summary: A guardian of a resident failed to return him to the facility, and the resident was discharged against medical advice. The explanation for the AMA discharge was due to an alleged incident between the resident and a peer at the facility. 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: 018260
Date of Incident: 12/26/2023
Date Received by DCCECE: 12/28/2023
Facility Name: Dacus RTC
Facility Number: 108
Incident Type: Dual
Report Description: Client: Insurance: Empower Private
Payor: guardian of , failed to
return him to the facility on 12/26/2023. On 12/27/23 he was discharged against the
medical advice of the attending physician, Dr Sara Vanscoy. explanation for the
AMA discharge was allegedly due to an alleged incident between and a peer at
the facility. This alleged incident was not disclosed to therapist, nurse, or the
program director until the day was scheduled to return from his pass on 12/26/23.
However, this alleged incident is currently being investigated. Also worth mentioning,
has made multiple requests and attempts for to discharge home
with intent to assist with the care for his disabled father.
Interim Action Narrative: The was called and call was accepted.
Maltreatment Narrative: AV is AOs are the PRFC ( )
and father ( ). refused to return back to Dacus RTC after he
went home on pass for Christmas. She said it was because of an alleged incident that
happened with a peer. This is against medical advice of Dacus RTC's psychiatrist, Dr. Sara
VanScoy. has a history of depression, SI, and defiance. History of aggression in
home such as punching walls. He has had a couple of passes home where he has yelled at
his father because he did not get his way. At the facility, his behavior was mostly good but
his main issues were at home on pass.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns. Program Coordinator will request documentation of discharge. Program
Director informed Program Coordinator of the alleged allegations. 12/29/2023, Program
Coordinator received discharge from facility. 1/2/2024, Program Coordinator followed-up
with the facility on the internal investigation. Program Coordinator informed that the
was called because the guardian did not return the resident and call was accepted.
That is the facility's policy. Facility reported that the BI's stated that resident requested a
room change and did not disclose the reason why. Program Coordinator will inquire about
the referral #. 1/4/2024, facility provided referral number. Program Coordinator will inquire
about investigator. Program Coordinator will contact investigator for permission to contact
the facility. Program Coordinator received permission to contact the facility. 1/25/2024,
Program Coordinator inquired about an update from the investigator. Investigator Anderson
informed Program Coordinator her report was accepted for medical neglect with the
resident's guardian as the AO. This case is still pending. 1/29/2024, investigator reported
case is still pending. 2/9/2024, investigator reported case found unsubstantiated.


state: AR

facility_name: United Methodist Children's Home - Dacus (Bono)

summary: During interviews regarding a maltreatment investigation, resident’s guardian reported to the investigator that approximately 3 weeks ago, she took resident to the dentist. He was bragging to his brothers that he has a 35-year-old girlfriend at the facility (Dacus Psychiatric Residential). Resident stated that they were having sex in the bathrooms because there were no cameras there. Resident reported it to the facility staff, who failed to report it to the director. Staff was terminated from the facility on 12/18/23. CACD investigation found TRUE.

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: 018198
Date of Incident: 12/21/2023
Date Received by DCCECE: 12/21/2023
Facility Name: Dacus RTC
Facility Number: 108
Incident Type: Dual
Report Description: AV is , PRFC is , and AO is
. During the interviews, PRFC, reported to FSWS Emery that
approximately 3 weeks ago, she took to the dentist. He was bragging to his brothers
that he has a 35-year-old girlfriend named at the facility (Dacus Psychiatric
Residential). stated that they were having sex in the bathrooms because there were
no cameras there. reported it to the facility staff, who failed to report it to the
director or to the
Interim Action Narrative: The staff was terminated from the facility on 12/18/2023 due to
another incident that occurred on 12/17/2023 with the same A/V.
Maltreatment Narrative: AV is , PRFC is , and AO is
. During the interviews, PRFC, reported to FSWS Emery that
approximately 3 weeks ago, she took to the dentist. He was bragging to his brothers
that he has a 35-year-old girlfriend named at the facility (Dacus Psychiatric
Residential). stated that they were having sex in the bathrooms because there were
no cameras there. reported it to the facility staff, who failed to report it to the
director or to the
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: 12/21/2023-Program Manager was made aware of this investigation
by the DON during a visit to the facility. The Program Manager was given details about the
investigation and the name of the person investigating it. The investigator was on site at the
facility and informed them of the report yesterday 12/20/2023. Camera footage was reviewed
for interactions between the A/V and A/O during the day of 12/17/2023. Permission will be
requested from the investigator before licensing proceeds with any further investigation.
The Program Manager spoke to the investigator after the visit and discussed what was
viewed on the camera footage seen today. Permission was granted for licensing to continue
with further investigation. 12/28/2023, Program Coordinator followed-up with the
investigator on whom the guardian spoke with. 1/5/2024, Program Coordinator contacted
the investigator for updates. 1/19/2024, Program Coordinator reached out to the investigator
for an update. 1/24/2024, Program Coordinator informed case is still pending. 2/9/2024,
case is still pending according to CHRIS. 2/22/2024, Program Coordinator checked CHRIS
for an update and reached out to the investigator. Investigator Burns informed Program
Coordinator case is still pending. 3/8/2024, Program Coordinator reached out to
investigator for an update. Investigator reported that case is still pending and is awaiting on
camera footage from Methodist.

doc_type: Notice of Incident


summary: During routine camera view on 12/18/2023 by the nurse, staff was seen pushing and kneeing client in the groin. Client was examined by the nurse. Bilateral testicles slightly red. A call to the child abuse hotline was completed and accepted. Staff was immediately terminated upon view of camera footage. Facility was cited 109.1.g for the unprofessional conduct of staff. The complaint has been FOUNDED by Licensing. CACD investigation found TRUE.

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: 018144
Date of Incident: 12/17/2023
Date Received by DCCECE: 12/19/2023
Facility Name: Dacus RTC
Facility Number: 108
Incident Type: Dual
Report Description: Insurance-Empower Private Payor-
Guardian- Staff: During routine camera view on
12/18/2023 by the nurse (Shellie L), staff ( ) was seen pushing and kneeing in the
groin client ( Client ( was examined by the nurse. Bilateral testicles
slightly red. No bruising or open area present. A was completed and accepted.
referral number is . Staff ( was immediately terminated upon
view of camera footage.
Interim Action Narrative: Staff ( was immediately terminated upon view of
camera footage.
Maltreatment Narrative: During routine camera view on 12/18/2023 by the nurse (Shellie
L), staff ) was seen pushing and kneeing in the groin client ( Client
( was examined by the nurse. Bilateral testicles slightly red. No bruising or open
area present. A was completed and accepted. referral number is .
Licensing Narrative: 12/19/2023- Program Manager CV reviewed the complaint and
emailed the investigator for permission to contact. 12/21/2023- Program Manager CV
visited the facility and reviewed the camera footage. 1/19/2024, Program Coordinator
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

reached out to investigator for an update. 1/24/2024, Program Coordinator informed case
was screened out.


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

raw_content:
521 Visit Compliance Report

Licensee: Dacus RTC

Facility Number: 108

Licensee Address: 211 CHURCH STREET
BONO AR 72146

Licensing Specialist: Kendra Rice
Person In Charge: Waynette Banks
Record Visit Date: 12/15/2023
Home Visit Date: 12/15/2023

Purpose of Visit: Subsequent Building and Grounds

Regulations Out of Compliance:

Regulations Needing Technical Assistance:

Regulation Not Applicable:

Regulations Not Correctable:

Narrative:

Time of visit: 11:00 am to 12:30 pm

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

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 3

Census: 16

Program Coordinator completed buildings and grounds. The following areas were observed: administration,
grounds, education hall, dining room, dayroom, bathrooms, laundry rooms, bedrooms, gym, educational hall,
and nurse’s station.

Walking into the administration area, Program Coordinator observed parked cars, a van for transportation, and
the grounds were free of debris. Program Coordinator was escorted by Ms. Waynette Banks, Program
Director.

Program Coordinator observed holiday decorations in the administration area. In the day area, Program
Coordinator observed a CASA worker and resident playing chess. The big boy residents were in the gym
playing basketball, ratio 2:8. On the educational hall residents were preparing for lunch, ratio 1:2. The other
residents were with their therapist.

On both halls (Big Boys and Little Boys), bedrooms and bathrooms were clean. Program Coordinator could
smell the aroma of cleaning products. There were no more than three residents in a bedroom. Residents had
their belongings organized on the shelves and most beds were made. Residents’ hygiene containers are kept in
the laundry room on each hall.

Nurse Nettie informed Program Coordinator there are currently no residents on any controlled substances.
Nurse Nettie was preparing for medication time.

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

All initialed and up to date.

Provider Comments:

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

CCL Staff Signature :

Provider Signature :

i} | | | | | f/) i

www.arkansas.gov/dhs

Serving more than one million Arkansans each year

Date: 12/18/2023

Date: 12/18/2023

Page 3 of 3

doc_type: Compliance Report


summary: Officers responded to the facility for an aggressive juvenile. A staff member advised that the juvenile punched him in the face and stomach.

raw_content:
Incident # 23-00649 Bono Police Department Report Date 12/13/23
Page 1 of 2 Incident Report Report Time 10:56 PM
Status Exception Clearance Date Reporting Officer ORI/Agency
Not Applicable 528 Morgan, Don AR0160700
Active
Assigned Officer Entered By Approving Officer
dmorgan
Assisting Officers
Complainant
SSN/ID/TIN Title Name DOB Age Sex Resident Status
Mr Sigman, Charles 57 M Unknown
Race White Ethnicity DL (#, ST) Email
Not Hispanic/Latino ,
Home Phone Work Phone Other Phone Personal Cell Work Cell
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
Dacus Rtc
Work Address Occupation
Behavioral Instructor
Offenses
Incident Location Zone
211 Church ST Bono, AR 72416
Earliest Possible Date Time Latest Possible Date Time
12/13/2023 15:30 12/13/2023 16:30
# Statute/Code Description Fel/Misd Att/Comp Loc Bias Wpn CATypes
1 5-13-203A(1) BATTERY - 3RD DEGREE / PURPOSE OF CAUSING INJURY, CAUSES INJURY Misd Completed 25 88 99
MO Method Of Entry # Prems
n/a 0
Location Types 13 Hway/Road/Alley 37 Abandoned/Condemned 48 Industrial Site Bias Motivation Codes
14 Hotel/Motel Structure 49 Military Installation 43Lesbian, Gay, Bisexual,
0 0 0 0 0 0 0 0 0 1 1 1 1 2 3 4 5 6 7 8 9 0 1 2 A B B C C C C D D F G G i i a a h o o o e r o r e r u o n r / u m n n p v l B / g d c k N t r s v t / m / e c u / / t e P D S W i S r h r s g n e u u y t i & / / s h r o i S r c T / b e / S c c L t o D t r l y n i i o i C a u o d a c n r c u i p n s l l a n e O / u B n e O g S b t T l f S r d / f f m S i T / e f t t g H o e t r B e a o m r o m l r e r d s k e i p n g p e l a t e l 1 1 1 1 1 F 2 2 2 2 2 5 6 7 8 9 0 1 3 4 5 a c J L L P R R R S S U i a l a i a e p e e e n i q t i k r r e y n s s k l u / k v e i t c n P t o d i a i a / i n c o W r r a e u l e i g w s S l n S r t / a a o y n G L c t t t o n n o / e o e S a O r t r / t r e s a t H / w t o G h g S o r a e a e e m t y r a ra e ti g o e n 3 3 g 4 4 N 4 4 4 M 4 4 8 9 r 0 1 2 4 5 6 7 e o o w A A A C D D F G d u A a a / n r T u a a o a U m e l r d t M m y c m o m n T s s u c k a p e b e / a / s D S C W F / / d l r e r S C i e e m e n a o m h p a t a g c l a i F i a a l n e m s i e d l a r r i a e n r f t i a p c / y u s l u t F t g i h m m P e l r i r i t e o a p y / f F r i u r g o k a n h m i d r t/ Bank 5 5 5 C 5 E 5 M 5 5 5 5 0 1 2 3 4 5 6 7 8 l o i e s l C m l s P R S S S S T C e i y r e o g a c c h h e o i b h h b n n e r e o s m e k o o a t / / t l p t a H U / r m o o e l A P p s r o n L l l r i p y u r l n a m i e - - a / - a n v g S y a n c e i e g t e d M e y r l r c e s s o C a o i s t u l y n s e l n d n d a te ry r A 1 1 A 1 A 1 1 1 O 2 2 N 1 2 3 4 5 6 1 2 m l t a h T W M J C B A A s e e N e k I l m s r a r u a h - a i w a i c t P l a c i e t h t t a i i N i k n e s v a r o - n i r h e c a c l o a i i a c t r f c H i i n v c e A a e s I f I w n r s , i d a c l G a a i i a i n r a n o n d n u e o p o r r r 2 2 2 2 2 3 3 3 L 4 4 3 4 5 6 7 1 2 3 a 1 2 t P I O M A A G L H N in s e r t r i o l t a o u h s o a a h s t y l p e t b m e b t H e i a i ( - r i s s i a m r i n c R s t e t n / i a a p A l c ( e i M n g l a g l e o i t i n g u n o ) r i i s o u c L o l s s a i n o m t t i g r i c n ) ro o up o G 4 4 5 5 6 6 7 7 8 9 r 4 5 1 2 1 2 1 2 8 9 r o T H B P M M F T G N U u r e r i h a e o n e e a p s a m y n t n k n n l e n e e ( s n s e d t x L a s r a g o o e u D G l g l e e w s r a e i D B s n e l N n n a i T d x s d o b e u ) a e n i r a l b r - , i l t C i M y li o ty i n xe fo d rming
Facility/Casino/Race Track
Suspected Of Using Criminal Activity Types Weapon Type(s) 20 Knife/Cutting Instr 65 Fire/Incendiary Device
None B P B P u o y s i s n e g s / s R in e g ce /C iv o in n g cealing C O C O u p l e ti r v a a t t in in g g / / P M ro a m nu o f t / i P n u g b /A li s s s h i i s n t g ing 1 1 1 2 F H i a re n a d r g m u n (A (A ut u o t ) o) 3 3 0 5 B M l o u t n o t r O V b e j h e i c c t le 7 8 0 5 D As ru p g h s y / x N ia a t r i c o . n /Sleeping Pills
D Distributing/Selling T Transport/Import/Transmit 13 Rifle (Auto) 40 Personal Weapons 90 Other
E Exploiting Children U Using/Consuming 14 Shotgun (Auto) 50 Poison 95 Unknown
15 Other Firearm 60 Explosives 99 None
A Simple/Gross Neglect I Intentional Abuse & Torment
F Organized Abuse S Sexual Animal Abuse
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 12/20/2023 8:47:08 AM

Incident # 23-00649 Bono Police Department Report Date 12/13/23
Page 2 of 2 Incident Report Report Time 10:56 PM
Victim #1 Is Complainant Event #s Related 1
SSN/ID/TIN Title Name DOB Age Sex Resident Status
Mr Sigman, Charles 57 M Unknown
Race White Ethnicity DL (#, ST) Email
Not Hispanic/Latino ,
Home Phone Work Phone Other Phone Personal Cell Work Cell
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
Dacus Rtc
Work Address Occupation
Behavioral Instructor
Victim Type Injury Type Aggravated Assault/Homicide Circumstances Relationship To Suspect
Individual None, None #1 N/A
Justifiable Homicide Circumstances Taken to: (Hospital Name)
None
Injury Description
Suspect #1
SSN/ID/TIN Title Name DOB Age Sex Resident Status
M Nonresident
Race White Ethnicity DL (#, ST) Email
Not Hispanic/Latino ,
Home Phone Work Phone Other Phone Personal Cell Work Cell
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
211 Church ST,Bono, AR 72416
Work Address Occupation
Height Weight Eyes Build AKA
- -
Narrative & Statements
Narrative - Morgan, Don - 12/13/2023 11:01:41 PM (Initial)
On 12/13/2023 I Officer Morgan received a call from Charles Sigman at Dacus RTC in reference to a juvenile
being aggressive and punching Sigman in the face. Upon arrival I spoke with Sigman. He had obvious injuries to
the bridge of his nose and his left check under his eye. Sigman stated that S1 was screaming and being
aggressive towards his peers. Sigman got in between S1 and peers. S1 punched Sigman several times in the
stomach and face. This is the second time I have been called out to Dacus RTC for S1's aggressive behavior. I
did NOT interview S1 due to him being a minor with his listed guardian not being present. This case will be
turned over to the Craighead County Juvenile Department. Nothing further to report at this time.
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 12/20/2023 8:47:08 AM

doc_type: Police Report


summary: Officers were dispatched to the facility in response to a juvenile making threats of killing staff members. Staff advised that the juvenile placed a peer in a headlock and wouldn’t let go. The juvenile advised he and his peer were playing around. The threats toward staff were un-corroborated.

raw_content:
Incident # 23-00637 Bono Police Department Report Date 12/02/23
Page 1 of 2 Incident Report Report Time 7:19 AM
Status Exception Clearance Date Reporting Officer ORI/Agency
Not Applicable 527 Mccracken, Joel AR0160700
Active
Assigned Officer Entered By Approving Officer
JMcCracken
Assisting Officers
Complainant
Name Contact Name
Methodist Family Health Sherry
Business Address Business Phone
211 N Church ,Bono, AR 72416 8709328880
Offenses
Incident Location Zone
211 W Church Bono, AR 72416
Earliest Possible Date Time Latest Possible Date Time
12/02/2023 04:45 12/02/2023 05:45
# Statute/Code Description Fel/Misd Att/Comp Loc Bias Wpn CATypes
1 5-13-207 ASSAULT - 3RD DEGREE / CREATES APPREHENSION OF IMMINENT INJURY Misd Completed 15 88 99
MO Method Of Entry # Prems
Juvenile n/a 0
Location Types 13 Hway/Road/Alley 37 Abandoned/Condemned 48 Industrial Site Bias Motivation Codes
14 Hotel/Motel Structure 49 Military Installation 43Lesbian, Gay, Bisexual,
0 0 0 0 0 0 0 0 0 1 1 1 1 2 3 4 5 6 7 8 9 0 1 2 A B B C C C C D D F G G i i a a h o o o e r o r e r u o n r / u m n n p v l B / g d c k N t r s v t / m / e c u / / t e P D S W i S r h r s g n e u u y t i & / / s h r o i S r c T / b e / S c c L t o D t r l y n i i o i C a u o d a c n r c u i p n s l l a n e O / u B n e O g S b t T l f S r d / f f m S i T / e f t t g H o e t r B e a o m r o m l r e r d s k e i p n g p e l a t e l 1 1 1 1 1 F 2 2 2 2 2 5 6 7 8 9 0 1 3 4 5 a c J L L P R R R S S U i a l a i a e p e e e n i q t i k r r e y n s s k l u / k v e i t c n P t o d i a i a / i n c o W r r a e u l e i g w s S l n S r t / a a o y n G L c t t t o n n o / e o e S a O r t r / t r e s a t H / w t o G h g S o r a e a e e m t y r a ra e ti g o e n 3 3 g 4 4 N 4 4 4 M 4 4 8 9 r 0 1 2 4 5 6 7 e o o w A A A C D D F G d u A a a / n r T u a a o a U m e l r d t M m y c m o m n T s s u c k a p e b e / a / s D S C W F / / d l r e r S C i e e m e n a o m h p a t a g c l a i F i a a l n e m s i e d l a r r i a e n r f t i a p c / y u s l u t F t g i h m m P e l r i r i t e o a p y / f F r i u r g o k a n h m i d r t/ Bank 5 5 5 C 5 E 5 M 5 5 5 5 0 1 2 3 4 5 6 7 8 l o i e s l C m l s P R S S S S T C e i y r e o g a c c h h e o i b h h b n n e r e o s m e k o o a t / / t l p t a H U / r m o o e l A P p s r o n L l l r i p y u r l n a m i e - - a / - a n v g S y a n c e i e g t e d M e y r l r c e s s o C a o i s t u l y n s e l n d n d a te ry r A 1 1 A 1 A 1 1 1 O 2 2 N 1 2 3 4 5 6 1 2 m l t a h T W M J C B A A s e e N e k I l m s r a r u a h - a i w a i c t P l a c i e t h t t a i i N i k n e s v a r o - n i r h e c a c l o a i i a c t r f c H i i n v c e A a e s I f I w n r s , i d a c l G a a i i a i n r a n o n d n u e o p o r r r 2 2 2 2 2 3 3 3 L 4 4 3 4 5 6 7 1 2 3 a 1 2 t P I O M A A G L H N in s e r t r i o l t a o u h s o a a h s t y l p e t b m e b t H e i a i ( - r i s s i a m r i n c R s t e t n / i a a p A l c ( e i M n g l a g l e o i t i n g u n o ) r i i s o u c L o l s s a i n o m t t i g r i c n ) ro o up o G 4 4 5 5 6 6 7 7 8 9 r 4 5 1 2 1 2 1 2 8 9 r o T H B P M M F T G N U u r e r i h a e o n e e a p s a m y n t n k n n l e n e e ( s n s e d t x L a s r a g o o e u D G l g l e e w s r a e i D B s n e l N n n a i T d x s d o b e u ) a e n i r a l b r - , i l t C i M y li o ty i n xe fo d rming
Facility/Casino/Race Track
Suspected Of Using Criminal Activity Types Weapon Type(s) 20 Knife/Cutting Instr 65 Fire/Incendiary Device
None B P B P u o y s i s n e g s / s R in e g ce /C iv o in n g cealing C O C O u p l e ti r v a a t t in in g g / / P M ro a m nu o f t / i P n u g b /A li s s s h i i s n t g ing 1 1 1 2 F H i a re n a d r g m u n (A (A ut u o t ) o) 3 3 0 5 B M l o u t n o t r O V b e j h e i c c t le 7 8 0 5 D As ru p g h s y / x N ia a t r i c o . n /Sleeping Pills
D Distributing/Selling T Transport/Import/Transmit 13 Rifle (Auto) 40 Personal Weapons 90 Other
E Exploiting Children U Using/Consuming 14 Shotgun (Auto) 50 Poison 95 Unknown
15 Other Firearm 60 Explosives 99 None
A Simple/Gross Neglect I Intentional Abuse & Torment
F Organized Abuse S Sexual Animal Abuse
Victim #1 Event #s Related 1
SSN/ID/TIN Title Name DOB Age Sex Resident Status
M Unknown
Race Unknown Ethnicity DL (#, ST) Email
Unknown ,
Home Phone Work Phone Other Phone Personal Cell Work Cell
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
211 W Chruch ,Bono, AR 72416
Work Address Occupation
Victim Type Injury Type Aggravated Assault/Homicide Circumstances Relationship To Suspect
Individual None, None #1 N/A
Justifiable Homicide Circumstances Taken to: (Hospital Name)
None
Injury Description
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 12/20/2023 8:44:06 AM

Incident # 23-00637 Bono Police Department Report Date 12/02/23
Page 2 of 2 Incident Report Report Time 7:19 AM
Suspect #1
SSN/ID/TIN Title Name DOB Age Sex Resident Status
M Unknown
Race Black / African Ethnicity DL (#, ST) Email
American Not Hispanic/Latino ,
Home Phone Work Phone Other Phone Personal Cell Work Cell
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
211 W Chruch ,Bono, AR 72416
Work Address Occupation
Height Weight Eyes Build AKA
- -
Narrative & Statements
Narrative - Mccracken, Joel - 12/2/2023 7:25:46 AM (Initial)
On 12/2/23 at 0456 hours I was dispatched in reference to a Suspect #1 ( ) making threats of
killing staff members. When I arrived on scene I spoke with Staff Complainant and other staff. They stated that
Suspect #1 ( ) had put Victim #1 ( ) in a headlock and refused to let go. Victim #1 (
) sustained no injuries. The threats towards staff were un-corroborated. Suspect #1 ( ) stated that
he and Victim #1 ( ) were just playing around. I spoke with Suspect #1 ( ) over his behavior
and what the possible consequences to his behavior could be. Suspect #1 ( ) said that I would not have
any more issues out of him.
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 12/20/2023 8:44:06 AM


summary: Licensing conducted an after-hours visit at the facility. No deficiencies cited.

raw_content:
AR KAN S AS
DEPARTMENT OF

4 HUMAN
~«\ SERVICES

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot $140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550

521 Visit Compliance Report

Licensee: Dacus RTC

Facility Number: 108

Licensee Address: 211 CHURCH STREET
BONO AR 72146

Licensing Specialist: Kendra Rice
Person In Charge: Waynette Banks
Record Visit Date: 11/28/2023
Home Visit Date: 11/28/2023

Purpose of Visit: Monitor Visit

Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:

Regulations Not Correctable:

Narrative:

Time of Visit: 6:15 pm to 7:30 pm

www.arkansas.gov/dhs

Serving more than one million Arkansans each year Page 1 of 2

Census: 15

Licensing Specialist completed an after hours visit. Licensing Specialist was greeted by Mr. Brown, Program
Consultant, and Nurse Laura.

Mr. Brown escorted Licensing Specialist through the building. There was no staff in the administration
offices. Mr. Brown informed Licensing Specialist that some residents were in their bedrooms and others were
watching a movie in the Big Boy Classroom.

On the residents’ hall, Licensing Specialist observed the following ratio in the bedrooms: Room 117:2, Room
118:1, Room 119:3, 120:1, Room 126:1, Room 128:2, and Room 130:1. Licensing Specialist observed 3 staff
members on the residents’ hall. A staff member was at each end of the hallway and the other staff member
was completing the residents’ laundry.

Mr. Brown escorted Licensing Specialist upstairs on the education hall. Licensing Specialist observed ratio
2:3 in the first classroom. Residents were watching the movie titled, Surf Ninjas. There were no residents in
the other classroom down the hall.

Nurse Laura showed Licensing Specialist where the medication cart is kept when all medication has been
administered for the day. Licensing Specialist observed the MAR’s on the residents listed below. All initialed
and up to date.

Provider Comments:
CCL Staff Signature : Date: 11/28/2023

nercllY ed
Provider Signature : Ue MME 7. 1 LO ANY Date: 11/28/2023

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


summary: A resident was transported to St. Bernard’s Emergency Department for treatment of a lacerated finger and a dislocated shoulder after he closed his finger in a bathroom door.

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: 11/15/2023
Date Received by DCCECE:11/15/2023
Facility Name: Dacus RTC
Facility Number: 108
Incident Type: Licensing
Report Description: Client: D.O.B- Insurance- Empower Private
payor: guardian-grandmother- Staff present: Sherry Collier Client ( )
went to use the restroom and closed his middle finger in the bathroom door. Client's
( ) finger was cut and bleeding. Client ( ) was taken to St. Bernard's
Emergency Department by ambulance. X-rays showed a
ER department reduced left shoulder back in
place. Sutures were placed on third digit and to be removed in 7-10 days. Continue to wear
left shoulder immobilizer in place for dislocation.
Interim Action Narrative: Resident was transported via ambulance for further evaluation.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed provider reported incident for licensing
concerns. Licensing Specialist will follow up with facility in 7 to 10 days regarding sutures
being removed. 11/22/2023, Licensing Specialist followed-up with facility on resident.
Licensing Specialist informed resident is scheduled to have his sutures removed on
11/26/2023 by the facility's nurse when he returns from pass.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was taken to NEA Baptist ER after dislocating his shoulder while playing basketball.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 11/12/2023
Date Received by DCCECE:11/13/2023
Facility Name: Dacus RTC
Facility Number: 108
Incident Type: Licensing
Report Description: Client: D.O.B- Insurance: Empower Private
Payor: Guardian-grandmother- Staff present: Autumn Blair, Deljuan Brown
While playing basketball, Client ) ran into the wall and injured shoulder. Left
shoulder appeared deformed. Mobile X-ray completed . Shoulder seemed to be dislocated.
Client ( ) was taken to the NEA Baptist Emergency room.
Interim Action Narrative: Resident had a mobile x-ray and transferred to the emergency
room.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed provider reported incident for licensing
concerns. Licensing Specialist will follow-up with facility on resident's x-ray finding.
Facility informed Licensing Specialist that the emergency room confirmed resident's
shoulder as being dislocated and reset his right shoulder. The emergency room also advised
to see an orthopedic as needed if symptoms worsens.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: An x-ray was ordered after a resident landed awkwardly on his ankle while playing basketball.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 11/12/2023
Date Received by DCCECE:11/13/2023
Facility Name: Dacus RTC
Facility Number: 108
Incident Type: Licensing
Report Description: Client: D.O.B- Insurance: Summit Community
Care Private payor: guardian-mother- Staff present: Autumn Blair, Deljuan
Brown While playing basketball in the gym, Client ( ) jumped and landed awkwardly
on right ankle. Scant amount of edema noted to right ankle without open area or bruising
present. X-ray ordered. No acute ankle fracture or dislocation.
Interim Action Narrative: Resident assessed and x-ray ordered.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed provider reported incident for licensing
concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: An officer was dispatched to the facility for an out-of-control child. Upon arrival, a staff member advised that the child hit one of the staff members and broke a toilet. The officer spoke to the child who agreed to stay calm and let staff know when he is struggling with a problem.

raw_content:
Incident # 23-00611 Bono Police Department Report Date 11/08/23
Page 2 of 2 Incident Report Report Time 2:27 PM
Suspect #1
SSN/ID/TIN Title Name DOB Age Sex Resident Status
M Unknown
Race Black / African Ethnicity DL (#, ST) Email
American Not Hispanic/Latino ,
Home Phone Work Phone Other Phone Personal Cell Work Cell
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
211 Church ST,Bono, AR 72416 Dacus Residential
Work Address Occupation
Height Weight Eyes Build AKA
- -
Narrative & Statements
Narrative - Simino, Shannon - 11/9/2023 8:42:51 AM (Initial)
On 11/8/2023 I was dispatched to Dacus Treatment Center in reference to a child out of control. Upon arrival
I made contact with Mrs. Banks the administration. She advised they child out of control hitting one of the staff
members and breaking the toilet. Mrs. Banks wanted me to speak with the child about his behavior. I spoke with the
child he stated he couldn't do his school work because he didn't have glasses to see it. He then got upset at the staff
and went off on them. The child agreed to stay calm and let the staff know when he was struggling with a problem.
The staff advised then didn't want to purse anything that if he would keep his behavior down they didn't mind
helping him with any problem
Nothing further at this time.
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 11/17/2023 2:26:00 PM


summary: A resident was sent to the ER after injuring his arm by falling while trying to climb on a basketball hoop.

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: 11/3/2023

Date Received by DCCECE:11/6/2023

Facility Name: Dacus RTC
Facility Number: 108
Incident Type: Licensing

Report Description: Client: D.O. B. Insurance: Empower Private
Payor: Guardian father Date of Incident: 11/3/2023 Staff present: ) |

f The client 7) jumped and tried to climb on basketball hoop and fell. Client
BB) teported pain of 10/10, moderate amount edema noted , capillary refill < 3 seconds,
color pink. Client QJ could move fingers freely but it caused pain. J's arm was
stabilized with a pillow and an ice pack applied. Mobile x-ray ordered.
the ER. Due to the nature of the injury and the requiring follow up care from orthopedic
surgeon, Client J) was discharge from the facility on 11/5/23.

Interim Action Narrative: Resident was assessed by the nurse, mobile x-ray was ordered,
and resident referred to the ER.

Maltreatment Narrative:

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

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


raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
Dacus RTC Kendra Rice
211 CHURCH STREET Donaghey Plaza
BONO AR 72146 P.O. Box 1437
Little Rock, AR. 72203
Facility Visit Compliance Notice
__________________________________________________________________________
Facility#: 108
Date of Visit: 10/23/2023
Visit Type(s): Subsequent Building and Grounds
Time: 12:30 AM - 2:03 PM
_______________________________________________________________________________________________
Visit Comment :
Time of visit: 12:30 pm to 1:45 pm
Census: 14
Licensing Specialist completed buildings and grounds. The following areas were observed: grounds, dining
room area, activity room, bathrooms, bedrooms, seclusion room, gym, administration hall, nurse's station, and
courtyard.
Licensing Specialist was escorted by Ms. Program Director.
Walking to the building, Licensing Specialist observed parked vehicles in the front and rear of the building.
There were also two parked vans on the side of the building. The grounds were well maintained. The
administration hall was organized and free of debris.
The activity room was clean and organized. The older residents were finishing up lunch and getting ready to
head back to their classroom, ratio 2:8. Licensing Specialist reviewed the MAR’s while in the nurse's station.
Nurse unlocked the medicine cart and showed Licensing Specialist where medications and controlled
substances are kept. There are not any residents taking controlled substances at this time.
Page 1 of 2

On the halls where the residents sleep, Licensing Specialist observed the bedrooms, bathrooms, and the
seclusion room. There were no more than three (3) residents to a bedroom. Bedroom furnishings and
bedrooms were safe, clean and in good repair. The bathrooms and seclusion rooms were clean.
Licensing Specialist requested a copy of the facility’s liability insurance. Ms. informed Licensing
Specialist that she would email a copy once received.
Licensing Specialist reviewed the MAR’s on the residents listed below:
All initialed and up to date.
CCL Staff Signature : Date: 10/23/2023
Provider Signature : Date: 10/23/2023
Your Signature indicates that this form has been reviewed with you; it does not imply your agreement with
it.
Right to Appeal: For more information on how to appeal these findings, refer to the minimum Licensing
Requirements or contact your Licensing Specialist.
Page 2 of 2


summary: A resident reported that a staff member brought a THC and nicotine vape into the facility for the resident to use. The resident did test positive for THC. The complaint was UNFOUNDED by Licensing.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Date of Incident: 10/19/2023
Date Received by DCCECE: 10/19/2023
Facility Name: Dacus RTC
Facility Number: 108
Incident Type: Dual
Report Description: Client: Insurance: Empower Private
Payor: Guardian- Staff: Nurse information reported to:
Shellie Loggins Date of Incident: 10/16/2023 Client ( disclosed to nurse on
10/19/2023 that staff ( brought a THC vape and Nicotine vape into the facility for
him to use. A THC vape and nicotine vape were confiscated on 10/16/2023. did test
positive for THC. On 10/19/2023, Staff ( has been suspended pending further
investigation.
Interim Action Narrative: Vape was confiscated, incident called into the and staff
member was suspended. Resident was placed on 60K focus, restricted from going on pass
home until he is able to test negative for THC.
Maltreatment Narrative: Client disclosed to nurse on 10/19/2023 that staff brought a THC
vape and Nicotine vape into the facility for him to use. A THC vape and nicotine vape were
confiscated on 10/16/2023. did test positive for THC.
Licensing Narrative: Licensing Specialist reviewed complaint for licensing concerns.
Licensing Specialist inquired about referral number. Referral , call was not
accepted but combined with Referral . Licensing Specialist will request permission
to contact the facility. 10/23/2023, Licensing Specialist informed that staff member involved
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

was informed of her suspension verbally. Licensing Specialist will request nursing note for
this complaint. 10/24/2023, Licensing Specialist received permission to contact the facility
from Investigator Burns. Licensing Specialist will request documentation. 10/25/2023,
Licensing Specialist requested documentation regarding this complaint. Licensing
Specialist informed resident was drug screened and tested positive for THC. Resident will
be monitored with weekly UDS screens. 11/20/2023, Licensing Specialist will follow-up with
the investigator for an update. Licensing Specialist informed that case is still pending.
12/8/2023, Licensing Specialist followed-up with investigator for an update. 12/11/2023,
Licensing Specialist informed case found unsubstantiated.


summary: A resident disclosed that a staff member brought in a nicotine vape and a THC vape for him to use. The resident tested positive for THC on 10/16/23. The complaint was UNFOUNDED by Licensing.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Date of Incident: 10/19/2023
Date Received by DCCECE: 10/19/2023
Facility Name: Dacus RTC
Facility Number: 108
Incident Type: Dual
Report Description: Client : Insurance: Arkansas Total
Care Private payor: Staff: Nurse informed:
Shellie Loggins Date of Incident: 10/16/2023 Client ( disclosed to nurse (Shellie)
on 10/19/2023 that Staff ( brought in a nicotine vape and a THC vape for him to
use. Client ( tested positive for THC on 10/16/2023. Client further states
that the staff ( was instructing him to lie on other staff regarding who brought in
the vapes. On 10/19/2023, staff ( was suspended pending further investigation. The
incident was
Interim Action Narrative: Vapes were confiscated, was called, and staff member was
suspended pending investigation. Resident was placed on 60K focus and restricted from
going on pass home until he is able to test negative for THC.
Maltreatment Narrative: Client : Insurance: Arkansas
Total Care Private payor: Staff: Nurse informed:
Shellie Loggins Date of Incident: 10/16/2023 Client ( disclosed to nurse (Shellie)
on 10/19/2023 that Staff ( brought in a nicotine vape and a THC vape for him to
use. Client ( tested positive for THC on 10/16/2023. Client further states
that the staff ( was instructing him to lie on other staff regarding who brought in
the vapes.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing Specialist reviewed complaint for licensing concerns.
Licensing Specialist will reach out to investigator for permission to contact the facility.
10/23/2023, Licensing Specialist informed that staff member involved was informed of her
suspension verbally. Licensing Specialist will request nursing note for this complaint.
10/24/2023, Licensing Specialist received permission to contact the facility from
Investigator Burns. Licensing Specialist will request documentation. 10/25/2023, Licensing
Specialist requested documentation regarding this complaint. Licensing Specialist informed
that resident was drug screened and tested positive for THC. Resident will continue to be
monitored with weekly UDS screens. 11/20/2023, Licensing Specialist will follow-up with
the investigator for an update. Licensing Specialist informed that case is still pending.
12/8/2023, Licensing Specialist followed up with investigator for an update. 12/11/2023,
Licensing Specialist informed that case found unsubstantiated.


summary: A resident reported that a staff member brought a phone, and a THC and nicotine vape into the facility and gave them to another resident to use. The resident also reported the staff member instructed her to lie about other staff instead of telling on her. The complaint was UNFOUNDED by Licensing.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Date of Incident: 10/19/2023
Date Received by DCCECE: 10/19/2023
Facility Name: Dacus RTC
Facility Number: 108
Incident Type: Dual
Report Description: Client: Insurance: Empower Foster care:
Private payor- Staff: Nurse informed:
Shellie Loggins Date of Incident: 10/16/2023 Client ( disclosed to nurse on
10/19/2023 that staff ( brought in a phone, THC and nicotine vape into the facility
and gave this to a peer to use. further states that staff ( has been
instructing him to lie on other staff instead of telling on her. does state he used
staff?s phone to text brother. Staff( was suspended pending further investigation.
filed.
Interim Action Narrative: Vapes were confiscated, was called, and staff member was
suspended.
Maltreatment Narrative: Client disclosed to nurse on 10/19/2023 that staff brought in a
phone, THC and nicotine vape into the facility and gave this to a peer to use. Client further
states that staff has been instructing him to lie on other staff instead of telling on her.
Licensing Narrative: Licensing Specialist reviewed complaint for licensing concerns.
Referral was screened out and combined with Referral Licensing
Specialist will request permission to contact the facility. 10/23/2023, Licensing Specialist
informed that staff member involved was informed of her suspension verbally. Licensing
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Specialist will request nursing note for this complaint. 10/24/2023, Licensing Specialist
received permission to contact the facility from Investigator Burns. Licensing Specialist will
request documentation. 10/25/2023, Licensing Specialist requested documentation
regarding this complaint. Licensing Specialist informed that resident was the first to inform
staff of the vapes. Resident denied using the vape and tested negative for THC. Resident
was not placed on precautions or Focus. 11/20/2023, Licensing Specialist will follow-up
with the investigator for an update. Licensing Specialist informed that case is still pending.
12/8/2023, Licensing Specialist followed up with investigator for an update. 12/11/2023,
Licensing Specialist informed case found unsubstantiated.


summary: Officers were dispatched to the facility in response to an uncontrollable juvenile. A staff member reported that the juvenile punched and bit him.

raw_content:
Incident # 23-00570 Bono Police Department Report Date 10/14/23
Page 2 of 2 Incident Report Report Time 10:10 PM
Suspect #1
SSN/ID/TIN Title Name DOB Age Sex Resident Status
M Nonresident
Race White Ethnicity DL (#, ST) Email
Not Hispanic/Latino ,
Home Phone Work Phone Other Phone Personal Cell Work Cell
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
211 Church ST,Bono, AR 72416
Work Address Occupation
Height Weight Eyes Build AKA
- -
Narrative & Statements
Narrative - Morgan, Don - 10/14/2023 10:20:32 PM (Initial)
On 10/14/2023 I Officer Morgan was first dispatched to Methodist Family Health in reference to a 13 year old
male that was uncontrollable. Upon arrival I spoke with Autum Hurst. Hurst lead me into a large room where the
suspect was sitting. I first tried talking to him and he told me to shut up and leave him alone. I continued talking
to him and he eventually settled down and talked to me. The program nurse and another staff member came in
and we were able to get the suspect settled down and we thought all was well.
Later on that evening 10/14/2023 I received another call from dispatch in reference to the same suspect and
location. This time when I arrived I spoke with Behavioral Therapist Kyle Wesley. He stated that suspect was
again acting out. Kyle advised that the suspect became angry when he was told he could not be in his room. He
hid under his bed until the nurse came into the room. At that point he came out from under his bed and began
hitting his head against the wall. Kyle stated that he asked the suspect if he was hungry. Suspect grabbed the
food and threw it at Kyle. Suspect then started punching Kyle and bit him. Kyle advised that he grabbed suspect
to restrain him and suspect began to kick him. Suspect was placed in group 2 side where he urinated on the
other patients doors and in their rooms.
Kyle advised me that he wanted to press charges on suspect for hitting and biting him. I contacted Juvenile
Officer Keith Michael with Craighead County. I advised Michael of the charges and he advised that he would get
in touch with Craighead County Juvenile Detention Center to see if they would be able to take suspect. Michael
called me back and stated that they would not take him unless Boone County would pay for the jail bill for
suspect being jailed there, since he was from Boone County. I spoke with Mrs. Lindsey who is suspects DHS
case worker from Harrison Arkansas. She advised the preferred action would be for Methodist Family Health to
take suspect to an emergency department and have him assessed. Kyle advised me that they would start
working on suspects transfer but it would take a couple days.Nothing further to report at this time.
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 11/17/2023 2:25:49 PM


summary: No deficiencies were noted during the Inpatient Psychiatric Inspection of Care (IOC) conducted on 09/19/23.

raw_content:
September 25, 2023
United Methodist Childrens Home
211 Church St
Bono, AR 72416-9578
The Division of Provider Services and Quality Assurance (DPSQA) of the Arkansas Department of Human
Services has contracted with Arkansas Foundation for Medical Care (AFMC) to perform Inspections of Care
(IOC) for Inpatient Psychiatric Services for Under 21. The Medicaid Manual for Inpatient Psychiatric Services
for Under Age 21 was used in the completion of this report.
Observations and any deficiencies noted are listed below for the inspection conducted at the following service
site on the following date:
United Methodist Childrens Home
Provider Medicaid ID:
Onsite Inspection Date: September 19, 2023
Onsite Inspection Time: 7:49a.m.
A summary of the inspection and any deficiencies noted are outlined below.
Inspection of Care Summary
Facility Tour:
Upon arrival to facility, AFMC staff was promptly greeted at the entrance by a United Methodist Children’s
Home staff member. AFMC was immediately taken to a conference room where they were met by the Program
Director and Compliance Director. AFMC staff received the completed and signed consent form listing approval
for access to the AFMC portal prior to arrival for site visit.
A tour of the facility was completed with the Program Director for the residential unit. The facility environment
was extremely clean and well-organized. Therapeutic educational classes were in session. Several staff members
were observed interacting calmly with clients throughout the facility. Staff were able to answer questions
regarding the facility. There were no concerns found during the facility tour.
Facility Review – Policies and Procedures:
Upon review of the site’s policies and procedures, there were no deficiencies noted.
Personnel Records – Licenses, Certifications, Training:
There was a total of ten personnel records reviewed; two (29%) professional staff and eight (25%)
paraprofessional staff. During the review of the personnel records, no deficiencies were noted.
Clinical Summary
As a part of the Quality-of-Care survey of the IOC, an active Fee for Service (FFS) Medicaid client list was
requested, client and/or guardian interviews were conducted, and a clinical record review was completed. The
following is a summary of findings and noted deficiencies.
Client/Guardian Interviews:
There was no active FFS Medicaid clients currently admitted at the time of IOC. Therefore, no client interviews
were conducted.

Clinical Record Review Deficiencies:
There was no active FFS Medicaid clients currently admitted at the time of IOC. Therefore, no clinical records
reviews were conducted.
Program Activity/Service Milieu Observation:
All clients were observed in educational classrooms on the second floor of the facility. Staff and clients were
calmly interacting and engaged in classroom learning. Staff were providing a therapeutic environment
conducive to learning.
Medication Pass:
No active FFS Medicaid clients received medications during a medication pass while AFMC staff was onsite.
Due to the observation of non-Medicaid clients not being complaint with the HIPAA minimal necessary rule, no
medication pass was observed. AFMC RN visited with the facility medication nurse who was able to show
AFMC RN the facility policies and procedures regarding medication administration, narcotic
count/reconciliation/handling, and medication discrepancies. Tour of medication room completed no
discrepancies with medication storage, cleanliness of medication room, and knowledge of medication dispensing
found.
Respectfully,
Inspection of Care Team
InspectionTeam@afmc.org
1020 W. 4TH ST., SUITE 300
LITTLE ROCK, AR 72201 • afmc.org
United Methodist Childrens Home – Bono, AR – IOC Report 2 | P ag e

doc_type: IOC Report


summary: A resident was taken to St. Bernard’s ER after injuring his hand by striking a wall with a closed fist.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 9/7/2023
Date Received by DCCECE:9/8/2023
Facility Name: Dacus RTC
Facility Number: 108
Incident Type: Licensing
Report Description: Client: D.O.B Insurance: Empower
Private Pay: guardian mother Staff present: Elisha Brewer Date of Incident:
9/7/2023 Client ( )threatened to harm staff. After receiving consequences (60k focus
and placed on assault precautions) for behavior. The client ( ) became argumentative
and defiant. Client ( ) struck the wall with a closed hand. Client ( ) injured his 5th
metacarpal & knuckle. Client has mild amount of edema to 5th knuckle. Mobile x-ray was
ordered. X-ray showed an . Client was taken to
St. Bernard's ER. Client was given a splint for the injury.
Interim Action Narrative: Resident was assessed by nursing, mobile x-ray, and taken to the
ER for further treatment. He was placed on 60k focus and assault precautions.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed provider reported incident for licensing
concerns. 9/11/2023, Licensing Specialist inquired about camera footage. Licensing
Specialist is scheduled to review camera footage on 9/13/2023. 9/13/2023, Licensing
Specialist reviewed camera footage.
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
Dacus RTC Kendra Rice
211 CHURCH STREET Donaghey Plaza
BONO AR 72146 P.O. Box 1437
Little Rock, AR. 72203
Facility Visit Compliance Notice
__________________________________________________________________________
Facility#: 108
Date of Visit: 9/13/2023
Visit Type(s): Self Report Visit
Time: 10:30 AM - 0:41 AM
_______________________________________________________________________________________________
Visit Comment :
Time of Visit: 10:30 am to 11:30 am
Census: 14
Licensing Specialist spoke with Ms. , Program Director, regarding ELS Case . The
provider reported incident happened on 9/7/2023 in the dining room. Licensing Specialist reviewed camera
footage on 9/13/2023.
Licensing Specialist observed resident standing in the doorway of the nursing station. It appeared that the
Lead was talking with the resident. The resident was observed pacing back and forth in front of the nursing
station doorway. Licensing Specialist observed the nurse poke her head out of the doorway, ratio 2:1.
Once the resident walked back past the doorway, Licensing Specialist observed the resident move swiftly
toward the water fountain. Resident was observed striking the water fountain with closed fist (right hand),
ratio 1:1. Licensing Specialist observed resident pacing the dining room. Licensing Specialist observed the
nurse come out the doorway from the nursing station. Resident was assessed by the nurse.
Per maintenance, the chair lift has been repaired. Licensing Specialist observed the lift chair. Licensing
Specialist informed resident returned from acute care on 9/12/2023.
Page 1 of 2

CCL Staff Signature : Date: 9/13/2023
Provider Signature : Date: 9/13/2023
Your Signature indicates that this form has been reviewed with you; it does not imply your agreement with
it.
Right to Appeal: For more information on how to appeal these findings, refer to the minimum Licensing
Requirements or contact your Licensing Specialist.
Page 2 of 2


summary: A resident was transported for acute care after damaging property and self-harming.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 9/7/2023
Date Received by DCCECE:9/8/2023
Facility Name: Dacus RTC
Facility Number: 108
Incident Type: Licensing
Report Description: D.O.B- Insurance: Empower Private Pay:
guardian -grandmother Staff members present: Elisha Brewer, Yasmine
Prater Date of Incident: 9/7/2023 Client ( ) broke the soap dispenser in the
bathroom. When Staff opened the door, client ( ) refused to leave and proceeded to
hit and kick walls and doors. While transitioning downstairs, Client ( ) attempted to
go down the stairs head first. Once staff instructed him to stop, Client ( ) complied.
Once the client reached the bottom of the stairs, he broke the handicap chair lift. While in
the transitional hallway, client screamed, threatened to kill staff and a peer, and kicked
doors and walls. Client took his hoodie and placed it around his neck in the cafeteria. Client
( ) was able to flex, extend each finger on right hand and dorsiflex right wrist without
difficulty. Slight redness present to right hand. No other injuries noted. Client transferred to
MBH via ambulance- Medic One , no distress noted, resp. even , non labored., denies SI ,
AVH, C/O HI . Client became aggressive when the ambulance got here but eventually
calmed down after talking to Consultant and was cooperative with staff.
Interim Action Narrative: Resident was assessed by nursing and transported to MBH by
Medic One.
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing Specialist reviewed provider reported incident for licensing
concerns. Licensing Specialist will inquire about camera footage. Licensing Specialist is
scheduled to review camera footage on 9/13/2023. 9/13/2023, Licensing Specialist reviewed
camera footage. Resident returned from acute care on 9/12/2023.


summary: After a restraint, a staff member pushed a resident back, causing the resident to fall to the floor. The facility was cited 109.1.g and 905.4.g as a result of this incident.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 9/4/2023
Date Received by DCCECE:9/5/2023
Facility Name: Dacus RTC
Facility Number: 108
Incident Type: Licensing
Report Description: Client: D.O.B- Insurance: Caresource Foster care:
Sebastian County DCFS-caseworker Melissa Kaupp Staff : Staff witness:
Yasmine Prater Nurse: Laura Carter Date of Incident: 9/4/2023 Client ( ) was leaned
against a chair in the dayroom screaming. Staff ( ) placed client ( ) in a CCP.
Staff (Yasmine) notified the nurse. The client ( ) was released from hold and
immediately tried to attack staff ). Staff ( ) placed client ( ) back in a
CCP. After 3 mins of being in the hold, nurse (Laura) instructed staff ) to release
the hold. Staff ) pushed client ) back and client ( ) fell to the floor. Nurse
(Laura) instructed staff ( ) to leave the room. No injuries noted to client ( ),
denies pain. Child abuse hotline referral not accepted: Reference number .
Interim Action Narrative: Resident was placed in a restraint. Nurse assessed resident. Staff
member suspended on 9/5/2023.
Maltreatment Narrative:
Licensing Narrative: 9/5/2023- Licensing Specialist visited the facility to review camera
footage of the incident. Licensing Specialist informed staff member was suspended pending
investigation. Licensing Specialist called AR hotline and reported the incident. Licensing
Specialist provided with details of what was observed during review of camera
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

footage. Licensing Specialist was informed that an email would be sent. Hotline call not
accepted, Referral # . 9/6/2023, Licensing Specialist requested witness statements,
restraint justification, and copy of camera footage. Licensing Specialist informed that S.
Rouse was working on downloading the camera footage. Licensing Specialist received
requested documentation. 9/12/2023, Program Director contacted Licensing Specialist
regarding staff member returning to work. Program Director informed Licensing
Specialist that would be retrained in CPI with focus on using a physical restraint being
used as a last resort. Staff member would be required to sign a written warning stating
any other policies or procedures which are not followed would result in immediate
termination. 9/13/2023, Licensing Specialist received documentation for staff member
being retrained and written warning. 9/19/2023, Licensing Specialist picked copy of camera
footage.

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Dacus RTC
Facility Number: 108
Licensee Address: 211 CHURCH STREET
BONO AR 72146
Licensing Specialist: Kendra Rice
Person In Charge: Waynette Banks
Record Visit Date: 9/5/2023
Home Visit Date: 9/5/2023
Purpose of Visit: Self Report Visit
Regulations Out of Compliance:
Regulation Number: 1.109.1.g
Regulation Description: Unprofessional conduct in the practice of child welfare activities shall include, but not
limited to the following:
Finding Description: Staff observed displaying behavior that could be viewed as physically harmful to the
resident.
Action Due Date:
Action Due Description:
Comply Date:
Sub-Regulation Level 1 Description: Engaging in behavior that could be viewed as sexual, dangerous,
exploitative, or physically harmful to children.
Action Due Description:
Regulation Number: 9.905.4.g
Regulation Description: The following actions shall not be used, including as discipline:
Finding Description: Staff member was observed what appeared to push resident out of a CCP restraint.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 3

Action Due Date:
Action Due Description:
Comply Date:
Sub-Regulation Level 1 Description: Physical injury or threat of bodily harm;
Action Due Description:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Time of Visit: 1:30 pm to 4:00 pm
Census: 14
Licensing Specialist spoke with Ms. Waynette Banks, Program Director, regarding ELS Case #015860. The
provider reported incident happened on 9/4/2023 in Classroom 2. Licensing Specialist reviewed camera
footage on 9/5/2023.
Licensing Specialist observed ratio 2:6 in Dayroom. Residents were sitting in chairs or laying on furniture.
Licensing Specialist observed staff member walk toward resident and resident trying to move away from staff.
Staff member and resident were observed in what appeared to be scuffling. Licensing Specialist then observed
staff member place resident in a CCP restraint, reason unknown. Resident and staff member were observed by
the doorway leading into the dining room area.
3:08 pm, Licensing Specialist observed residents being escorted out the Dayroom. 3:09 pm, ratio 3:1. Staff
member had resident in a hold and resident was attempting to get out of hold. Licensing Specialist observed
what appeared staff member pushing resident away and resident falling to the floor. Another staff member
assisted resident off the floor and resident was observed charging toward the staff member that appeared to
push him
Staff member that assisted resident off the floor guided resident to the opposite side of room. Nurse was
observed pointing toward the door where the alleged staff member walked out the area.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 3

Licensing Specialist was informed the RTC Director was called immediately after the incident and the alleged
staff member was informed to leave the premises. On 9/5/2023, RTC Director reviewed camera footage and
the alleged staff member was suspended pending investigation.
Facility will be cited for R109.1.g and R905.4.g due to what appeared staff member pushing the resident. Staff
member was observed displaying unprofessional conduct and demonstrating improper restraint techniques.
Provider Comments:
CCL Staff Signature : Date: 11/27/2023
Provider Signature : Date: 11/27/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 3 of 3


summary: A resident was transported to JDC after punching a staff member, threatening to stab someone, hitting a peer in the head with a notebook, and stepping on a peer’s foot.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 8/31/2023
Date Received by DCCECE: 8/31/2023
Facility Name: Dacus RTC
Facility Number: 108
Incident Type: Licensing
Report Description: Client: D.O.B- Insurance: Caresource Foster
Care: Pulaski County DCFS Caseworker Treva Crockett Staff Present: Jermain Archield,
Autumn Blair, Spencer Rawlings Date of Incident: 8/31/2023 Client ( ) stepped
on a peer's foot and later hit the peer in the head with a notebook. Staff intervened,
separating the client ( ) from the peer. The Client ( ) tried to break the leg off
of the chair. The Client ( ) then attempted to get a pencil and threatened to stab
someone. The Client ( ) aggression increased when a male staff entered the room.
The Client ( e) punched staff with closed fist and swung at staff with closed fist while
also threatening to harm him. The client ( ) was placed in a child protective position
for 1 minute. The client ( ) got out of the position and continued to hit staff. Bono
Police department was called to the facility at 9:40am. was transported to the
Craighead Juvenile Detention Center in Jonesboro, AR.
Interim Action Narrative: Staff intervened and the residents were separated. Due to
aggression resident was placed in a child protective position. Police were called.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed provider reported incident for licensing
concerns. Licensing Specialist will inquire about camera footage and schedule day/time for
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

review. 9/1/2023, Licensing Specialist will review camera footage on 9/5/2023. 9/5/202,
Licensing Specialist reviewed camera footage.


summary: Officers were dispatched to the facility in response to a juvenile out of control. Staff advised that the resident punched a staff member. The resident was arrested and transported to JDC.

raw_content:
Incident # 23-00486 Bono Police Department Report Date 08/31/23
Page 1 of 2 Incident Report Report Time 1:22 PM
Status Exception Clearance Date Reporting Officer ORI/Agency
Not Applicable 523 Simino, Shannon AR0160700
Active
Assigned Officer Entered By Approving Officer
simino
Assisting Officers
Complainant
Name Contact Name
Daus Rtc Tiffany Harris
Business Address Business Phone
211 N Church ST,Bono, AR 72416 8709358880
Offenses
Incident Location Zone
211 Church ST Bono, AR 72416
Earliest Possible Date Time Latest Possible Date Time
08/31/2023 08:00 08/31/2023 10:30
# Statute/Code Description Fel/Misd Att/Comp Loc Bias Wpn CATypes
1 5-13-203A(2) BATTERY - 3RD DEGREE / RECKLESSLY CAUSES INJURY Misd Completed 4 88 99 P
MO Method Of Entry # Prems
n/a 1
Location Types 13 Hway/Road/Alley 37 Abandoned/Condemned 48 Industrial Site Bias Motivation Codes
14 Hotel/Motel Structure 49 Military Installation 43Lesbian, Gay, Bisexual,
0 0 0 0 0 0 0 0 0 1 1 1 1 2 3 4 5 6 7 8 9 0 1 2 A B B C C C C D D F G G i i a a h o o o e r o r e r u o n r / u m n n p v l B / g d c k N t r s v t / m / e c u / / t e P D S W i S r h r s g n e u u y t i & / / h s r o i S r c T / b e / S c c L t o D t r l y n i i o i C a u o d a c n r c u i p n s l l a n e O / u B n e O g S b t T l f S r d / f f m i S T / e f t t g H o e t r B e a o m r o m l r e r d s k e i p n g p e l a t e l 1 1 1 1 1 F 2 2 2 2 2 5 6 7 8 9 0 1 3 4 5 a c J L L P R R R S S U i a l a i a e p e e e n i q t i k r r e y n s s k l u / k v e i t c n P t o d i a i a / i n c o W r r a e u l e i g w s S l n S r t / a a o y n G L c t t t o n n o / e o e S a O r t r / t r e s a t H / w t o G h g S o r a e a e e m t y r a ra e ti g o e n 3 3 g 4 4 N 4 4 4 M 4 4 8 9 r 0 1 2 4 5 6 7 e o o w A A A C D D F G d u A a a / n r T u a a o a U m e l r d t M m y c m o m n T s s u c k a p e b e / a / s D S C W F / / d l r e r S C i e e m e n a o m h p a t a g c l a i F i a a l n e m s i e d l a r r i a e n r f t i a p c / y u s l u t F t g i h m m P e l r i r i t e o a p y / f F r i u r g o k a n h m i d r t/ Bank 5 5 5 C 5 E 5 M 5 5 5 5 0 1 2 3 4 5 6 7 8 l o i e s l C m l s P R S S S S T C e i y r e o g a c c h h e o i b h h b n n e r e o s m e k o o a t / / t l p t a H U / r m o o e l A P p s r o n L l l r i p y u r l n a m i e - - a / - a n v g S y a n c e i e g t e d M e y r l r c e s s o C a o i s t u l y n s e l n d n d a te ry r A 1 1 A 1 A 1 1 1 O 2 2 N 1 2 3 4 5 6 1 2 m l t a h T W M J C B A A s e e N e k I l m s r a r u a h - a i w a i c t P l a c i e t h t t a i i N i k n e s v a r o - n i r h e c a c l o a i i a c t r f c H i i n v c e A a e s I f I w n r s , i d a c l G a a i i a i n r a n o n d n u e o p o r r r 2 2 2 2 2 3 3 3 L 4 4 3 4 5 6 7 1 2 3 a 1 2 t P I O M A A G L H N in s e r t r i o l t a o u h s o a a h s t y l p e t b m e b t H e i a i ( - r i s s i a m r i n c R s t e t n / i a a p A l c ( e i M n g l a g l e o i t i n g u n o ) r i i s o u c L o l s s a i n o m t t i g r i c n ) ro o up o G 4 4 5 5 6 6 7 7 8 9 r 4 5 1 2 1 2 1 2 8 9 r o T H B P M M F T G N U u r e r i h a e o n e e a p s a m y n t n k n n l e n e e ( s n s e d t x L a s r a g o o e u D G l g l e e w s r a e i D B s n e l N n n a i T d x s d o b e u ) a e n i r a l b r - , i l t C i M y li o ty i n xe fo d rming
Facility/Casino/Race Track
Suspected Of Using Criminal Activity Types Weapon Type(s) 20 Knife/Cutting Instr 65 Fire/Incendiary Device
None B P B P u o y s i s n e g s / s R in e g ce /C iv o in n g cealing C O C O u p l e ti r v a a t t in in g g / / P M ro a m nu o f t / i P n u g b /A li s s s h i i s n t g ing 1 1 1 2 F H i a re n a d r g m u n (A (A ut u o t ) o) 3 3 0 5 B M l o u t n o t r O V b e j h e i c c t le 7 8 0 5 D As ru p g h s y / x N ia a t r i c o . n /Sleeping Pills
D Distributing/Selling T Transport/Import/Transmit 13 Rifle (Auto) 40 Personal Weapons 90 Other
E Exploiting Children U Using/Consuming 14 Shotgun (Auto) 50 Poison 95 Unknown
15 Other Firearm 60 Explosives 99 None
A Simple/Gross Neglect I Intentional Abuse & Torment
F Organized Abuse S Sexual Animal Abuse
Victim #1 Is Complainant Event #s Related 1
Name Contact Name
Daus Rtc Tiffany Harris
Business Address Business Phone
211 N Church ST,Bono, AR 72416 8709358880
Victim Type Injury Type Aggravated Assault/Homicide Circumstances Relationship To Suspect
Business None, None #1 N/A
Justifiable Homicide Circumstances Taken to: (Hospital Name)
None
Injury Description
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 9/18/2023 12:39:37 PM

Incident # 23-00486 Bono Police Department Report Date 08/31/23
Page 2 of 2 Incident Report Report Time 1:22 PM
Suspect #1 - Arrestee #23-A00037
SSN/ID/TIN Title Name DOB Age Sex Resident Status
M Nonresident
Race White Ethnicity DL (#, ST) Email
Not Hispanic/Latino ,
Home Phone Work Phone Other Phone Personal Cell Work Cell
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
211 Church ST,Bono, AR 72416
Work Address Occupation
Height Weight Eyes Build AKA
- -
Arresting Officer Arrest Date Time Arrest Type Warrant Number Juv Disp Disposition Date
523 - Simino, Shannon 8/31/2023 10:15 On-View Arrest Not Reported
Multiple Clearance Indicator BAC BAC Operator Arrest Location Zone
Arrest Cleared Incident Other/Unknown
Weapons At Arrest Court Date Court Name Time
01 - Unarmed
Narrative & Statements
Narrative - Simino, Shannon - 8/31/2023 1:36:52 PM (Initial)
on 8/31/2023 I was dispatched to 211 Church Street at the Daus RTC School in reference to juvenile out of
control, Upon arrival I made contact with Complaint. Complaint stated that arrestee got upset and kicked the trash
can across the room, When staff entered the room he punched one of them. While cursing at them. Complaint said
he has hit the staff in the past and tore up things in the room. Complaint advised when arrestee gets out of control he
causes problems with the other juveniles in the room.
I contacted Amy Powell with Juvenile and advised her of the situation. Amy Powell advised he could be
taken to juvenile detention. I transported Arrestee to the county.
Arrestee will be charged with Battery 3rd
Nothing further at this time.
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 9/18/2023 12:39:37 PM


summary: Officers were dispatched to the facility in response to a disruptive juvenile. Officers spoke with the juvenile and calmed him down.

raw_content:
Incident # 23-00483 Bono Police Department Report Date 08/29/23
Page 1 of 2 Incident Report Report Time 3:56 PM
Status Exception Clearance Date Reporting Officer ORI/Agency
Not Applicable 528 Morgan, Don AR0160700
Active
Assigned Officer Entered By Approving Officer
dmorgan
Assisting Officers
Complainant
Name Contact Name
Dacus Residential Treatment Center
Business Address Business Phone
211 N Church ,Bono, AR 72416 8709328808
Offenses
Incident Location Zone
211 N Church Bono, AR 72416
Earliest Possible Date Time Latest Possible Date Time
08/29/2023 01:00 08/29/2023 02:00
# Statute/Code Description Fel/Misd Att/Comp Loc Bias Wpn CATypes
1 5-71-207A(7) Misd Completed 25 88 99
DISORDERLY CONDUCT / CREATES HAZARDOUS OR PHYSICALLY OFFENSIVE CONDITION
MO Method Of Entry # Prems
n/a 0
Location Types 13 Hway/Road/Alley 37 Abandoned/Condemned 48 Industrial Site Bias Motivation Codes
14 Hotel/Motel Structure 49 Military Installation 43Lesbian, Gay, Bisexual,
0 0 0 0 0 0 0 0 0 1 1 1 1 2 3 4 5 6 7 8 9 0 1 2 A B B C C C C D D F G G i i a a h o o o e r o r e r u o n r / u m n n p v l B / g d c k N t r s v t / m / e c u / / t e P D S W i S r h r s g n e u u y t i & / / s h r o i S r c T / b e / S c c L t o D t r l y n i i o i C a u o d a c n r c u i p n s l l a n e O / u B n e O g S b t T l f S r d / f f m S i T / e f t t g H o e t r B e a o m r o m l r e r d s k e i p n g p e l a t e l 1 1 1 1 1 F 2 2 2 2 2 5 6 7 8 9 0 1 3 4 5 a c J L L P R R R S S U i a l a i a e p e e e n i q t i k r r e y n s s k l u / k v e i t c n P t o d i a i a / i n c o W r r a e u l e i g w s S l n S r t / a a o y n G L c t t t o n n o / e o e S a O r t r / t r e s a t H / w t o G h g S o r a e a e e m t y r a ra e ti g o e n 3 3 g 4 4 N 4 4 4 M 4 4 8 9 r 0 1 2 4 5 6 7 e o o w A A A C D D F G d u A a a / n r T u a a o a U m e l r d t M m y c m o m n T s s u c k a p e b e / a / s D S C W F / / d l r e r S C i e e m e n a o m h p a t a g c l a i F i a a l n e m s i e d l a r r i a e n r f t i a p c / y u s l u t F t g i h m m P e l r i r i t e o a p y / f F r i u r g o k a n h m i d r t/ Bank 5 5 5 C 5 E 5 M 5 5 5 5 0 1 2 3 4 5 6 7 8 l o i e s l C m l s P R S S S S T C e i y r e o g a c c h h e o i b h h b n n e r e o s m e k o o a t / / t l p t a H U / r m o o e l A P p s r o n L l l r i p y u r l n a m i e - - a / - a n v g S y a n c e i e g t e d M e y r l r c e s s o C a o i s t u l y n s e l n d n d a te ry r A 1 1 A 1 A 1 1 1 O 2 2 N 1 2 3 4 5 6 1 2 m l t a h T W M J C B A A s e e N e k I l m s r a r u a h - a i w a i c t P l a c i e t h t t a i i N i k n e s v a r o - n i r h e c a c l o a i i a c t r f c H i i n v c e A a e s I f I w n r s , i d a c l G a a i i a i n r a n o n d n u e o p o r r r 2 2 2 2 2 3 3 3 L 4 4 3 4 5 6 7 1 2 3 a 1 2 t P I O M A A G L H N in s e r t r i o l t a o u h s o a a h s t y l p e t b m e b t H e i a i ( - r i s s i a m r i n c R s t e t n / i a a p A l c ( e i M n g l a g l e o i t i n g u n o ) r i i s o u c L o l s s a i n o m t t i g r i c n ) ro o up o G 4 4 5 5 6 6 7 7 8 9 r 4 5 1 2 1 2 1 2 8 9 r o T H B P M M F T G N U u r e r i h a e o n e e a p s a m y n t n k n n l e n e e ( s n s e d t x L a s r a g o o e u D G l g l e e w s r a e i D B s n e l N n n a i T d x s d o b e u ) a e n i r a l b r - , i l t C i M y li o ty i n xe fo d rming
Facility/Casino/Race Track
Suspected Of Using Criminal Activity Types Weapon Type(s) 20 Knife/Cutting Instr 65 Fire/Incendiary Device
None B P B P u o y s i s n e g s / s R in e g ce /C iv o in n g cealing C O C O u p l e ti r v a a t t in in g g / / P M ro a m nu o f t / i P n u g b /A li s s s h i i s n t g ing 1 1 1 2 F H i a re n a d r g m u n (A (A ut u o t ) o) 3 3 0 5 B M l o u t n o t r O V b e j h e i c c t le 7 8 0 5 D As ru p g h s y / x N ia a t r i c o . n /Sleeping Pills
D Distributing/Selling T Transport/Import/Transmit 13 Rifle (Auto) 40 Personal Weapons 90 Other
E Exploiting Children U Using/Consuming 14 Shotgun (Auto) 50 Poison 95 Unknown
15 Other Firearm 60 Explosives 99 None
A Simple/Gross Neglect I Intentional Abuse & Torment
F Organized Abuse S Sexual Animal Abuse
Suspect #1
SSN/ID/TIN Title Name DOB Age Sex Resident Status
M Unknown
Race White Ethnicity DL (#, ST) Email
Not Hispanic/Latino ,
Home Phone Work Phone Other Phone Personal Cell Work Cell
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
211 N Church ST,Bono, AR 72416
Work Address Occupation
Height Weight Eyes Build AKA
- -
Narrative & Statements
Narrative - Morgan, Don - 8/29/2023 4:01:10 PM (Initial)
On 8/29/2023 I Officer Morgan was dispatched to the Dacus Center at 211 N. Church St. in reference to one
of the juvenile patients being disruptive and causing problems. Upon arrival I spoke with one of the employees.
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 9/18/2023 12:39:24 PM

Incident # 23-00483 Bono Police Department Report Date 08/29/23
Page 2 of 2 Incident Report Report Time 3:56 PM
Narrative & Statements
Narrative - Morgan, Don - 8/29/2023 4:01:10 PM (Initial)
She took Deputy Drum and myself in to where the patients room. We spoke with the patient and got him calmed
down. He advised that he did take a piece of wood off the bed and was hitting the walls just to make noise. He
advised that he never tried to attack anybody. He advised that the people there were unfair and he wanted to
leave, that's why he was acting up. He stated that he would lay down and would not cause anymore trouble and
talk to his counselor in the morning. Nothing further to report at this time.
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 9/18/2023 12:39:24 PM


summary: Officers were dispatched to the facility in response to an out-of-control juvenile. The officer spoke to the juvenile who advised the behavior wouldn’t happen again.

raw_content:
Incident # 23-00466 Bono Police Department Report Date 08/23/23
Page 1 of 2 Incident Report Report Time 2:05 PM
Status Exception Clearance Date Reporting Officer ORI/Agency
Not Applicable 523 Simino, Shannon AR0160700
Active
Assigned Officer Entered By Approving Officer
simino
Assisting Officers
Complainant
Name Contact Name
Dacus School Waynette Banks
Business Address Business Phone
211 Church ST,Bono, AR 72416 8709328880
Offenses
Incident Location Zone
211 Church ST Bono, AR 72416
Earliest Possible Date Time Latest Possible Date Time
08/23/2023 14:05 08/23/2023 14:05
# Statute/Code Description Fel/Misd Att/Comp Loc Bias Wpn CATypes
1 5-13-203A(1) BATTERY - 3RD DEGREE / PURPOSE OF CAUSING INJURY, CAUSES INJURY Misd Completed 25 88 99 P
MO Method Of Entry # Prems
n/a 1
Location Types 13 Hway/Road/Alley 37 Abandoned/Condemned 48 Industrial Site Bias Motivation Codes
14 Hotel/Motel Structure 49 Military Installation 43Lesbian, Gay, Bisexual,
0 0 0 0 0 0 0 0 0 1 1 1 1 2 3 4 5 6 7 8 9 0 1 2 A B B C C C C D D F G G i i a a h o o o e r o r e r u o n r / u m n n p v l B / g d c k N t r s v t / m / e c u / / t e P D S W i S r h r s g n e u u y t i & / / s h r o i S r c T / b e / S c c L t o D t r l y n i i o i C a u o d a c n r c u i p n s l l a n e O / u B n e O g S b t T l f S r d / f f m S i T / e f t t g H o e t r B e a o m r o m l r e r d s k e i p n g p e l a t e l 1 1 1 1 1 F 2 2 2 2 2 5 6 7 8 9 0 1 3 4 5 a c J L L P R R R S S U i a l a i a e p e e e n i q t i k r r e y n s s k l u / k v e i t c n P t o d i a i a / i n c o W r r a e u l e i g w s S l n S r t / a a o y n G L c t t t o n n o / e o e S a O r t r / t r e s a t H / w t o G h g S o r a e a e e m t y r a ra e ti g o e n 3 3 g 4 4 N 4 4 4 M 4 4 8 9 r 0 1 2 4 5 6 7 e o o w A A A C D D F G d u A a a / n r T u a a o a U m e l r d t M m y c m o m n T s s u c k a p e b e / a / s D S C W F / / d l r e r S C i e e m e n a o m h p a t a g c l a i F i a a l n e m s i e d l a r r i a e n r f t i a p c / y u s l u t F t g i h m m P e l r i r i t e o a p y / f F r i u r g o k a n h m i d r t/ Bank 5 5 5 C 5 E 5 M 5 5 5 5 0 1 2 3 4 5 6 7 8 l o i e s l C m l s P R S S S S T C e i y r e o g a c c h h e o i b h h b n n e r e o s m e k o o a t / / t l p t a H U / r m o o e l A P p s r o n L l l r i p y u r l n a m i e - - a / - a n v g S y a n c e i e g t e d M e y r l r c e s s o C a o i s t u l y n s e l n d n d a te ry r A 1 1 A 1 A 1 1 1 O 2 2 N 1 2 3 4 5 6 1 2 m l t a h T W M J C B A A s e e N e k I l m s r a r u a h - a i w a i c t P l a c i e t h t t a i i N i k n e s v a r o - n i r h e c a c l o a i i a c t r f c H i i n v c e A a e s I f I w n r s , i d a c l G a a i i a i n r a n o n d n u e o p o r r r 2 2 2 2 2 3 3 3 L 4 4 3 4 5 6 7 1 2 3 a 1 2 t P I O M A A G L H N in s e r t r i o l t a o u h s o a a h s t y l p e t b m e b t H e i a i ( - r i s s i a m r i n c R s t e t n / i a a p A l c ( e i M n g l a g l e o i t i n g u n o ) r i i s o u c L o l s s a i n o m t t i g r i c n ) ro o up o G 4 4 5 5 6 6 7 7 8 9 r 4 5 1 2 1 2 1 2 8 9 r o T H B P M M F T G N U u r e r i h a e o n e e a p s a m y n t n k n n l e n e e ( s n s e d t x L a s r a g o o e u D G l g l e e w s r a e i D B s n e l N n n a i T d x s d o b e u ) a e n i r a l b r - , i l t C i M y li o ty i n xe fo d rming
Facility/Casino/Race Track
Suspected Of Using Criminal Activity Types Weapon Type(s) 20 Knife/Cutting Instr 65 Fire/Incendiary Device
None B P B P u o y s i s n e g s / s R in e g ce /C iv o in n g cealing C O C O u p l e ti r v a a t t in in g g / / P M ro a m nu o f t / i P n u g b /A li s s s h i i s n t g ing 1 1 1 2 F H i a re n a d r g m u n (A (A ut u o t ) o) 3 3 0 5 B M l o u t n o t r O V b e j h e i c c t le 7 8 0 5 D As ru p g h s y / x N ia a t r i c o . n /Sleeping Pills
D Distributing/Selling T Transport/Import/Transmit 13 Rifle (Auto) 40 Personal Weapons 90 Other
E Exploiting Children U Using/Consuming 14 Shotgun (Auto) 50 Poison 95 Unknown
15 Other Firearm 60 Explosives 99 None
A Simple/Gross Neglect I Intentional Abuse & Torment
F Organized Abuse S Sexual Animal Abuse
Victim #1 Event #s Related 1
SSN/ID/TIN Title Name DOB Age Sex Resident Status
Rawlins, Spencer Lane 25 M Resident
Race White Ethnicity DL (#, ST) Email
Not Hispanic/Latino
Home Phone Work Phone Other Phone Personal Cell Work Cell
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
Methodist Family Heath Dacus Rtc
Work Address Occupation
211 W Church ST,Bono, AR 72416
Victim Type Injury Type Aggravated Assault/Homicide Circumstances Relationship To Suspect
Individual None, None #1 N/A
Justifiable Homicide Circumstances Taken to: (Hospital Name)
None
Injury Description
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 9/18/2023 12:38:58 PM

Incident # 23-00466 Bono Police Department Report Date 08/23/23
Page 2 of 2 Incident Report Report Time 2:05 PM
Suspect #1
SSN/ID/TIN Title Name DOB Age Sex Resident Status
M Nonresident
Race White Ethnicity DL (#, ST) Email
Not Hispanic/Latino ,
Home Phone Work Phone Other Phone Personal Cell Work Cell
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
211 Church ST,Bono, AR 72416
Work Address Occupation
Height Weight Eyes Build AKA
- -
Narrative & Statements
Narrative - Simino, Shannon - 8/24/2023 9:19:26 AM (Initial)
On 8/22/2023 I was dispatched to 211 Church street in reference to a suspect (juvenile) out of control. Upon
arrival I made contact with Complaint. Complaint stated they had a juvenile hitting one of the staff members.
Complaint called for Victim to speak with me. Victim stated when he walked into the room where Suspect ran up and
started hitting him with a tee shirt and cursing at him. Victim then through punches striking Victim. The Victim didn't
want to pursue charges, He wanted me to talk to suspect about his behavior. I spoke with suspect and he advised
this wouldn't happen again.
Nothing further at this time.
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 9/18/2023 12:38:58 PM


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

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

Dacus RTC Kendra Rice
211 CHURCH STREET Donaghey Plaza
BONO AR 72146 P.O. Box 1437

Little Rock, AR. 72203

Facility Visit Compliance Notice

Facility#: 108

Date of Visit: 8/22/2023

Visit Type(s): Subsequent Building and Grounds
Time: 1:30 PM - 3:02 PM

Visit Comment :
Time of visit: 1:30 pm to 3:00 pm

Census: 15

Licensing Specialist completed buildings and grounds and observed the following areas: activity room, dining
room, nurse’s station, big boys hall, little boys hall, laundry room, focus room, seclusion rooms, and
classrooms.

Licensing Specialist was escorted by Ms. |), Program Director. Walking into the building,
Licensing Specialist observed parked cars and a van for transportation. The grounds were well maintained and
free of safety hazards.

All posters were covered with plexiglass. Smoke detectors and sprinklers were covered with plastic coverings.
The exit signs were covered with metal case to prevent residents from hitting the signs. The fire extinguishers
were in a locked metal case. Licensing Specialist informed that staff members have keys for the locks.

Entering the big boy and little boy hallways, Licensing Specialist could smell the aroma of cleaning products.
All bedrooms were cleaned and organized. All bathrooms were clean with running hot and cold water.
Licensing Specialist observed evacuation plans in each of the bathrooms and bedrooms.

Page 1 of 2

Licensing Specialist observed the medication cart where medications are kept for the residents. Nurse
provided Licensing Specialist with the MAR’s. Licensing Specialist observed the protocol for the stairs at the
top and bottom of the stairs.

Water fountains were observed in the hallways of the bedrooms and classroom hall.

Ratio 2:5 big boy class. Ratio 2:7 little boy class. There was a staff member and resident in the hallway, ratio
1:1.

Licensing Specialist spoke with JJ, Maintenance, regarding the last fire drill. Mr. JJ showed Licensing
Specialist the logbook of fire drills. The last fire drill was completed on 8/6/2023 at 7:11 am. Licensing
Specialist informed that Bono Fire Department has a new Fire Chief and inspection has been scheduled.
Licensing Specialist will follow-up in 30 days.

Ms. J. Administrative Case Manager, showed Licensing Specialist the logbook for hotline/incidents.

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

All initialed and up to date.

CCL Staff Signature : Date: 8/22/2023
Ny) ;
Provider Signature : Date: 8/22/2023

Ih Va

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

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

Page 2 of 2


summary: After a physical altercation with a peer, a resident wrapped clothing around his neck. Staff removed the clothing.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 7/15/2023
Date Received by DCCECE: 7/17/2023
Facility Name: Dacus RTC
Facility Number: 108
Incident Type: Licensing
Report Description: Client: birthdate: Foster Child: Sebastian County
DHS-Melissa Kaupp Caresource Staff Present: Shantelle Moore and Eric Bonner Date of
Incident: 7/15/2023 Client got into a verbal altercation with peer. The Peer proceeded
to jump over the table to get to the Client . The Client and the Peer exchanged
hits with closed and open hands. After the two were seperated by staff, the Client
became defiant throwing items and getting on top of tables. Client threatened to
elope and tried to break in the cafeteria window. Client took his shoes, socks, and
shirt off. Client later took clothing and wrapped it around his neck. Staff removed
clothing. Client did not have any injuries. No pain noted. Client was placed on 60k
focus, Assault precautions, Elopement precautions, and Suicide precautions.
Interim Action Narrative: Staff removed piece of cloth from the resident. He was assessed
by nursing. Resident was placed on 60k focus, assault precautions, elopement precautions,
and suicide precautions.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed provider reported incident. Licensing
Specialist will inquire about camera footage and schedule a day and time to review.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Specialist will review camera footage on 7/20/2023. 7/20/2023, Licensing
Specialist reviewed camera footage.

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Dacus RTC
Facility Number: 108
Licensee Address: 211 CHURCH STREET
BONO AR 72146
Licensing Specialist: Kendra Rice
Person In Charge: Waynette Banks
Record Visit Date: 7/20/2023
Home Visit Date: 7/20/2023
Purpose of Visit: Self Report Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Time of Visit: 11:00 am to 12:45 pm
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 3

Census: 13
Licensing Specialist spoke with Ms. Waynette Banks, Program Director, regarding ELS Case #015121.
Licensing Specialist reviewed camera footage for ELS Case #015121 for licensing concerns. The provider
reported incident took place in the dining room area, ratio 2:4. Licensing Specialist observed two (2) residents
sitting down at the table and two (2) walking around the dining room area.
Licensing Specialist observed resident come across the table, jump on the table, jump off the table toward his
peer, and the altercation began. Licensing Specialist observed staff separate the residents by taking them to
different areas of the dining room. The resident broke free from staff and ran around the room toward his peer.
Resident was seen running toward a corner of the dining room area that was off camera. Two (2) of the
residents were removed from the dining room area into the day area, ratio 2:2.
Licensing Specialist observed resident jumping on the tables, turning flips, banging on the serving window,
banging on the door leading to the nursing area, banging on the walks, and laying on the seal of the serving
window and floor. At 3:51 pm, Licensing Specialist observed resident take off his socks and shoes and he
continued to jump on the tables. Licensing Specialist observed staff what appeared to be talking to the
resident. Resident was observed throwing his shoes at the serving window and banging his shoe against the
window.
At 3:53 pm, Licensing Specialist observed resident what appeared to be meditating (yoga style) sitting on top
of the table. Licensing Specialist observed resident walking around the dining room with his hands covering
his ears, ratio 2:1. The other resident was in the nursing area. Resident was observed sitting in the floor where
it appeared that he removed his shirt and placed it around his neck. Licensing Specialist observed staff around
the resident and the shirt was removed.
Resident was observed grabbing a jacket and attempting to wrap it around his neck. Staff was observed
removing the jacket from the resident. Licensing Specialist observed resident take a sock and attempted to put
it around his neck. When staff attempted to take the sock from the resident he ran around the room. Licensing
Specialist observed resident lay on the floor and the sock was removed by staff. Resident was observed with
only his pants on. Licensing Specialist observed staff on her cell phone.
At 4:19 pm, Licensing Specialist observed the Program Consultant enter the dining room. Resident and
Program Consultant left the dining room area and the other staff went to the day area.
Provider Comments:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 3

CCL Staff Signature : Date: 8/23/2023
Provider Signature : Date: 8/23/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 3 of 3


summary: A resident stated that he wanted to die then took a piece of blue jean material and wrapped it around his neck. Staff removed the fabric.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 7/13/2023
Date Received by DCCECE: 7/14/2023
Facility Name: Dacus RTC
Facility Number: 108
Incident Type: Licensing
Report Description: Client: D.O.B: Insurance: Empower Private
Pay: Guardian-grandmother- Staff present: Charles Sigman Date of Incident:
7/13/2023 Client ( ) kicked wood panel out from the bed. Client ( ) used the
panel to knock holes in the wall. Client ) stated," he wanted to die". While in his
bedroom, Client took a piece of blue jean material from his jeans and wrapped it
around his neck. Staff retrieved the fabric. Client ( ) did not have any injuries. No
pain noted. Client ( ) was placed on assault precautions, suicide precautions, and line
of sight to be directly supervised by staff at all times.
Interim Action Narrative: Staff intervened by taking the piece of jean material from resident.
He was placed on assault precautions, suicide precautions, and line of sight to be directly
supervised by staff at all times.
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist reviewed provider reported incident for licensing
concerns. Licensing Specialist will inquire about the damages. Licensing Specialist
informed that the Maintenance Supervisor is scheduled to have repairs completed by 1:00
pm. There is no camera footage due to incident taking place in the resident's bedroom.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


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

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Dacus RTC
Facility Number: 108
Licensee Address: 211 CHURCH STREET
BONO AR 72146
Licensing Specialist: Kendra Rice
Person In Charge: Waynette Banks
Record Visit Date: 7/6/2023
Home Visit Date: 7/6/2023
Purpose of Visit: Special Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Time of Visit: 1:15 pm to 2:30 pm
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Census: 13
Licensing Specialist conducted an annual review of policies and procedures for Dacus RTC at Methodist
Family Health. Fatima Stepps, Compliance Specialist, assisted Licensing Specialist with the review.
Policies and procedures for Dacus RTC complied with minimum licensing standards.
Provider Comments:
CCL Staff Signature : Date: 8/17/2023
Provider Signature : Date: 8/17/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident wrapped an HDMI cord around his neck. Staff removed the cord. Then, the resident attempted to use the metal part from staff’s clipboard to cut his arm. The wound was cleaned and bandaged, and the resident was placed on precautions.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 7/2/2023
Date Received by DCCECE: 7/3/2023
Facility Name: Dacus RTC
Facility Number: 108
Incident Type: Licensing
Report Description: Client: D.O.B: Insurance: Empower Private
Pay: Guardian-grandmother- Staff present: Shantelle Moore and Sara Virgin
Date of Incident: 7/2/2023 Staff(Shantelle) informed the client( ) it was time for bed.
Client( ) refused to go to bed. Client( ) ran behind the desk detached the
HDMI Cord and wrapped it around his neck. Client ( ) crawled under the desk. Staff
unwrapped the cord from around the client's ) neck. Client ( grabbed a
staff's clipboard, ran down the hallway and tried to use the metal part to cut his arm. The
nurse noted client( ) made a small 1-2cm abrasion to left forearm. A small amount of
blood was noted. Client ( ) denied having pain. The wound was cleaned and
bandaged. Client ( ) was placed on assault precautions, elopement precautions,
suicide precautions, and line of sight to be directly supervised by staff at all times.
Interim Action Narrative: Resident was assessed by the nurse. Wound was cleaned and
bandaged. He was placed on assault, elopement, and suicide precautions. Resident was also
placed on line of sight.
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing Specialist reviewed provider reported incident. Licensing
Specialist will inquire about camera footage. Licensing Specialist informed camera footage
is available. Licensing Specialist will schedule a day and time to review camera footage.
7/11/2023, Licensing Specialist reviewed camera footage.