residents
Name/DOB: State: South Dakota Date/Time of incident:
10/26/23-18:01 Please give a description of the incident: Resident injured right knee and
complained of pain and this injury took place during recreational activities. Corrective
Actions Taken: Resident was assessed and checked by nurse. Nurse consulted with APRN
who advised that resident be sent to the Forrest City Medical Center for evaluation. Results
of examination and X-Ray are no significant findings or injury per examination and X-Ray
Additional Information: None currently. Guardian Notified: Tanya Septla DHS Case
Manager
Interim Action Narrative: Resident was assessed by the nurse. APRN advised for resident to
be evaluated at FCMC.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed provider reported incident for licensing
concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for assessment after injuring his right elbow.

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: 10/23/2023
Date Received by DCCECE: 10/25/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Serious injury requiring outside medical attention Residents
Name/DOB: State: Arkansas Date/Time of incident: 10/23/23-
17:58 Please give a description of the incident: Resident injured right elbow and complained
of pain and did not disclose what happened to the nurse or staff when prompted Corrective
Actions Taken: Resident was assessed and checked by nurse who observed the skin above
the eye broken that injury had taken place. Nurse consulted with APRN who advised that
be sent to the Forrest City Medical Center for evaluation. Results of examination and
X-Ray are right elbow pain, contusion, no acute fracture, or dislocation Additional
Information: None currently. Guardian Notified: Mother
Interim Action Narrative: Resident was assessed by the nurse and referred to FCMC for an
evaluation.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist was informed of provider reported incident via
email. 10/25/2023, Licensing Specialist informed facility that the provider reported incident
was not in ELS and to submit the incident. 10/26/2023, Licensing Specialist reviewed the
provider reported incident for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for assessment after a peer fell on his leg while playing in the gym.

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: 10/21/2023
Date Received by DCCECE: 10/23/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Serious injury requiring outside medical attention Residents
Name/DOB: State: Arkansas Date/Time of incident:
10/21/23/15:01 Please give a description of the incident: Resident came to Nurse station
with pain after playing with another peer in the gym and the peer fell on his leg. Corrective
Actions Taken: Resident was assessed and checked by nurse. The nurse consulted with
APRN who recommended that resident be sent to Forrest City Medical Center for
assessment and X-Ray. Results of X-Ray and assessment are
Additional Information:
Guardian Notified: Mother
Interim Action Narrative: Resident was assessed by the nurse and sent to FCMC for an
assessment/x-ray,
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed the provider reported incident for
licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for assessment after reporting swelling and pain from punching 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: 10/21/2023
Date Received by DCCECE: 10/23/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Serious injury requiring outside medical attention Residents
Name/DOB: State: Arkansas Date/Time of incident:
10/21/23/16:00 Please give a description of the incident: Resident came to Nurse station
with swelling and pain from punching the wall. Corrective Actions Taken: Resident was
assessed and checked by nurse. The nurse consulted with APRN who recommended that
resident be sent to Forrest City Medical Center for assessment and X-Ray. Results of X-Ray
and assessment are not findings or significant injury sent back to the facility for
continuance of care. Additional Information: Guardian Notified: Mother
Interim Action Narrative: Resident was assessed by the nurse and sent to FCMC for an
assessment/x-ray.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed provider reported incident for licensing
concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for assessment after complaining of shortness of breath.

raw_content:
AR KAN S A S&S
DEPARTMENT OF

+4 HUMAN
<a¥ SERVICES

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot $140, Little Rock, AR 72203-1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550

Notice of Serious Incident

Date of Incident: 10/20/2023

Date Received by DCCECE: 10/23/2023

Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing

Report Description: Serious injury requiring outside medical attention Residents
Name/DOB: Po State: Arkansas Date/Time of incident:
10/20/23/13:50 Please give a description of the incident: Resident was observed and
complained of shortness of breath. Corrective Actions Taken: Resident was assessed and
checked by nurse. The nurse consulted with APRN who recommended that resident be sent
to Forrest City Medical Center for assessment and X-Ray. Results of X-Ray and assessment

Additional Information:
Guardian Notified: HR Mother

Interim Action Narrative: Resident was assessed by the nurse and sent to FCMC for
assessment/x-ray.

Maltreatment Narrative:

Licensing Narrative: Licensing Specialist reviewed provider reported incident for licensing
concerns.

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


summary: A resident was sent to Forrest City Medical Center for assessment after complaints of chest pain.

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: 10/20/2023
Date Received by DCCECE: 10/23/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Serious injury requiring outside medical attention Residents
Name/DOB: State: Idaho Date/Time of incident: 10/20/23/13:13
Please give a description of the incident: Resident was observed coughing and wheezing
and complained of chest pain. Corrective Actions Taken: Resident was assessed and
checked by nurse. The nurse consulted with APRN who recommended that resident be sent
to Forrest City Medical Center for assessment and X-Ray. Results of X-Ray and assessment
are . Additional
Information: Guardian Notified: Nicolette Segura Case Manager
Interim Action Narrative: Resident was assessed by the nurse and sent to FCMC for an
assessment/x-ray.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed provider reported incident for licensing
concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Forrest City Medical Center for assessment due to complaints of pain and blurry vision after he was attacked by 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: 10/20/2023
Date Received by DCCECE: 10/23/2023
Facility Name: Perimeter Behavioral of Forrest City
Facility Number: 142
Incident Type: Licensing
Report Description: Serious injury requiring outside medical attention Residents
Name/DOB: State: Arkansas Date/Time of incident: 10/20/23/07:40
Please give a description of the incident: Resident was kicked in the eye/face area after
being attacked by another peer who was trying to take his candy. Resident complained of
pain and blurry vision, redness also observed. Corrective Actions Taken: Resident was
assessed and checked by nurse. The nurse consulted with APRN who recommended that
resident be sent to Forrest City Medical Center for assessment and X-Ray. Results of X-Ray
and assessment are contusion;
Additional Information: Guardian Notified:
Mother
Interim Action Narrative: Resident was assessed by the nurse and sent to FCMC for
assessment/x-ray. Peer involved was placed on assault precautions.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed provider reported incident for licensing
concerns. Licensing Specialist will inquire about camera footage, safety plans and
precautions for the residents. 10/26/2023, Licensing Specialist inquired about the safety
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

plans and precautions for the residents. 10/30/2023, Licensing Specialist informed there
was no camera footage and peer was placed on assault precautions.