summary: A resident was sent to Urgent Care after punching a window during a behavior.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 023883
Date of Incident: 9/9/2024
Date Received: 9/10/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Sturgis House Incident report date/time:
09/09/24 8:35am Location of Incident: Sturgis House Incident Description: Aggressive to
Adults, Threat to Safety, Property Destruction Staff Involved: Jonathan Pulliam, Barrett
Harger, Marilyn Howell Events Leading: UM received a text from staff saying that they may
have to do an all call due to behavior. I replied that I was on my way. Once
entering Sturgis, was observed "bowing up" on staff threatening to punch them.
was asked what was going on and replied that "this place is just like all the others".
began walking around the milieu throwing things off staff's desk and flipping over
furniture. then walked towards the front door and with one kick, kicked it open and
want outside. 8:35am-Personal Restraint: was placed in a personal restraint after
kicking the front door open and going outside. Pt was escorted back into the house.
is cursing and yelling at staff as staff try talking with him. 8:36am-Personal Restraint End:
is released in the comfort room. is continuing to yell and threaten staff.
punches the window to the comfort room. Staff are able to continue talking with him and he
is able to calm and be assessed by the Nurse and return to his area. Patient Debriefing
date/time: 09/09/24 9:00am: talked with his therapist about his behaviors.
was able to return to his area with no further issues thus far. Injuries to staff or client: PT's
right pinky knuckle swollen Follow-up to the injury: Ice pack given. Pt will be going to
Urgent Care or ER when deemed safe to do so Note: This UM initiated the personal
restraint. Pt left at 1730 for Ortho Urgent Care. Pt returned at 1950 results of the visit are as
follows Recommendations are use ulnar
gutter brace, elevate right hand at rest, take nsaids or tylenol prn for pain. Wear brace until
symptoms improve. Nursing Assessment date/time: 09/09/24 8:50am: Pt. seen after being
placed in a physical restraint from 0835 - 0836. Pt was informed that he could not attend
school today and became very upset; he was aggressive with staff, destroyed property, and
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

became a threat to safety. When I arrived, pt. was in the comfort room looking out window
with therapist speaking with him. Pt. agreed to let me to a physical assessment on him. Pt.
calm currently, able to come out of the comfort room and walk to the milieu. No abnormal
gait noted, pt stated that he is having pain in his right hand. Redness noted to knuckles,
capillary refill<3secs, has limited ROM, pain verbalized when attempting to close hand,
tenderness noted to right pinky when palpated. Pt. has possible injury to right pinky as it
does not align with other fingers when pt. extends finger. Pt. has small wound noted to right
index finger; area cleaned, triple antibiotic ointment & Band-Aid applied. Pt. denies any
other injury. VSS: 96% on RA, 147/94. 89, 18, 10/10. The provider present during assessment
wants to send pt. to urgent care to have hand x-rayed for injury & treatment. Guardian was
notified on 09/09/24 at 9:03am and 9:35am. Urgent Care paperwork will be emailed to
Kendra Slade on 09/09/24
Interim Action Narrative: Resident placed in a restraint for safety, assessed by the nurse,
and evaluated at urgent care.
Maltreatment Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensng concerns.
Facility provided documentation for this incident. Program Coordinator will inquire of any
damages. Facility reported that the door was not damaged and is working properly.


state: AR

facility_name: Youth Home

summary: A resident was sent to Arkansas Children’s Hospital for evaluation after an altercation with peers.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 023824
Date of Incident: 9/5/2024
Date Received: 9/6/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Sturgis House Incident report
date/time: 09/05/24 11:30am Location of Incident: Siebert School Incident Description:
Medical Emergency (Trip to ER/Urgent Care) Staff Involved: Valerie Alvarez, Angela Shy
Events Leading: was seen today for routine weekly medication management and
evaluation. He discussed the physical altercation that occured over the weekend. After
asking direct questions, it was determined he will be sent to ACH ER to rule out concussion
or other injuries. Nursing Assessment date/time: 09/05/24 11:30am: was seen today
for routine medication management and evaluation. He reported to be "good" today. He
reports his week is getting "better". Denies peer conflict. He reports he can get to sleep but
wakes throughout the night. Feels the Vyvanse 10mg "definitely helps". Discussed he feels
he could benefit from bumping the dose up. Discussed past medications trials. Discussed
fight that occurred over the weekend. He feels that he and the peers that hit him have
restored and he feels safe around them. He discussed he is mostly upset with the 2 that
instigated the altercation. He has a mild headache, predominantly on the right side of his
head, that has remained. He admits only mentioning this to the nurse the day of the
incident and received apap. Upon further questioning, he endorsed blurred vision out of (R)
eye and a popping/clicking jaw. Denies any nausea, vomiting, weakness, numbness,
tingling, fatigue, sensitivity to light or noise, or tinnitus. He reported pain on inhalation on
the right lower back, no obvious bruising noted, and no difficulty taking a breath. No signs
of respiratory distress, retractions, accessory muscle use, or nasal flaring. No visible signs of
trauma, erythema, bruising, abrasions, lacerations, deformities, deviations, protrusions, or
edema. No signs of trauma or abnormalities to oral mucosa. To be noted: there is some sort
of hyperpigmentation/scar tissue noted above his (R) eye in which he reports is the result of
an older injury. Denies difficulty eating/swallowing/talking. No palpable hematomas were
noted to scalp. He answers appropriately. Clear, calm coherent speech. AAOx4. PERRLA.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Grip strength bil equal, +2. Capillary refill brisk, less than 3 seconds, and WNL. Gait is
steady. Discussed when at home, he usually takes 800mg of IBP once daily. No further
concerns or physical complaints voiced. Due to c/o continued headache, clicking/popping
jaw, and blurred vision out of (R) eye, MD ordered for to be transported to ACH to
rule out concussion or any other sustained injuries. increase in addition to increasing
trazodone 150mg QHS and schedule ibuprofen 800mg BID x3 days Guardian was notified
on 09/05/24 at 1:15pm ER paperwork was emailed to Kendra Slade on 09/06/24
Interim Action Narrative: Resident was assessed and transported to ACH for further
evaluation.
Maltreatment Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Facility provided documentation for this incident.

doc_type: Notice of Incident


summary: A resident was transported to Arkansas Children’s Hospital for evaluation after complaints of pain following an altercation with peers.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 023745
Date of Incident: 9/4/2024
Date Received: 9/5/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Rose House Incident Report
date/time: 09/04/24 1:12pm Location of incident: Siebert School on the Youth Home
campus Incident Description: Aggressive to Peers, Threat to Safety, Medical
Emergency(Trip to ER/Urgent Care) Staff Involved: Marilyn Howell, Valerie Alvarez,
Caitlin Henthorne Events Leading: Peers were in conflict in class and pt was inserted into
the conflict. Pt expressed not wanting to pick sides but a peer charged at pt, swinging fists.
Pt raised her fists to fight back. Pt was restrained. 1:12pm-Personal Restraint: Pt was placed
in a personal restraint and escorted away from her peer. Pt began swinging to hit peer
several times but once she was guided away from peer, she ceased in attempting to fight.
1:14pm-Personal Restraint End: Once the classroom was clear of the other peers. Pt and
staff sat on the floor. Pt contracted for safety and cried about her head hurting due to being
struck by peer. Patient Debriefing date/time: 09/04/24 1:30pm: Time was spent validating
pt's feelings as she explained her account of the incident. Pt stated she did not want to
"pick sides" in the conflict. While debriefing, pt expressed no concerns with the restraint
but stated her head her significantly from being attacked. Pt was also remorseful towards
staff during debriefing. Pt asked if she could press charges and the nurse stated she would
inform pt's parents of her wishes. After nursing assessment it was determined pt needed to
be sent out for medical care to assess her post being struck in the head. Nursing
Assessment 1 date/time: 09/04/24 1:19pm: was observed sitting against the wall,
next to staff, tearful, diaphoretic, exclaiming her head hurts. She voiced being struck by her
peer on her (L) temple. She reported, "she hit me on my head, and I hit her back". She
stated, "she ran up on me. I told her to calm down, and I told her I wasn't picking sides".
AAOx4. Clear coherent speech although appears overwhelmed, distressed, and in pain. She
voiced significant increased pain and pressure of her (L) temple. Rating pain 10/10. No
signs of slurred speech. Responds appropriately. Pupils initially unequal and slow to
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

respond and small. Anisocoria noted. (L) pupil noted at 4mm and (R) pupil noted at 3mm.
Denies any numbness, weakness, tingling, sensitivity to light or noise, nausea, vomiting,
feeling lightheaded, or nausea. BP: 148/91, HR 90. Temp: 99.2. RR 22 breaths/min,
unlabored. No signs of respiratory distress. No retractions, accessory muscle use, or nasal
flaring. SpO2 saturation 99%. Grip strength bil equal +2. Gait is steady. Bruising beginning
to form on (L) temple and swelling where patient reports being struck. Erythema noted
below (L) eye that appears to be consistent with being struck and alongside (L) jawline.
Able to open and close mouth without difficulty. MD notified of findings. Approved order to
administer ibuprofen 600mg po x1 now and transport to ACH ER for further evaluation and
rule out concussion. continued: was able to swallow without difficulty. No signs of
hoarseness, cough, SOB, or wheezing.She endorsed also being struck on her neck, left side.
She voiced feeling as if her peer struck her in this location (near carotid sinus) with intent to
cause a syncope episode. No visible or apparent physical markings, erythema, or edema
noted to this area. Denies pain at this time. Voiced the pressure in her head continues to
hurt, and is 10/10 pain with 10 being the worst pain. No palpable hematomas noted to scalp.
No apparent physical markings, erythema, bruising, abrasions, deformities, edema, or
protrusions noted from emergency interventions. Active ROM to all extremities. Gait is
steady. To be noted: she has a split on her (R) hand/arm following punching the wall at
some point over the weekend/Monday that was evaluated on Monday at urgent care with
findings: Right hand swelling and tenderness to touch X-ray result
No apparent further injuries noted. Capillary refill less than 3 seconds
and WNL. Injuries to Staff or client: Pt was struck in the head/face and peer was struck as
well. Follow-up to injury: Nursing assessed both pts and sent this pt out to the ER for
assessment due to being struck in the head. Actions that might have prevented injury: If
staff had called for help, perhaps additional staff could've helped separate the class sooner.
However, multiple pts were escalated in the school at the time, making help difficult to
come by. If peer had used coping skills, not attempted to fight, or accepted pt's stance of
not wanting to take sides, injuries would not have occurred. Guardian was notified on
09/04/24 at 1:40pm ER paperwork was emailed to Kendra Slade on 09/05/24
Interim Action Narrative: Resident was assessed by the nurse and evaluated at ER.
Maltreatment Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Facility provided documentation for tihs incident.


summary: A resident became aggressive after learning she would be transferred to an acute facility. The resident tried to rush past staff, continuing to escalate, and was placed in a restraint.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 023632
Date of Incident: 8/28/2024
Date Received: 8/29/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Clients were told to return to their bedrooms in preparation for the next
structured activity. The client was asked not to as this client would be transferred to an
acute facility. Upon hearing this information, the client became aggressive and tried to rush
past staff to open the door to the hallway which was being blocked by a staff member. Staff
tried to reassure the client that they would be safe in this new placement and attempted to
verbally de-escalate the situation however the client was not receptive to verbal de-
escalation. The client was irate with receiving this information. Client continued to escalate,
and attempted to continue to force her way through staff down the hallway. Client placed in
personal restraint to remove computer components from her hands. Client physically
resisted against the restraint and became tearful with the news of being transferred to acute.
Client feelings were validated by staff. Client dropped to the floor in a seated position and
staff followed the momentum and continued restraint for safety. Client attempted to strike
out towards staff with her hands, and clawed at client hands, contorting her body. Client
made several demands to talk with a peer she identifies as her boyfriend and was denied.
Client then made demands to call her father, and agreed to willingly go with MEMs for
transport. Staff facilitated this call. Nursing Assessment The nurse informed staff that all
patients needed to return to their rooms due to the arrival of MEMs to transport a patient to
an acute facility. The patient in question was instructed not to return to her room because of
her upcoming transfer. Upon receiving this information, the patient became aggressive and
attempted to push past staff to access the hallway. Staff reassured her that she would be safe
in the new placement and tried verbal de-escalation techniques, but the patient did not
respond positively. The patient became increasingly agitated and continued to force her way
through staff down the hallway. At this point, the patient was placed in a personal restraint
to remove computer components from her hands as she made several attempts to strike staff
and clawed at their hands. The patient repeatedly requested to speak with a peer she
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

identified as her boyfriend, which was denied. She then demanded to call her father and
eventually agreed to cooperate with MEMs for transport. After contracting for safety, she
was released from the hold, and staff facilitated the call with her father. The phone call did
not go well; the patient became upset and began wrapping the phone cord around her hand,
necessitating another personal restraint to retrieve the cord. Patient contracted to safety and
was released from the personal restraint. The nurse did not complete a full face-to-face
assessment as MEMs was already on the scene to transport the patient. The nurse observed
that the patient showed no signs of pain and did not express any concerns, other than her
reluctance to leave as she got onto the cot. The patient sat calmly with a comfort pillow as
she was placed into the MEMs vehicle. She departed the facility at 7:23 PM via MEMs, en
route to ACH with the plan to transfer to Bridgeway for acute care. The on-call UM was
present during the incident, and the on-call therapist was notified at 7:25 PM. The on-call
MD was informed and approved the orders for the facility transfer and personal restraints at
7:29 PM. The patient's father was informed at 8:30 PM that she had been transferred to
ACH with intentions to move to Bridgeway for acute care, and he had no further questions
or concerns at that time.
Interim Action Narrative: Resident was placed in a restraint for saftey, assessed by the
nurse, and transported via MEMS to the hospital.
Maltreatment Narrative:
Licensing Narrative: Program Coordinator received an email stataing facility was unable to
enter provide reported incident and received an error message. 8/30/2024, Program
Coordinator reviewed provider reported incident for licensing concerns and uploaded
documentation. 9/3/2024, Program Coordinator reviewed documentation and inquired if
light cover was replaced. Facility reported light cover has been replaced.


summary: Resident complained of blurry vision and dizziness after hitting her head on a door. The resident was transported to Arkansas Children’s Hospital for evaluation.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 023515
Date of Incident: 8/25/2024
Date Received: 8/26/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Rose house Incident Report
date/time 08/25/24 6:36pm Location of Incident: Rose house Incident Description:
Medical Emergency(Trip to ER/Urgent Care) Staff Involved:
Events Leading: Patient was at gym and went to the bathroom
and stated she bumped her head on the bathroom door while exiting. Nurse arrive to patient
in the gym sitting on floor with staff. Patient verbalizing that her vision is blurry and dizzy.
Poor cognition noted. vital unremarkable BP-115/82, Pulse 113, Resp. 18/min, Pulse ox 97%.
Waited 15 minutes and rechecked vitals and still unremarkable. Attempted to walk to house
and after the stairs patient went limp and lowered to the ground. Reassessed and vitals bp-
136/88, resp. 19/min, pulse ox 98%. After 15 minutes two staff attempted to support and
walk patient to rose house. Upon entry to rose house began to loose strength and went limp
and lowered to the floor. Seizure like presents noted. Nursing Assessment date/time:
08/25/24 6:36pm: Patient presents on rose floor after being walked with two staff supporting
from gym post dizziness, double vision reported, and agonal/gasping breathing poor
unstable gate noted. Unable to obtain bp due to movement., Respirations 27 per minute of
short gasping breaths. Pulse ox 97% on room air. pulse 118. Seizure like presentation noted.
Pt unable to provide orientation and utilize conversation at this time. Poor cognition
displayed. MEMs notified and transported to ACH by ambulance. Guardian was notified on
08/26/24 at 7:26pm ER paperwork was emailed to on 08/26/24.
Interim Action Narrative: Resident was assessed by the nurse and transported to the ER via
MEMS.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Maltreatment Narrative:
Licensing Narrative: Licensing reviewed provider reported incicdent for licensing concerns.
Facility provided documentation for this incident and it has been uploaded.


summary: A resident was transported for acute care after exhibiting self-harming behaviors.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 023554
Date of Incident: 8/24/2024
Date Received: 8/28/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Reports for
client in our PRTF program and resides in Rose House Incident Report 1
date/time: 08/24/24 4:35pm Location of Incident: Rose House Incident Description:
Threat to Safety, Property Destruction Staff Involved:
Events Leading: Patient was walking through living area
being defiant to peer property, attempting to hide between washer and dryer when informed
by staff that was a safety issue, climbing onto furniture and jumping off of furniture despite
staff redirection. Patient obtained a broken rubber hair band and attempted to put it up to
her neck in a manor to choke self. Unsafe behavior due to climbing and obtaining items she
cannot have on eyeball precaution. 4:35pm Personal Restraint: Patient placed into personal
restraint due to performing unsafe behavior such as climbing onto furniture and jumping off
it in a reckless manner. Patient was defiant to staff redirection to remain safe and stop
jumping off of furniture. Patient currently hyperactive, covert, and attention seeking. Staff
continued to educate patient on discontinuing reckless unsafe behavior and her options
provided included stop jumping onto and off of furniture or staff would intervene to keep
patient safe. 4:45pm Personal Restraint End: Patient verbalizing that she can be safe and
wants to be released from intervention. Patient reports understanding of contracting to
safety and states "I will stop jumping off furniture and be safe now." Patient beginning to
calm and show cooperative affect and released from hold. Patient Debriefing date/time:
08/24/24 4:45pm: Discussed patient safety concerns implied by patient activity which
included threat of safety of patient falling and injuring herself from jumping of furniture and
causing bodily harm. Intervention hold procedure discussed and all members agreed that
intervention was performed in accordance with training in a safe manner. De-escalation
verbridge was noted to be satisfactory attempting to challenge patient behavior and educate
patient to reframe from unsafe behavior being performed. Nursing Assessment 1 date/time:
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08/24/24 4:45pm: Patient presents in rose living area after intervention. Pt calming but still
hyperactive and attempting to defy staff direction despite redirection. Pt alert and oriented
to person place time and event. Pt denies having injury and physical complaint due to
intervention. Pt remains agitated and not able to follow staff directions at this time. Nursing
Assessment 2 date/time: 08/25/24 8:36am: Patient was reported from staff to have
transported by MEMS to pinnacle point behavioral hospital per transport order received
yesterday. Guardian was contacted on 08/24/24 at 6:24pm Incident Report 2 date/time:
08/24/24 5:50pm Location of Incident: Rose House Incident Description: Threat to Safety
Staff Involved:
Events Leading: Client was walking around milieu, climbing
and jumping on furniture. She found a broken hair rubber band and was putting it up to her
neck, but then agreed to give it to the nurse. After she gave it to the nurse, she took a
popsicle stick from the nurse's desk and refused to give it back. She started to attempt to
break it in half, creating sharp pieces. The unsafe behavior and threat of using a sharp
object initiated hold 1. Hold 2 was initiated by jumping from being unsafe, jumping from
furniture. 5:50pm Personal Restraint: Patient was put in personal restraint by the arms to get
the popsicle stick from her due to her trying to break it after already displaying unsafe
behavior. 5:51pm Personal Restraint End: Client released popsicle stick and restraint ended.
5:52pm Other/None: Client continued walking around the milieu, continuing with attention
seeking behavior. She bounced basketballs and volleyballs until they were removed by staff,
and threw a popit fidget as if it were a volleyball, until it was also removed. Client did sit
down to eat dinner when it was brought to her in the house. She ate the majority of dinner,
along with an ensure. She then got up and got into peers things in their lockers and jewelry
drawers until these things were removed as well. Staff continued verbal deescalation, asking
client what it is she needs, and she would only say she's hungry, when she had just eaten
dinner, including an ensure and fruit a few minutes beforehand. Client began
climbing/walking on milieu chairs again. Staff continued verbal deescalation. She began
jumping from one to another, which initiated the second restraint. 6:15pm Personal
Restraint: Client was placed in seated restraint due to jumping on furniture, from chair to
chair. She was agitated and not receptive to information for a couple of minutes, wiggling
until the hold moved to the floor. She was able to be moved back to a seated restraint.
6:20pm Personal Restraint End: Client calmed and contracted to safety. Patient Debriefing
date/time: 08/24/24 6:30pm: Client was calmer and contracted for safety. She did receive
and eat another apple after contracting for safety and following staff directions, as she was
stating she was still hungry. Client was not apologetic, but was receptive to instructions at
this point. Client fell asleep shortly after, on front of house. Nursing Assessment 1
date/time: 08/24/24 5:10pm: Patient presents in living area agitated currently over staff
performing intervention to remove popsicle stick patient took from nurse station desk.
Patient is alert and oriented times 4 and displaying very hyperactive behavior and not
following redirection prompts from staff. Pt encouraged to follow unit rules and directions.
Pt denies injury from intervention and no needs at this time. Nursing Assessment 2
date/time: 08/24/24 6:22pm: Patient presents siting on couch with sheriff officers present.
Pt denies injury from staff personal hold intervention and denies needs at this time. Pt alert
and oriented times 4. Pt is still displaying hyperactive behavior and not following staff

directions. Pt has made statement such as "I don't care". No bruising, abrasions, or
scratches observable on patient. Guardian was contacted on 08/24/24 at 6:24pm
was transported by MEMs on 08/25/24 at 8:36am to Pinnacle Pointe for an acute stay. She
remains at Pinnacle Pointe and was discharged from Youth Home due to her PASSE
requirements. Once she completes her acute stay, she will be readmitted to Youth Home.
Interim Action Narrative: Resident was placed in restraints for safety, assessed by the nurse,
and transported to acute care.
Maltreatment Narrative:
Licensing Narrative: Licensing was informed of incident via email and received
documentation for this provider reported incident. 8/29/2024, Program Coordinator
reviewed provider reported incident and uploaded documentation. Per report, resident will
return to the facility after acute care.


summary: Officers responded to the facility regarding a disturbance. Staff told officers that a resident would not listen to instruction and was physically hitting staff.

raw_content:
Pulaski County

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

Case P24-009136 Printed on September 19, 2024

Approved
Report Type Patrol
Primary Officer Doneson Harrington
Investigator None
Records Technician
Reported At 08/24/24 18:01
Incident Date 08/24/24 18:01
Incident Code DIST : DISTURBANCE
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
2
Southwest
None
Ereferral County None

Disposition P- PENDING
Disposition Date/Time 08/24/24 19:04
Disposition Comments

BC 4311
Review for Gang Activity Not Applicable

Asst Officers
2X71 - Bass, Steven

Primary Narrative By Doneson Harrington, 08/24/24 19:22

Disturbance

On 8/24/2024, at 1825 Deputy S. Bass and |, Deputy D. Harrington arrived at 20400 COLONEL GLENN RD in
reference to a Disturbance.

Upon arrival, | made contact with Montez Peterson. Montez stated was physically hitting the staff
and would not listen to instruction given to .. advised staff multiple times _.._ was still hungry. . .. Was
pulling away from the staff while they were trying to get .._. to take a seat on the couch. The RN (Greg Nesdahl) gave

a tablet to take to help calm down and relax. The staff provided a bottle of water. After
approximately 15 minutes started to calm down and relax.

Greg and Beauty Moore were speaking with a Doctor trying to determine the next course of action to take with
Moore advised Deputy S. Bass and | the staff would handle contacting transport if needed for

| provided Moore with a business card with the report number.

Case P24-009136 Page 1 of 1

doc_type: Police Report


summary: Officers responded to the facility regarding a disturbance. Staff advised officers that a resident was hitting staff and would not follow instructions.

raw_content:
Pulaski County

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

Case P24-009135 Printed on September 19, 2024

Approved
Report Type Patrol
Primary Officer Doneson Harrington
Investigator None
Records Technician
Reported At 08/24/24 17:15
Incident Date 08/24/24 17:15
Incident Code DIST : DISTURBANCE
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
2
Southwest
None
Ereferral County None

Disposition P- PENDING
Disposition Date/Time 08/24/24 19:02
Disposition Comments

BC 4311
Review for Gang Activity None

Asst Officers
2X71 - Bass, Steven

Primary Narrative By Doneson Harrington, 08/24/24 19:06

Disturbance

On 8/24/2024 at 1740 hours, Deputy S. Bass and I, Deputy D.Harrington arrived at 20400 COLONEL GLENN RD in
reference to a disturbance.

Upon arrival, | made contact wit David Barnes. David stated would not comply with rules. David
stated on multiple occasions have thrown objects at the staff and has made attempts to hit the staff, and the
staff have placed in restraints on multiple occasions.

Deputy S. Bass called over the radio to dispatch to have MEMS (Unit #432) started to our location. Beauty Moore
advised needed to be transported so _— could receive acute care. Deputy S. Bass and | waited with the staff
and until MEMS arrived and was Safely loaded into the ambulance.

| Provided David with a business card with the report number.

Case P24-009135 Page 1 of 1


summary: While walking back to the house from dinner, a resident and two peers rushed by staff in efforts to elope. The resident was returned to the facility by Pulaski County Sheriff’s Department.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 023305
Date of Incident: 8/17/2024
Date Received: 8/19/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for Incident Report
date/time: 08/17/24 5:50pm Location of Incident: Outdoors on Youth Home campus
Incident Description: Runaway Staff Involved:
Events Leading: While
walking back to the house from dinner client and two other peers quickly rushed pass staff
in efforts to elope. Staff quickly followed protocol while also ensuring safety of client's
remaining. When client was bought back to the house: client had a smirk on his face due to
being caught by PCSD. Client stated "It was dumb what I did, I don't know what I am
thinking about. It was hot". Client and peers made a makeshift bag of his peer's jeans.
Client stated that they went into a bandit house and found two blades, screwdriver and a pill
bottle. Nursing Assessment date/time: 08/17/24 9:20pm Patient assessed following
elopement. Multiple pink scratches legs bilaterally. Also multiple pink and round bug bites
to right and left leg. No open bleeding noted. Small scratches to wrist areas of both arms.
Upper body examined. No bruising or open scratches noted. Guardian was notified on
08/17/24 at 9:28pm
Interim Action Narrative: The police were called and the resident was assessed by the nurse
upon his return.
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Program Coordinator inquired about nursing notes, if a police report number was provided,
and safety precuations. Facility reported that resident was placed on run risk, house
restriction, and freeze. Nursing note was provided and uploaded. 8/20/2024, Program
Coordinator requested police documentation.


summary: While walking back to the house from dinner, a resident and two peers rushed by staff in efforts to elope. The resident was later brought back to the facility by Pulaski County Sheriff’s Department.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 023304
Date of Incident: 8/17/2024
Date Received: 8/19/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for Incident Report
date/time: 08/17/24 5:50pm Location of Incident: Outdoors on Youth Home campus
Incident Description: Runaway Staff Involved:
Events Leading: While
walking back to the house from dinner client and two other peers quickly rushed pass staff
in efforts to elope. Staff quickly followed protocol while also ensuring safety of client's
remaining. When client was bought back to the house: client was shaking up due to being
handcuffed by PCSD. Client and peers made a makeshift bag of his peer's jeans. Client
stated that they went into a bandit house and found two blades, screwdriver and a pill bottle.
Nursing Assessment date/time: 08/17/24 8:20pm: Patient examined after eloping. Denies
pain or any discomfort. 2 small superficial scratches to left forearm near the wrist. Patient
feels diaphoretic in upper body especially back. Encouraged liberal fluid intake to prevent
dehydration. Breathing regular and unlabored. Moves all extremities. Will continue to
monitor closely. Guardian was notified on 08/17/24 at 8:29pm
Interim Action Narrative: The police were called and resident was assessed by the nurse.
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licening reviewed provider reported incident for licensing concerns.
Program Coordinator will inquire about nursing note, safety precuations, and if a police
report number was provided. Facility reported that resident was placed on run risk, house
restriction, and freeze. Nursing note was provided and uploaded. 8/20/2024, Program
Coordinator requested police documentation.


summary: A resident was transported for acute care after exhibiting aggressive and self-injurious behaviors.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 023220
Date of Incident: 8/13/2024
Date Received: 8/14/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Mabee House Incident Report
date/time: 08/13/24 5:13pm Location of Incident: Mabee House Intervention Type:
Personal Restraints, Chemical Restraints, Acute Placement Incident Description:
Aggressive to Adults, Threat to Safety, Property Destruction Staff Involved:
Events Leading: Client was
upset about her still being on freeze from yesterday. Client went to her room and closed her
door behind her. Staff went to open the door to ensure supervision and she closed it again.
Staff sat outside of client's door to ensure she did not close it again. Client did not like staff
sitting at her door and began pulling out chunks of her hair. Staff tried holding her hands so
she would stop pulling her hair out and she began kicking staff. 5:13pm Personal Restraint:
milieu restraint 5:24pm Personal Restraint End: Client became tearful and laid her head on
staff. The personal restraint ended. Client talked to staff about her dog, bandit, that she
alleges was run over by her mom. Staff offered verbal support. Client continued to sob and
yelled, "It's all my fault!" She stood up and charged to the bathroom, slamming the door.
Staff managed to get the door open. Staff tried to offer to client that she could sit in the
bathroom if she left the door cracked, but client was continuing to escalate and slamming
the door. Client stood up and ripped the shower curtain off of the shower, then started
swinging the shower rod at staff. Client struck a nurse with the shower rod, and while the
rod was down, a staff and CT grabbed the rod and removed it from the client's hands.
5:25pm Personal Restraint: A personal restraint was initiated due to physically aggressive
behaviors. Client sat on the floor while restrained and continued yelling and breathing
loudly. Staff continued to offer water, verbal support, and let client know that she could call
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

dad when she is calm. Client pretended to pass out and then regained consciousness within
one minute. After she regained consciousness, she continued fighting the restraint. With
staff support, client began to calm down and become tearful. 5:38pm Personal Restraint
End: Client sat between staff members and cried while talking about abuse from her sister.
Client told staff her sister threatened to shoot her if she told anyone about the abuse. Staff
offered client support. Client then hallucinated her sister and her sisters voice and talked to
staff about what she was seeing and hearing. 5:53pm Other/None: Staff offered to walk
client to her room to lay down and take a break. Staff used supportive touch and walked
client to her room. After some prompting, client was able to walk to her room and lay down.
Staff continued to offer support. Nursing staff informed client that they had a shot that
could take the voices away. 5:58pm Chemical Restraint: Client was hesitant but cooperative
with taking the shot while she held staff's hands and talked about the show Bluey. Nursing
administered a chemical restraint. Patient Debriefing date/time: 08/13/24 6:15pm: During
debriefing, client asked staff not to say anything to her therapist about the things she said
regarding her sister. Staff decided not to address her concern and just reassured her that she
was safe and focused on staying calm. She said that her elbows hurt from thrashing on the
ground. Nursing heard this and assessed her. She talked more about trust issues with her
mom. She said that she could stay calm with a meal and a phone call to dad. After the
chemical, she still appeared on edge and on the verge of tearfulness. Client was transported
to acute by MEMs at 8:38. Nursing Assessment date/time: 08/13/24 5:13pm: Upon nurses
arrival to unit at about 1635, pt is in assigned room rocking back and forth pulling at hair,
scratching at wrists, and popping hairband to wrist. Pt bumped head against wall about 4
times. Pt states that she is 'overwhelmed' and 'wants to leave'. Pt able to calm down after
sitting and talking w/ nurse Pt states that she 'wants to quit the program', says
that she 'misses her dog and family'. Upon assessment, pt is A&Ox4. Speech clear. No h/a,
dizziness, n/v. Eyes PERRLA. No bumps, bruises, or bleeding noted to head. Gait steady.
Full ROM in all extremities w/o pain. Redness to L forearm from scratching wrist. Redness
to R wrist from popping hair tie. Bruises that are purple/black noted to L forearm and
upper arm, pt states that these are 'old'. Unsure of origin. VS as follows; BP 113/83, HR 97,
RR 20, temp 99.2F. Resp even, unlabored. Zyprexa 5mg ODT given per MAR. Pt sat in
nurses station to debrief. Pt expressed wants to leave, pt encouraged to work on therapy in
order to d/c when tx is complete. Encouraged pt to journal/read and use other coping
mechanisms. Pt walked out of nurses station and attempted to barricade self in room. This
RN called an all call. Pt attempted to kick door of milieu down. QBHP stepped in
front of door. Pt threw self backwards onto floor. Pt laid on floor with eyes closed for about 1
to 2 minutes. Pt responsive to sound, opening and closing eyes when there is verbal stimuli.
Resp even, unlabored. Pt got up quickly from floor, then began to destroy property in
milieu. Pt began to knock over locker, rip papers off of wall. Pt was placed in PR, while in
PR was grabbing staff badges, attempting to hit head on wall. Pillow placed to wall. Pt
attempting to throw self onto floor, attempted to run while in PR. PR ended at 1717 after pt
stated she could be calm. Pt started to talk to staff about feeling overwhelmed, then ran into
bathroom and attempted to barricade self in bathroom. Pt grabbed shower rod and began
waving it around, threatening staff. Pt made contact with multiple staff members. Pt put in
PR at 1724. Pt continued to attempt to run while in PR. Pt closed eyes, had fainting-like

episode for about 1 minute, resp even/unlabored. Pt able to be startled w/ verbal stimuli. Pt
continuing to yell/scream, expresses both A/VH, states that ' is going to come after
her', states that her sister ' shocked her using the TV remote and that she 'was going to
shoot her if she told'. Told her that she was safe, encouraged her to look at what was real
and focus on what was around her. Pt able to open eyes, name all present staff members. Pt
continuing to shift between escalating and deescalating. Notified provider on call of
situation. Order placed for CR. Pt released from PR at 1740. Talked to pt about chemical
restraint to help w/ pt's A/VH, mood swings, violent outbursts. Pt allowed this RN to
administer thorazine 50mg/2mL IM to R gluteal medius area. Unable to do full assessment
as pt is still elevated, begins to yell when talked to. Pt able to deny h/a, no n/v. Eyes
PERRLA, resp even/unlabored, full ROM noted in all extremities. Gait steady when
walking to day area for med pass. Pt rec'd HS medications. Assessed after administration of
HS medications. Pt is A&Ox4. VS as follows; BP 96/59, HR 93, RR 17, temp 98.1. Pt denies
h/a, dizziness, n/v. Pt states 'I'm just tired'. Pt has bruise to bilat elbows d/t hitting elbows
against during restraint. Bruises purple/red, about 1in in length, 1/2 in. width. Bruises
present to upper arms d/t pulling against staff attempting to escape restraint, 3 bruises to R
arm that are red/purple, about 3cm in diameter and 3 bruises to L arm that are red, about
1cm in diameter. No further s/sx of injury/deformity. No further c/o. Provider on call
notified. Therapist on call present for most of incident. Pt transported to acute care by
MEMs at 2038. Guardian was notified on 08/13/24 at 5:37pm, 9:12pm, and 9:21pm
was transferred via MEMS at 8:38pm to Rivendell for an acute stay where she
still remains at this time.
Interim Action Narrative: Resident was placed in restraint for safety, assessed by the nurse,
and transported to acute care via MEMS.
Maltreatment Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Program Coordinatotr inquired about nursing note and camera footage. Facility provided
documentation and has been uploaded. 8/15/2024, facility reported that camera footage was
saved. Program Coordinator will schedule a day and time to review. 8/21/2024, Program
Coordinator reviewed camera footage for this provider reported incident. Staff were
observed keeping resident safe from harming herself and verbal de-escaltion was used
throughout the incident.


summary: A Resident was transported to Arkansas Children’s Hospital after becoming anxious and displaying a seizure-like episode.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 023112
Date of Incident: 8/9/2024
Date Received: 8/9/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
Private placement client in our PRTF program and resides in Rose House Incident Report
date/time: 08/08/24 5:30pm Location of Incident: Outdoors on Youth Home Campus
Incident Description: Medical Emergency(Trip to ER/Urgent Care) Staff Involved:
Events Leading: After hearing her peers gossip about drama, client
became extremely anxious and began to display seizure-like episode. MEMs was called to
transport her to Arkansas Children's Hospital. Nursing Assessment date/time: 08/08/24
6:13pm: At about 1734, patient began to experience seizure like episode out on soccer field.
Nurse stat called. Upon this nurses arrival at about 1740, pt laying on L side with LPN
supporting patient and QBHP sitting beside pt to monitor airway. Patient had
intermittent episodes of muscle rigidity, gurgling, and shaking. Airway clear. No
obstructions noted. No vomiting. Small amounts of drool noted, pt able to clear throat w/o
need for assistance. Pt diaphoretic, skin flushed. SPO2 monitor placed to finger. Pt did not
respond to talking, tapping, sternal rub, or attempts to assess hand grip for duration of
incident. One time dose of diazepam 10mg gel PR given at 1748 by RN. Incontinence of
bladder noted by RN. Episodes of muscle rigidity, shaking, and gurgling continued
after administration of medication. HR fluctuated b/t 97-124BPM, SPO2% fluctuated b/t
97-99% for duration of episode. MEMs arrived at 1813 and took pt to Children's Hospital
ER. Pt was discharged from Children's Hospital and returned to Rose at 2120. See new
orders placed in chart. HS medications given upon return. Pt affect is normal, tells this RN
that when she is feeling overwhelmed she will notify staff and sit down. Guardian was
notified on 08/08/24 at 6:28pm. ER paperwork was emailed to on 08/09/24.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Interim Action Narrative: Resident was assessed by the nurse and transported to ACH.
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns. Facility provided documentation for this incident.


summary: Resident reported that he swallowed a spring he found in his room. Resident was assessed by nursing then sent to Arkansas Children’s Hospital for further evaluation.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 023110
Date of Incident: 8/8/2024
Date Received: 8/9/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for Private
placement client in our PRTF program and resides in Sturgis House Incident Report
date/time: 08/08/24 8:11pm Location of Incident: Sturgis House Incident Description: Self
Injury(Not Suicidal), Medical Emergency(Trip to ER/Urgent Care), Patient Injury Staff
Involved: Events Leading: Pt had a
therapy session with his therapist and was feeling depressed and sad afterwards. He found a
spring in his room and uncoiled it. He put the ends together placed the spring in his
"throat" and used water to swallow it earlier in the day. Nursing Assessment 1 date/time:
08/08/24 8:30pm: Nurse called to Sturgis d/t report that pt had 'swallowed a spring' and
was being sent to ER for evaluation. Upon arrival to unit, pt is smiling and organizing in
milieu. Pt tells this RN that he 'had a spring from a pen in the seclusion room' and
'swallowed the spring after therapy session around lunch time'. Pt states that he
intentionally 'undid the spring so that when swallowed it would expand'. Pt states he found
it on the floor of the milieu. This is inconsistent information to what was given to both staff,
and LPN. Pt tells this RN that it was in an attempt to harm self. States the he was
feeling 'sad and depressed'. Pt is A&Ox4. Vitals as follows: BP 142/107, HR 103, RR 20,
SPO2 98%, temp 99F. Pt endorses pain in midline chest, states that it feels like 'something
is stuck'. Lungs clear to auscultation. Breathing unlabored, even. Pt endorses pain in upper
L quadrant when area is palpated. States that it feels 'not sharp but not dull'. Normoactive
bowel sounds in all four quadrants. Pt stated that he had 1 BM today that was difficult to
pass. Pt sent to ACH ER for further evaluation. Did not return on this RN's shift. No
updated given to this RN. Nursing Assessment 2 date/time: 08/08/24 12:35am: Arrived
back on campus @ around 12:12am.Upon arrival was resting FOH. Alert and oriented. No
visible signs or symptoms of distress. Complaining about getting vitals done
again.....wanted to go lay down. Vitals: 117/59 80 20 97.3 pulse ox 97%. Made no complaints
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

of pain or discomfort. Continues to be on FOH and Eyeball. Will continue to monitor.
Guardian was notified on 08/08/24 at 8:20pm and again on 08/09/24 at 7:30am. ER
paperwork was sent via email to on 08/09/24.
Interim Action Narrative: Resident was assessed by the nurse and transported to ACH for
an evaluation. Resident was also placed on restrictions, front of house and eyeball.
Maltreatment Narrative:
Licensing Narrative: Provider reported incident reviewed by licensing for concerns. Facility
provided documentation for this incident. Program Coordinator will inquire about camera
footage to determine when/where the resident found the pen. 8/13/2024, facility reported
via text they are still going through camera footage. 8/21/2024, Program Coordinator spoke
with who reported that they have reviewed different dates of camera footage
and interviewed the resident. No camera footage havve been found to indicate when or
where the resident found the spring. When asked about where the spring was found, the
resident changed the location and date again. Because of the resident's behavior, he has
remained on eyeball sight and is scheduled to be re-evaluat4ed.


summary: Three residents eloped from the facility while walking back from dinner.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 023301
Date of Incident: 8/17/2024
Date Received: 8/19/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Sturgis House Incident Report date/time:
08/17/24 5:50pm Location of Incident: Outdoors on Youth Home campus Incident
Description: Runaway Staff Involved:
Events Leading: While walking
back to the house from dinner client and two other peers quickly rushed pass staff in efforts
to elope. Staff quickly followed protocol while also ensuring safety of client's remaining.
When client was bought back to the house seems upset due to being caught by PCSD.
Client and peers made a makeshift bag of his peer's jeans. Client stated that they went into
a bandit house and found two blades, screwdriver and a pill bottle. Nursing Assessment
date/time: 08/17/24 9:25pm: Patient assessed after elopement. Multiple scratches to both
legs bilaterally above and below the knee. Multiple scratches that are pink in color to both
lower arms. Patient's back has a mix of old pink scratches and new scratches. No open
bleeding noted. Moves all extremities. Respirations even and unlabored. Encourage fluid
intake to prevent dehydration. Will monitor as needed. Guardian was notified on 08/17/24
at 9:30pm
Interim Action Narrative: The police were called and the resident was assessed by nurse.
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Program Coordinator inquried about safety precautions, nursing note, and police report
number. Facility reported that resident was placed on run risk, house restriction, and freeze.
Nursing note was provided and uploaded. 8/20/2024, Program Coordinator requested
police documentation.


summary: A resident was transported to Arkansas Children’s Hospital after reporting he swallowed a screw.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 023083
Date of Incident: 8/7/2024
Date Received: 8/8/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
t client in our PRTF program and resides in Sturgis House Incident Report
date/time: 08/07/24 1:45pm Location of Incident: Sturgis House Incident Description: Self
Injury (Not Suicidal), Medical Emergency(Trip to ER/Urgent Care) Staff Involved:
Events Leading: This nurse
responded to a nurse call to Sturgis. reported that he was attempting to clean out
the trash beside his bed with his comb, yawned, and swallowed a screw. Nursing
Assessment 1 date/time: 08/07/24 1:45pm: This nurse responded to a nurse call to Sturgis.
reported that he was attempting to clean out the trash beside his bed with his comb,
yawned, and swallowed a screw. He then would alter his story as more questions were
asked. AAOx4. general appearance is healthy. Dressed fairly appropriate in his Pjs.
Poor hygiene as he presents with a mild odor. Speech fairly clear(mumbling) and coherent,
WNL for this client. No signs of hoarseness, coughing, gagging, retching, drooling, nausea,
or vomiting. RR 18/min, unlabored. No retractions, accessory muscle use, or nasal flaring.
Skin is pink, warm, and dry. Clear lung sounds in all lobes. No adventitious sounds,
wheezing, or stridor. SpO2 99%. No signs of oropharynx obstructions, abrasions, ulcers, or
lacerations. Denies pain in mouth, neck, throat, or chest. Airway patent. No signs of
respiratory distress. Abd is fairly soft, symmetric, and non-tender without distention. No
palpable masses. No signs of rigidity or guarding. Bowel sounds are present and
normoactive in all four quadrants. He reports last BM this morning, rating "4 or 6" on the
Bristol stool scale. He admits to recent straining and difficulty passing stool the past few
days. After this nurse completed the abd assessment, client then started guarding his upper
abd quad reporting a "stabbing sensation". Able to swallow without difficulty. Patient
continues to alter story and presents with unreliable history. He was challenged on
conflicting parts of his history and report. BP: 152/90, HR 109. Avoidant of eye contact and
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

use of excessive hand gestures to plead his case with mumbling (WNL for this client). He
attempted to show this nurse as he crawled under his bed, explaining. He was challenged
again in which he admitted to lying about how the screw initially fell into his mouth. He
denies intentionally ingesting. Denies any current thoughts of self-harm or SI. He reports
last incident of self-harm was approx. last Friday. He endorsed some feelings of
hopelessness and sadness. He discussed wanting to come off TRS. He reported he had a
session with his CT earlier today and feels it went well. He discussed he was provided more
assignments. The size of the reported screw varied as well as how the screw went down the
esophagus. Patient also disclosed locations in his room where screws were missing. He was
challenged into how the screw from his door was under his bed. voiced uncertainty
and feelings of anxiety. He voiced frustration and displeasure that his CT has been notified.
The metal detector wand did not signal any signs of metal object. Attending MD and CT
notified. He is NPO (nothing by mouth) while he remains under close observation. Nursing
Assessment 2 date/time: 08/07/24 7:28Pm: Pt told nursing staff earlier in shift that pt
'accidentally swallowed screw'. See previous Nursing page. Upon this nurses assessment, pt
states that he 'swallowed a mechanical screw while under the bed reading what people
wrote'. Pt states that he believes that 'someone put a screw under the bed to hide it and
when it fell it went down his throat and he couldn't stop it'. Pt states that screw was about
'3-4 inches'. Pt affect is calm, pt is alert and oriented to self and situation. Speech
clear/coherent. VS as follows: BP 122/69, HR 84, RR 18, temp 97.9. Resp even, unlabored.
Airway patent. Breathing clear to auscultation. Pt states that he had one BM this AM that
was a 5-6 on the Bristol chart. States that he has been constipated lately. Bowel sounds
normoactive in all four quadrants when auscultated. Pt endorses pain in middle upper abd
area. Denies pain when swallowing, denies pain when abd is pressed on, no
guarding/rigidity. Pt denies n/v. No drooling, gagging. Provider notified of findings. Due
to pt's c/o pain and statement that he swallowed a screw, pt taken to ACH ER. Pt taken to
ACH ER at 1935 by staff. Staff reported that
No further updates were rec'd this shift. Nursing
Assessment 3 date/time: 08/07/24 11:53pm: Resting in bed but was easily awakened by staff
who gave directs to take night time meds. Alert and oriented. No visible signs or symptoms
of distress. No complaints of pain or discomfort. Vital signs: 118/71 80 Pulse ox 96% 18.
Took night time meds without any difficulty. Requested crackers afterwards. Seemed to be
in good spirits as evidenced by talking with this nurse about future plans to join army and
how what's learned @ Youth Home will be beneficial in the years to come. Remains on
Eyeball and Front Of House. Will continue to monitor. Guardian was notified on 08/07/24
at 2:30pm and 7:20pm. Guardian was also notified on 08/08/24 at 12:04am ER paperwork
has been emailed to
Interim Action Narrative: Resident was assessed by the nurse and sent to ACH ER for an
evaluation.

Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns and uploaded documenation from the facility. 8/9/2024, Prorgam
Coordinator inquired about timeframe of resident being seen at ACH. Faciltiy reported the
direct care staff and medical team were collecting information to determine if there was any
merit to the resident's claim about the object. The information that the resident gave to staff
changed multiple times during the interview. When nursing called the residentt's father, he
insisted on speaking to his son to determine if he was telling the truth about the situation.
The resident showed no signs of acute distress, he did not choke, no trauma to the throat,
no hoarseness, his airway was patent, breathing not labored, respiration were normal rate
and rhythm. Resident was eating and drinking without difficulty as well. There were no
signs that would deem this a medical emergency. The decision was made to send him out
for evaluation and then staff had to be arranged to take him to ACH. Facility also reported
that maintenance is removing the wooden furniture from the resident?s bedroom to
hopefully making it more difficult to acquire screws.


summary: Officers were dispatched to the facility in response to an aggressive juvenile.

raw_content:
Pulaski County

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

Case P24-008358 Printed on August 21, 2024

Approved
Report Type Patrol
Primary Officer Lindsey Wheeler
Investigator None
Records Technician
Reported At 08/03/24 18:19
Incident Date 08/03/24 18:19 - 08/03/24 18:22
Incident Code DIST : DISTURBANCE
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
2
Southwest
None
Ereferral County None

Disposition JUVENILE/NO CUSTODY
Disposition Date/Time 08/03/24 20:20
Disposition Comments

Reviewed by B.Scott #2495 0n08/03/2024.
Review for Gang Activity Not Applicable

Asst Officers
L27 - Scott, Bruce

Primary Narrative By Lindsey Wheeler, 08/03/24 21:27

Disturbance/Battery 3

On July 3, 2024 at 1822 hours |, Deputy Wheeler, responded to 20400 Colonel Glenn Road in reference to a
disturbance.

Upon my arrival, | made contact with Crystal Green. Ms. Green stated that a 14-year-old juvenile,
was upset with another juvenile for sharing confidential information. Ms. Green stated that due to
miscommunication, the supervisor had called for everyone to have an early bedtime.

Ms. Green stated that had become angry and started to tear up everything. Ms. Green stated ran to
room and slammed the door. Ms. Green stated when she opened the door, started pushing and punching
her in the back. Ms. Green stated that was when she called for the deputy's assistance.

| asked Ms. Green if she needed medical attention, and Ms. Green advised she was OK. | observed the upper back
area with Ms. Green's consent, and photos were taken for evidence and uploaded to the property. Ms. Green stated
she did not want to press any charges against

| made contact with who appeared to be upset and crying. After calming down, . stated Ms.
Green was in .._. way and would not move out way. | asked to stand so pictures could be taken for
evidence. After enforcing the rules and law to | advised that can be in trouble if

continues this behavior.

| provided Ms. Green with an incident report number and instructions on how to obtain a copy.

Case P24-008358 Page 1 of 1


summary: Resident became upset after an altercation with her roommate and began punching a wall. Afterward, the resident was transported to Urgent Care for evaluation of her hand.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 022859
Date of Incident: 7/26/2024
Date Received: 7/29/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Mabee House Incident Report
date/time: 07/26/24 6:25pm and 07/27/24 12:30pm Location of Incident: Mabee House
Incident Description: Self-Injury(Not Suicidal), Medical Emergency(Trip to ER/Urgent
Care) Staff Involved:
Events Leading: 07/26/24: Client came to staff requesting a room change
because she said her roommate threw a plushie at her and they had a few words with one
another. Client and her roommate were asked to come up and talk to staff so we could get
both stories. Client refused and sat in the corner of her room crying. Staff went back to her
room to check on her because she didn't come up and because a peer across the hall
reported hearing banging in her room. Client then admitted to staff that she did punch the
wall a few times. 07/27/24: Client was taken to Urgent Care to have her hand assessed.
Nursing Assessment 1 date/time: 07/26/24 6:30pm: Staff informed me at that was
sitting in a corner of her room refusing to sit on the bed and refusing to come out. Upon
arrival to room facing the corner in her room, crying with pillow in hand. She will tell
me why she is crying or why she is sitting in corner, she is only stating that she wants to be
left alone. I informed her that she cannot be left alone in the corner, so I was going to sit
down by her and gave her 3 mins to herself without bothering her so that she could feel her
feelings and then we would talk. Staff member sat outside of the door during this encounter.
After 3 mins, she still did not get out of the corner, she stated that staff wanted her out of the
corner because they think she will self-harm, when asked why they would think that
stated that she punched the wall because she was upset with her roommate. She allowed me
to assess both of her hands; there was bruising noted to the right middle, fourth, and pinky
finger knuckles, slight swelling noted, able to open & close hand with pain noted when
closing, pain level 9/10, requesting Tylenol. I informed her that the only way that she could
get Tylenol is if she gets up and comes up to the front for med pass. She stated that she did
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

not want to be around her peers, I offered her the option of sitting in the nurses' station
away from everyone while I did med pass, agreed and got out the corner without
incident. While in the nurses' station admitted to punching the wall 8 times with her
right hand. Nursing Assessment 2 date/time: 07/27/24 9:30am: pt reports severe pain to R
hand and limited ROM to the R hand joints. swelling noted to the knuckle area of the R
hand. cap refills < 3 sec. ice pack provided. Tylenol was administered per Night RN. Dr
notified and ordered for staff to take pt to UC for R hand injury evaluation.
making arrangements for pt transport. Nursing Assessment 3 date/time: 07/27/24 2:10pm
returned from UC. Dx with no FX. Recommendations: Tylenol for pain,
Rest/ice/compress, Ace wrap x 7 days ( 12 hr on/12 hr off) . pt presented with ACE wrap on
R hand with metal elements. Metal elements have sharp edges and removed for safety- tape
used to keep ACE wrap in place. pt instructed on appropriate use of ACE wrap, verbalized
understanding. pt has no s/sx of acute distress. Dr notified of the findings. Guardian
was notified 07/26/24 at 9:21pm, 07/27/27 at 11:32am, and 07/27/24 at 2:15pm Urgent Care
paperwork was emailed to on 07/29/24.
Interim Action Narrative: Resident waa assessed by the nurse and sent to urgent care for an
evaluation.
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns. Facility provided documentation for this incident and it has been
uploaded.


summary: A resident was sent to the emergency room due to complaining of pain after hitting her head while doing a backbend.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 022732
Date of Incident: 7/19/2024
Date Received: 7/22/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Rose House Incident Report
date/time: 07/19/24 4:20pm Location: Rose House Incident Description: Medical
Emergency (Trip to ER/Urgent Care) Staff Involved:
Events Leading: Client was redirected
several times by staff to stop doing flips in her area. Client then came into the milieu
informing the nurse that she did a backbend and hit her head. Client was transported to
Children's hospital by mems. Nursing Assessment date/time: 07/19/24 4:33pm: Nurse
called to Rose house d/t report of pt 'hitting head on floor of room' after doing 'backbends'.
Per house staff, pt was initially able to answer and respond to questions w/ inaccurate
answers. When staff asked pt's age, pt stated Pt is currently Upon
nurses arrival at about 1630, pt is sitting in day area w/ neck hyperextended and head rested
on back of chair with arms relaxed at sides and legs relaxed against chair. VS taken by
LPN are as follows: BP 128/88, HR 100, RR 18, temp 98.1F. Resp are even, slightly labored,
using abd muscles to support breathing. Pupils PERRLA w/ sluggish reaction to light.
Pupils 4mm bilat. Pt has full ROM in all extremities. Unable to assess hand grip as pt is
unable to follow nurses command. Speech is slurred. Pt is able to respond to nurse but is
unable to answer questions. When asked 'Do you know what happened today?' Pt responds
'I don't know, I don't remember anything'. When asked about presence of h/a, dizziness, pt
does not respond to nurses questions. Pt then began to call nurse 'mom' and asked if her
mom was here. Attempted to orient pt, upon hearing that this RN is not her mother pt
began to get further upset. Pt then began to move tongue around in mouth erratically and
stick tongue out to L side of mouth. Pt facial muscles are twitching around eyes and mouth.
Pt able to respond to gentle touches to hand/shoulder. Pt then became aphasic, words and
sentences were not making sense. Occasionally, pt can answer 'yes' or 'no' or say the words
'mom' or 'dad'. No other words can be understood. Pt appears drowsy, attempts to fall
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

asleep while staff are talking to pt. Pt able to be woken w/ verbal stimuli and touch. Affect is
tearful/anxious when this nurse and staff attempt to wake pt. Provider notified at 1633 upon
initial assessment. MEMs called at 1640. Guardian was notified on 07/19/24 at 4:39pm. ER
paperwork was emailed to on 07/22/24.
Interim Action Narrative: Resident was assessed by the nurse and transported to ACH via
MEMS.
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns. Facility provided documentation and it has been uploaded.


summary: A resident was left alone and unattended in the house while her housemates went to lunch. The facility was cited 907.2 as a result of this incident.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 022593
Date of Incident: 7/12/2024
Date Received: 7/15/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Rose House Incident Report date/
time: 07/12/24 at 11:29am Location of Incident: Rose House Incident Description: Client
was left unattended in house for about 4 minutes. Staff Involved:
Events Leading: The house went to lunch, was in her room asleep. Staff did not
realize she was in her room asleep and left the client in the house unattended. Guardian was
notified on 07/12/24 at 4:10pm: Guardian was notified that may or may not have been
unsupervised for a few seconds to a minute. Explained to guardian that this nurse met
up/ran into rose girls as they were walking to lunch and this nurse was in route to rose
house to pull a noon med. As this nurse entered rose house and the nursing office, was
found peeking around corners saying hello. She inquired where everyone else was and
inquired if she was left. This nurse said they would escort her to lunch asked her to wash her
hands and put on her shoes and we would walk together. A rose team member came to
escort her to lunch. When giving mom this information, she chuckled and said is
sneaky. This nurse also informed her that while at lunch, reported lost a loose baby
tooth to a piece of broccoli.
Interim Action Narrative: Staff involved were written up for breaking the facility's code of
conduct policy, was required to reivew the policy and were coached verbally on the proper
way to conduct count backs.
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns. Program Coordinator will inquire about internal incident form, if
incident was called, how long the resident was left unattended, was the incident called into
the hotline, did the staff involved receive any warning, and protocol for head count.
7/16/2024, facility reported resident was asleep in her bedroom when left unattended. Staff
members involved were written up and verbally coached on the proper way to conduct count
backs. Program Coordinator reviewed camera footage and received documentation of the
staff members corrective action. 7/17/2024, Program Coordinator requested other signed
correctived action form. 7/18/2024, Program Coordinator reviewed 521 to include citation,
907.2.


summary: Officers responded to the facility in reference to a disturbance.

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

Case P24-007315 Printed on July 23, 2024

Status Approved
Report Type Patrol
Primary Officer Josh Keyes
Investigator None
Records Technician
Reported At 07/07/24 20:20
Incident Date 07/07/24 20:20
Incident Code DIST : DISTURBANCE
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
2
Southwest
None
Ereferral County None

Disposition P- PENDING
Disposition Date/Time 07/07/24 23:49
Disposition Comments

Reviewed by B.Scott #2495 on 07/08/24.
Review for Gang Activity Not Applicable

Primary Narrative By Josh Keyes, 07/07/24 23:56

Disturbance
On 7/7/24, at around 2034 hours, | responded to 20400 Colonel Glenn Road in reference to a disturbance.
Upon my arrival. | made contact with Youth Home staff Bentron Parker and Tara Brown who advised one of the

children, had an outburst and had been kicking and head butting staff. Bentron and Tara both did not
sustain injuries and denied medical.

| made contact witr _who advised __ was upset about not being able to talk with father,and started
kicking and head butting staff. was not injured and refused medical.

Bentron and Tara advised had waited too long to make a phone callas_ _ was playing video games, and it had
been time for the children to go to bed. Bentron allowed to make a phone call anyway, however, Father
did not answer the phone. After multiple attempts, Bentron advised would have to try again tomorrow, to
which - began his outburst.

Youth Home staff was provided a report number and | left the scene without further incident.

Case P24-007315 Page 1 of 1


summary: Resident became upset after learning she was not on the list to go on an outing and began kicking and banging her head on the wall. Afterward, the resident was transported to the emergency room for evaluation due to complaints of hand pain.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 022458
Date of Incident: 7/4/2024
Date Received: 7/8/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Mabee House Incident Report
date/time: 07/04/24 at 9:27pm Location of Incident: Mabee House Incident Description:
Self-Injury(Not Suicidal), Medical Emergency(Trip to ER/Urgent Care) Staff Involved:
Events
Leading: Client was excited about the fireworks outing. Client later learned that she was not
on the list to go on said outing. Client became extremely upset about this news and went
into her closet, refused to come out, hitting the wall with her crocs, kicking the wall and
yelling at staff every time they tried talking to her. Client went from using her feet to using
her hand to bang on the wall leaving some bruising on her hand. Nursing Assessment 1
date/time: 07/04/24 9:48pm: Nurse came to Mabee house d/t call stating that pt had gotten
angry that they could not go on outing and punched wall in closet. Upon assessment, pt is
sitting in corner of closet with knees to chest. Pt refusing to verbally communicate w/ this
RN. Upon assessment, pt is alert and able to follow verbal communication. Full ROM in
both hands, grip strength even. Bruising noted to R hand, last 3 fingers (middle, ring,
pinky) bruised at the knuckle, swelling noted to R side of hand. Pt is able to move fingers
with some pain, expresses pain when area above knuckles of middle, ring, and pinky finger
are touched by this RN. Pt denies any further injury. No further s/sx of injury noted. Skin
intact. Pt is able to walk to nurses station for ice pack w/o difficulty. Pt told to keep ice on
area, rest hand, use ibu/acet as needed per MAR for pain. Pt nodded to nurses instruction.
Given ice pack. Refused ibu/acet at this time. Notified provider on call. Treatment team
notified to reassess in AM to see if swelling has worsened/improved. No further needs at
this time. Nursing Assessment 2 date/time: 07/05/24 10:05am: no s/sx of acute distress.
resp even/unlabored. cooperative. c/o pain to R hand after hitting the wall yesterday. R
hand noted with discoloration and swelling at the 3d - 5th digit knuckle area. cap refills < 3
sec. pain with ROM. APRN notified, ordered to take pt to UC for R hand pain
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

evaluation, which was changed late in the day to ACH ED due to pt insurance. ibuprofen
given per orders, ice pack provided. staff notified of the orders. awaiting for staff transport
Nursing Assessment 3 date/time: 07/05/24 7:44pm: The patient returned from the ER at
7:44 pm with no signs or symptoms of acute distress. A focused assessment revealed
respiration was even and unlabored, and the patient was cooperative. The right hand
showed discoloration and swelling in the knuckle area of the 3rd to 5th digits, with capillary
refill less than 3 seconds and mild pain reported with range of motion. Per ER records, the
diagnosis . The ER recommended
rotating ibuprofen and Tylenol for pain and using ice packs. The on-call MD was informed
of the patient's return at 8:02 pm and agreed with the ER recommendations. The patient's
mother was notified at 8:05 pm and had no concerns. The patient had received ibuprofen at
7:20 pm before leaving the ER and reported no additional complaints or concerns upon
return. Guardian was contacted on 07/04/24 at 10:26pm, 07/05/24 at 1:31pm, 3:35pm, and
8:05pm ER Paperwork will be emailed to when received in Medical Records.
Interim Action Narrative: Resident was assessed by the nurse on 7/4/204 and 7/5/2024.
Resident was evaluated at the ER on 7/5/2024.
Maltreatment Narrative:
Licensing Narrative: Progam Coordinator reviewed provider reported incident for licensing
concerns. Facility provided documentation for this incident. 7/9/2024, Program
Coordinator followed up with facility on ER paperwork. Documentation uploaded.


summary: Licensing completed a buildings and grounds walkthrough for Hickory House. No deficiencies cited.

raw_content:
ARR KAH GE A SE
Ee ) SEPARTMENT or

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

521 Visit Compliance Report

Licensee: Youth Home, Inc.

Facility Number: 128

Licensee Address: 20400 COLONEL GLENN ROAD
LITTLE ROCK AR 72210

Licensing Specialist: Kendra Rice
Person In Charge: Adria Riley
Record Visit Date: 6/21/2024
Home Visit Date: 6/21/2024

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: 9:30 am to 10:30 am

www.arkansas. gov/dhs

Serving more than one million Arkansans each year Page:1.0f 2

Census: 44

at a inator completed buildings and grounds for Hickory House. Licensing was escorted by | |
informed Program Coordinator that Hickory House will be named
Napier House. Possible date for residents to be placed in the house is in September 2024. Program

Coordinator observed lawn service working the grounds.

The following areas of the house were observed: day/common area, milieu, nurse’s office, kitchen (for staff
only), laundry room, storage closet, staff offices, linen closet, bedrooms, bathrooms, dining room area,
comfort room, seclusion room, and game room.

Program Coordinator was greeted by maintenance a: stated that they were doing some
final work. Program Coordinator observed boxed appliances (washer machine and dryer) being installed in the

laundry room.

The bathrooms, two (2) were observed, have been renovated. There will be a total of six (6) bedrooms
observed. Each bedroom had a bed and storage cubie. Maintenance informed Program Coordinator that the
furniture will be bolted down like the other houses at the facility. Numbers were placed inside of the door
entering each bedroom.

Program Coordinator observed two (2) water fountains, three (3) fire extinguishers in cases in different areas
of the house, smoke detectors in each bedroom and other areas of the house, a telephone was located behind
the desk at the milieu, and the evacuation plan was located on the wall near the milieu, Interior painting has
been completed throughout the entire house.

PE Program Coordinator of where other documentation will be posted throughout the
ouse.

Provider Comments:

CCL Staff Signature : Date: 6/21/2024
Ao,

ede

Provider Signature : ‘ Date: 6/21/2024

Holi bevp

www-arkansas govidhs - :
Serving more than one million-Arkansans each year.

doc_type: Compliance Report


summary: Licensing conducted an annual review of policies and procedures. All policies and procedures complied with minimum licensing standards.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Youth Home, Inc.
Facility Number: 128
Licensee Address: 20400 COLONEL GLENN ROAD
LITTLE ROCK AR 72210
Licensing Specialist: Kendra Rice
Person In Charge: Adria Riley
Record Visit Date: 6/18/2024
Home Visit Date: 6/18/2024
Purpose of Visit: Special Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Time of Visit: 10:15 am to 11:30 am
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Census: 41
Program Coordinator conducted an annual review of policies and procedures for Youth Home.
Policies and procedures for Youth Home complied with minimum licensing standards.
Provider Comments:
CCL Staff Signature : Date: 6/18/2024
Provider Signature : Date: 6/18/2024
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident fell while on an outing to Pinnacle Mountain. The resident was carried down the mountain by emergency responders and transported to Arkansas Children’s Hospital.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 021978
Date of Incident: 6/13/2024
Date Received:6/14/2024
Facility Name: Youth Home, Inc.
Facility Number:128
Incident Type: Licensing
Report Description: Incident Report for
in our PRTF program and resides in Chestnut House Incident Report date/time: 06/13/24
10:30am Location of Incident: Community Incident Description: Medical Emergency (Trip
to ER/Urgent Care), Patient Injury Staff Involved:
Events Leading: While climbing down pinnacle mountain,
patient hopped from the rock he was standing on to another rock. The rock he landed on
was wobbly and he twisted his knee. Patient stated he was ok at first but after a few minutes
he stated his knee was really hurting. A peer and staff helped patient walk further down.
However, he stated that his pain was worsening and began to cry. A man who stated he was
a doctor saw patient and asked to take a look at his knee, reported doctor stated that he had
swelling to his left knee. Patient was carried to a nearby bench to rest. Staff attempted to
carry patient further down the mountain however, client stated his pain was becoming
unbearable. A nurse walked past patient and staff and asked to look at his knee- he began
crying as soon as she touched his knee. Pinnacle Mountain Emergency Responders were
called- they assessed patient and called an ambulance. Responders carried patient down in
a stretcher and gave him to EMT's. EMT's decided he needed to go to ACH and
transported him there. Nursing Assessment 1 date/time: 06/13/24 10:04am: No face-to-face
assessment was completed as this patient was on a community outing, hiking at Pinnacle
mountain with REC and a Youth Home nurse was not present. 10:04am: Team member
notified this nurse and attending MD that fell while on the hiking outing. 10:25:
Team member notified this nurse and attending MD that is complaining of
significant knee pain and notable swelling of knee. A bystander reported they were a
physician and reportedly examined the knee, expressing concern of noted swelling,
expressed pain, and tenderness. 10:56: Team member and reported EMTs were
present and safely transporting down the remaining mountain on stretcher in order to
assess. 11:05: Team member reported EMTs are transporting to ACH ER for
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

further evaluation and she is following to accompany 11:06: Guardian,
called and notified of communication received from team member present on hiking
outing and being transported to ACH ER for further evaluation. Nursing Assessment
2 date/time: 06/13/24 4:30pm: Client returned from ACH ER around 4:30pm.
. Client is to take OTC pain meds,
use crutches and Ace wrap as needed for ambulation. Activity limit left leg. Crutches may be
used up until 06/16/2024. Client denies numbness/tingling and can move toes. ROM
decreased to left leg due to pain. Client was provided ice pack and Ibuprofen x 1 at 6:40pm
for 10/10 pain. Guardian was notified on 06/13/24 at 11:06am and again at 4:30pm. ER
Paperwork was emailed to and on 06/13/24.
Interim Action Narrative: Facility contacted Pinnacle Mountain Emergency Responders to
assess resident. An ambulance was called and resident was transported to ACH for
evaluation.
Maltreatment Narrative:
Licensing Narrative: 6/14/24, Licensing Specialist reviewed provider reported incident for
licensing concerns. Uploaded medical documentation into Notes & Attachments.


summary: A resident was injured when he was attacked by a peer while playing basketball.

raw_content:
Interim Action Narrative: Resident taken to urgent care to further to rule out a concussion.
No signs head injury noted on exam per Urgent Care. Resident told to notify nursing of any
further complaints.
Maltreatment Narrative:
Licensing Narrative: 6/13/24, Licensing Specialist reviewed provider reported incident for
licensing concerns. Sent email to inquire if any safety precautions have been put in place.
6/13/24, Per facility, the 2 clients were placed on a peer limit in which they are not allowed
to interact with each other. So far, they have had no other problems. 6/14/24, Facility
emailed Licensing Specialist to add that the residents were also placed on freeze status.


summary: A resident was transported to Arkansas Children’s Hospital for treatment of her hand after she became upset and punched a wall several times.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 021842
Date of Incident: 6/8/2024
Date Received:6/10/2024
Facility Name: Youth Home, Inc.
Facility Number:128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Mabee House Incident Report
date/time: 06/08/24 6:36pm Location of Incident: Mabee House Incident Description: Self
Injury (Not Suicidal), Threat to Safety, Medical Emergency (Trip to ER/Urgent Care) Staff
Involved:
Events Leading: Client was upset with staff about having to be placed in
the back of the lunch line. Client was placed in the back due to being put on a peer limit.
Client was very upset about that. Client waited till she got back to the house to start
punching the wall. I asked her several times to stop punching the wall she would not stop.
Nursing Assessment 1 date/time: 06/08/24 6:57pm: staff reported that pt punched the wall
with R hand. upon this RNs arrival, pt found sitting in her room in the corner, barricaded
herself behind the plastic chair. initially was not communicating and refusing assessment
and any tx. while trying to de-escalate, pt punched the wall 3 more different times randomly
while seemingly was calm and quiet. eventually this RN removed the chair , pt started to get
emotional and reported severe pain to R hand. LOP 10/10. limited ROM to the R hand
joints with severe pain. reported numbness to R 5th digit. purple discoloration noted around
the knuckle joints and mild swelling as well. denied any other pain/injuries/concerns.
cooperative . resp even/unlabored. no s/sx of acute physical distress. ibuprofen
administered per orders and ice pack applied. Cody Horn , APRN notified of the
assessment findings and ordered for staff to take pt to ACH ED for R hand injury
evaluation. UM notified and making arrangements to transport at this time. mom notified
via the phone call Nursing Assessment 2 date/time: 06/08/24 7:49pm: Patient assessed.
Patient found in bedroom sitting up. Complaints of right hand pain, specifically pinkey
finger is especially painful. Pt unable to make a fist. Will continue to monitor. Nursing
Assessment 3 date/time: 06/08/24 11:10pm: Patient back from Emergency Room. Denies
pain currently. Patient and staff working on gathering bedding to sleep front of house.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Mother contacted at 1120pm and made aware of patient's condition. Guardian was notified
on 06/08/24 at 7:30pm and 11:20pm ER Paperwork was emailed to Tara Norton and Kendra
Rice on 06/10/24
Interim Action Narrative: Facility transported resident to ACH for evaluation after resident
complained of pain. Resident returned to facility and is currently placed in the front of the
house to sleep.
Maltreatment Narrative:
Licensing Narrative: 6/10/24, Licensing Specialist reviewed provider reported incident for
licensing concerns. Uploaded medical documentation from ACH to Notes and
Attachments.


summary: Licensing visited the facility to review children’s records. All files complied with minimum licensing standards.

raw_content:
521 Visit Compliance Report

Licensee: Youth Home, Inc.

Facility Number: 128

Licensee Address: 20400 COLONEL GLENN ROAD
LITTLE ROCK AR 72210

Licensing Specialist: Tara Norton
Person In Charge: Adria Riley
Record Visit Date: 6/4/2024
Home Visit Date: 6/4/2024

Purpose of Visit: Children’s Records

Regulations Out of Compliance:

Regulations Needing Technical Assistance:

Regulation Not Applicable:

Regulations Not Correctable:

Narrative:

Time of Visit: 10:45 am to 1:15 pm

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

ARKANSAS
) DEPARTMENT OF

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

P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550

Page 1 of 2

Census: 41

Licensing Specialist reviewed ten (10) children files:

Chestnut House

Mabee House

Rose House

Sturgis House

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

Provider Comments:

CCL Staff Signature :

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

Date: 6/4/2024

Date: 6/4/2024

Page 2 of 2


summary: Licensing visited the facility to conduct a Buildings and Grounds review. The facility was cited 912.4 for issues identified during the walk through.

raw_content:
ARR AMS AE
DEPARTMENT OF

4 HUMAN
~_.' SERVICES
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 601.508.8910 F: 501.683.6060 TDD: 501.682.1550

521 Visit Compliance Report

Licensee: Youth Home, Inc.

Facility Number: 128

Licensee Address: 20400 COLONEL GLENN ROAD
LITTLE ROCK AR 72210

Licensing Specialist: Tara Norton
Person In Charge: Adria Riley
Record Visit Date: 5/29/2024
Home Visit Date: 5/29/2024

Purpose of Visit: Subsequent Building and Grounds

Regulations Out of Compliance:

Regulation Number: 900.912.4

Regulation Description: The bathroom shall be clean and sanitary.

Finding Description: One bathroom was noted to have a black substance around the top of the walls near the
ceiling.

Action Due Date:

Action Due Description:

Comply Date:

Action Due Description:

Regulations Needing Technical Assistance:

Regulation Not Applicable:

www.arkansas.gowdhs
Serving more than one million Arkansans each year Page 1 of 3

Regulations Not Correctable:

Narrative:

Time of Visit: 10:00 am — 10:45 am
Census: 40

Licensing Specialist Norton and Program Coordinator Rice completed buildings and grounds for the
following PRTF houses at Youth Home: Sturgis, Chestnut, Rose, and Mabee. Mr. Jon Pulliam, PRTF Lead
Unit Manager escorted Licensing throughout the buildings and grounds. The following areas were observed:
group rooms, common areas, laundry rooms, seclusions rooms, comfort rooms, milieus, game/craft rooms,
hygiene closets, storage rooms, bedrooms, and bathrooms.

The grounds around each house were clean, free of safety hazards, and appeared to be well-maintained. An
uprooted tree was observed near one of the buildings. According to Mr. Pulliam, the tree would be removed
today or tomorrow by a tree service that is set to come out.

No residents were present during the walk-throughs of the houses due to attending school.

Sturgis: House was mostly clean and organized. Staff reports there are currently eleven (11) residents in the
house. The bedrooms were mostly clean and organized. There were no more than two residents per bedroom.
In ano hadenam acunindaururac Ahearvad wsrith nlinunnd aver it Mr Pulliam ctated that ane of the olace hincks
had been broken and maintenance had been called to repair it. One bathroom was noted to have a black
substance around the top of the walls near the ceiling. The facility will receive a citation 912.4, for a black
substance on the bathroom walls. Before licensing left the house, staff put a call in to maintenance to repair
the window and to address the issue with the black substance on the wall in the bathroom.

Chestnut: House was clean and smelled of cleaning supplies. All bedrooms were clean and mostly organized.
Bathrooms were clean. Hygiene supplies for each resident were stored in a locked closet. Staff reports there
are currently nine (9) residents in the house with no more than one (1) resident per bedroom. All bedrooms are
single rooms. All furnishings throughout the house were safe, clean, and in good repair.

Rose: House was clean and smelled of cleaning supplies. All bathrooms were clean and sanitary with hot and
cold water. Hygiene supplies for each resident were stored in a locked closet. All bedrooms were clean and
mostly organized. Staff reports that there are currently ten (10) residents in the house with no more than two
(2) residents per bedroom. All furnishings throughout the house were safe, clean, and in good repair.

Mabee: House was clean and organized. All bathrooms were clean and sanitary with hot and cold water.
Hygiene supplies for each resident were stored in a locked closet. Staff reports there are currently ten (10)
residents in the house. All bedrooms were mostly clean and organized. All furnishings throughout the house
were safe, clean, and in good repair.

Provider Comments:

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

CCL Staff Signature Date: 5/29/2024

t
1

v

Provider Signature Date: 5/29/2024

“Bosny DR Tet

www.arkansas,gov/dhs
Serving more than one million Arkansans each year Page 3 of3


summary: A resident was transported for acute care after exhibiting aggressive behaviors.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 021544
Date of Incident: 5/26/2024
Date Received: 5/28/2024
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Rose House Incident Report
date/time: 05/26/2024 6:56pm Location of Incident: Rose House Incident Description:
Aggressive to Peers, Aggressive to Adults, Threat to Safety Staff Involved:
Events Leading:
was in the comfort room and refused to come out. Another client was needing some time to
clear her head and asked if would come out so that client could go in the room . said
no and acted like she was trying to go to sleep. They started arguing and exchanging words
and were separated . we tried to send most of the girls to the back to go into a safe area by
going to their room and was threatening and cussing at everyone to get a reaction
7:00pm: Personal Restraint: the client became unsafe in the house a threat to safety and
herself. 7:02pm: Personal Restraint End: the patient was escorted to unlocked seclusion to
try to keep her safe and not a threat 7:03pm: Unlocked Seclusion: patient was put in
unlocked seclusion and monitored thoroughly 7:04pm: Unlocked Seclusion End: out of
seclusion , patient seemed to be calm enough for staff to trust her to make the right choices.
Client Debriefing date/time: 05/26/24 7:15pm: we were able to help the patient decompress
and talk out their feelings . Was able to get her to open up about some stuff that really
makes her mad. Nursing assessment date/time: 05/26/24 7:25pm: Patient found sitting
calmly in a chair at a table in the house. Patient denies pain or injury and is calm and
cooperative with a depressed affect. Will monitor as needed. Guardian was notified on
05/26/24 at 8:06pm and 8:37pm Client was transferred to Pinnacle Pointe for an acute stay
on 05/27/24 at 1:30am. Client will return to Youth Home from acute at this time.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Interim Action Narrative: Staff placed resident in a personal restraint and escorted resident
to seclusion room until she could calm down. Resident was transported to Pinnacle Pointe
for an acute stay.
Maltreatment Narrative:
Licensing Narrative: 5/29/24, Licensing Specialist reviewed provider reported incident for
licensing concerns. 5/29/24, Reviewed and uploaded nursing notes into Notes and
Attachments Section.