summary: A resident was sent for an x-ray of his toe after he became angry and kicked a chair.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 027331
Date of Incident: 2/4/2025
Date Received: 2/5/2025
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: , PRTF, ) went to
for an x-ray of his toe. stated that he had gotten angry
and kicked a chair. The x-ray revealed a involving the base of the
.
Interim Action Narrative: Client was taken to the
Narrative:
Licensing Narrative: 2/6/25-Reviewed for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


state: AR

facility_name: Millcreek Behavioral Health / Habilitation Center, Inc.

summary: A resident forcefully kicked the living unit door open after becoming upset and remained outside until a physical restraint was implemented. Afterward, the resident was evaluated and referred for an x-ray. The Physical Escort Technique used was not an approved technique. The facility was cited 905.9 for the improper escort.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 027293
Date of Incident: 2/1/2025
Date Received: 2/4/2025
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type:
Report Description: On February 1, 2025,
exhibited agitation after a game of Tic-Tac-Toe, during which he forcefully
kicked open the living unit door. Despite multiple prompts from staff to return, he remained
outside. As the situation escalated, a physical restraint was implemented when resisted a
staff member's attempt to assist him from his seated position against the wall. Following the
release from the restraint, was escorted to his room, where he engaged in self-injurious
behavior by striking himself with a plastic tote. Due to the continued risk of harm, a second
physical restraint was applied. Upon assessment, reported pain at a 5/10 level but
demonstrated a full range of motion with no visible swelling or deformity. Initially, it was
considered that the pain might have resulted from the forceful contact with the door. A
subsequent evaluation on February 3rd led to a referral to for
an outpatient x-ray,
During a follow-up interview, stated that he first noticed the pain while
being physically escorted to his room. He acknowledged fighting against staff members and
struggling during the escort. He expressed that he did not believe the injury was intentional.
Millcreek has made a report to the . No return
correspondence has been received at the time of this report.
Interim Action Narrative: Per , two A/O's will be named in this
case: and . Phone call made to Chris Butler of
Millcreek 2/5/25. Both A/O's will immediately be placed on administrative leave pending
investigation and/or
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Narrative: A/V is . A/O is unknown (staff at Millcreek of
Arkansas). PRFCs are . On February 1, 2025,
exhibited agitation after a game of Tic-Tac-Toe, during which he forcefully kicked open the
living unit door. Despite multiple prompts from staff to return, he remained outside his
living unit. As the situation escalated, a physical restraint was implemented when
resisted a staff member's attempt to assist him from his seated position against the wall.
Following the release from the restraint, was escorted to his room, where he engaged in
self-injurious behavior by striking himself with a plastic tote. Due to the continued risk of
harm, a second physical restraint was applied. Upon assessment, reported pain at a 5/10
level but demonstrated a full range of motion with no visible swelling or deformity. Initially,
it was considered that the pain might have resulted from the forceful contact with the door.
A subsequent evaluation on February 3rd led to a referral to
for an outpatient x-ray,
. During a follow-up interview, stated that he first noticed the pain while
being physically escorted to his room. He acknowledged fighting against staff and
struggling during the escort. He expressed that he did not believe the injury was intentional.
Licensing Narrative: 2/4/25-
.
Clayton DeBoer and granted permission to visit the facility. Phone call was made to Emily
Burris and Chris Butler of Millcreek to ascertain if there was an A/O. Ms. Burris and Mr.
Butler indicated they did not see anything in video reviewed that would support allegation
against a specific staff. 2/5/24-Phone call made to who visited
A/V and reviewed video yesterday. stated that there would be two A/O's in this
report: and ). Phone call made to Emily
Burris and Chris Butler of Millcreek that both A/O's would need to be placed on
administrative leave pending investigation and/or an approved ICA by Program Manager
Chelsea Vardell. Visit scheduled for 2/6/25. Per phone call with Chris Butler, the incident
occurred on 2/1/25, but there was no complaint or hospital visit until 2/3/25, thus was
reported timely. 2/5/25-ICA requested for . 2/6/25-Facility visited and
camera footage reviewed. Facility cited 905.9. Licensing is not prepared to make a
complaint finding at this time. 2/11/25-ICA for approved by Program
Manager Chelsea Vardell. 2/14/25-Staff training sent to licensing. Witness Statements for
incident provided to licensing and reviewed. statement indicates his ankle was injured
by staff. All staff statements do not support that client was injured during restraints.
2/27/25- Conversation had regarding
incident. 2/27/25-Case reviewed and staffed with Program Coordinator Kendra Rice.
Licensing investigation for complaint is unfounded. 2/28/2025, case and documentation
reviewed. Complaint unfounded by licensing case complete. ICA has NOT been lifted as of
2/28/2025.

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: Millcreek of Arkansas PRTF
Facility Number: 233
Licensee Address: 1828 INDUSTRIAL DR
FORDYCE AR 71742-7110
Licensing Specialist: Clayton DeBoer
Person In Charge:
Record Visit Date: 2/27/2025
Home Visit Date: 2/27/2025
Purpose of Visit: Revisit Complaint
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
This is to document that Case#027293 has been investigated and determined to be unfounded by Licensing.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Provider Comments:
CCL Staff Signature : Date: 2/27/2025
Provider Signature : Date: 2/27/2025
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2

doc_type: Notice of Incident


summary: A resident complained of thumb pain after a fall. An x-ray was ordered. The x-ray showed no fracture or abnormality.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 027020
Date of Incident: 1/23/2025
Date Received: 1/24/2025
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: PRTF, , Parent Custody)
complained of right thumb pain after a fall. He went to for an
x-ray. The x-ray revealed no abnormalities or fractures.
Interim Action Narrative: Client went to for thumb pain. X-ray revealed no fractures.
Narrative:
Licensing Narrative: 1/27/25-Reveiwed for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Complaint #AR00036068 was in compliance.

raw_content:
Division of Provider Services
& Quality Assurance
P.O. Box 8059, Slot S404
Little Rock, AR 72203-8059
February 5, 2025
Brady Serafin, Administrator
Habilitation Center, Llc
P.O. Box 727
Fordyce, AR 71742
Dear Mr. Serafin:
A Complaint Investigation survey was conducted on January 21, 2025. We are pleased to inform you
that no deficiencies were cited during the survey and that your facility was in compliance with the
requirements of 42 CFR Part 483, Subpart G, Requirements for Psychiatric Residential Treatment
Facilities. Your certification remains in effect unless terminated due to non-compliance with program
requirements or voluntary withdrawal from the program.
We have enclosed form CMS 2567, “Statement of Deficiencies and Plan of Correction” for the January
21, 2025 Complaint Investigation survey conducted at your facility for participation in the Medicaid
program. CMS 2567 is enclosed, indicating your facility's compliance status. Please sign and
date the 2567 and email to breanna.marengo@dhs.arkansas.gov.
If you have any questions please contact your reviewer at 501-320-6280.
Sincerely,
Breanna Marengo, QA Team
DPSQA/Office of Long Term Care
Survey and Certification Section
bbm
cc: DRA
Brady Serafin - Habilitation Center, Llc - 02/05/2025- (AOLTC - PRTF No Def) Page 1]

PRINTED: 02/05/2025
DEPARTMENT OF HEALTH AND HUMAN SERVICES FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING ______________________
C
04L103 B. WING _____________________________ 01/21/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1810 INDUSTRIAL DRIVE
HABILITATION CENTER, LLC
FORDYCE, AR 71742
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETION
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
N 000 Initial Comments N 000
Note: The CMS-2567 (Statement of Deficiencies)
is an official, legal document. All information must
remain unchanged except for entering the plan of
correction, correction dates, and the signature
space. Any discrepancy in the original deficiency
citation(s) will be reported to the Dallas Regional
Office (RO) for referral to the Office of the
Inspector General (OIG) for possible fraud. If
information is inadvertently changed by the
provider/supplier, the State Survey Agency (SA)
should be notified immediately.
Complaint # (AR00036068) was in compliance.
The facility was in compliance with §483, Subpart
G - Conditions of Participation for Psychiatric
Residential Treatment Center.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that
other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days
following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14
days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued
program participation.
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID:DEQM11 Facility ID: 3002 If continuation sheet Page 1 of 1

doc_type: Complaint Survey


summary: A staff member was seen on video pushing a resident twice. The resident was pushed to the ground. The facility was cited 109.1.g and 907.2 as a result of the incident. The staff member was terminated.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 026960
Date of Incident: 1/19/2025
Date Received: 1/21/2025
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: Staff member was seen on video pushing
PRTF, , Parent Custody) twice with the second push resulting
in falling to the ground. Staff member was terminated
immediately. A report to the has been submitted.
.
Interim Action Narrative: Staff viewed pushing client in video immediately terminated.
Narrative:
Licensing Narrative: 1/21/25-Reviewed for licensing concerns. Visit scheduled for 1/22/25
to review video. Phone call made to Emily Burris of Millcreek who stated that they have not
received confirmation if the was accepted or not and that the
. Ms. Burris did state they had a confirmation # .
. 1/22/25-Facility visited and cited 109.1g,
905.4g and 907.2.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent for an x-ray after complaining of pain due to punching a wall. The x-ray showed no fracture or abnormality.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 026954
Date of Incident: 1/17/2025
Date Received: 1/21/2025
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: PRTF, Parent Custody) went to
for an x-ray on her right hand after complaining of pain after
punching a wall. X-ray showed no abnormalities or fractures.
Interim Action Narrative: Client was X-rayed.
Narrative:
Licensing Narrative: 1/21/25-Reviewed for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to the Emergency Room due to a previous injury to his carotid artery, after staff found him barricaded in his room with a pair of pants tied around his neck. The resident was placed on suicide precautions and 1:1 monitoring.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 026957
Date of Incident: 1/17/2025
Date Received: 1/21/2025
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: , PRTF, , Parent Custody) went to
to be checked out after a suicide gesture. At the
facility had tied a pair of pants around his neck. had barricaded himself in his
room while staff were dealing with another behavior on the unit. There was about 3 minutes
between when staff checked on and when this happened. Staff removed the pants
from around his neck. had petechia on his neck from this incident. The mother stated
that he had previous damage to his carotid artery from a previous attempt. Out of an
abundance of caution he was sent to the to be checked out. was sent back to
Millcreek and was placed on suicide precaution and 1:1 monitoring until a therapist feels he
can be downgraded. A safety plan has been put in place.
Interim Action Narrative: Client taken to . Safety plan put in place.
Narrative:
Licensing Narrative: 1/21/25-Reviewed for licensing concerns. Safety plan is in place.
Phone call made to Emily Burris of Millcreek. Client had not given any indication to staff or
peers that he was suicidal. Client was not previously on suicide watch or any increased
precautions. Client later stated he did this because he did not want to go home. Client does
not have a soon upcoming discharge date. There is video of the hallway which indicates a
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

timeframe of staff checking on client's room. Visit scheduled for 1/22/25. 1/22/25-Facility
visited. No citations.


summary: A resident complained of knee pain after falling. He was sent for an x-ray. The x-ray showed no fracture or abnormalities.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 026831
Date of Incident: 1/14/2025
Date Received: 1/15/2025
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: , PRTF, , Parent Custody)
complained of knee pain, stating that he had fallen. He was sent to
for an x-ray. X-ray revealed no abnormalities.
Interim Action Narrative:
Narrative:
Licensing Narrative: 1/16/25-Reviewed for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent for a follow up x-ray after her discharge from the 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
R
Notice of Serious Incident
Case Number: 026832
Date of Incident: 1/14/2025
Date Received: 1/15/2025
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: , , Parent Custody) went to
for a follow up x-ray following her discharge from the
hospital for . The x-ray showed improving with
Interim Action Narrative:
Narrative:
Licensing Narrative: 1/16/25-Reviewed for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was admitted to the hospital. The resident returned to the facility on 1/12/2025.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 026703
Date of Incident: 1/9/2025
Date Received: 1/9/2025
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: PRTF, , Parent custody) was
admitted to .
Interim Action Narrative: Resident was evaluated and .
Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Licensing requested nurse's note and if a timeframe was provided from the hospital. Facility
provided a copy of the nurse's note and it has been uploaded. 1/10/25-Email sent to facility
to notify licensing if/when client returns to facility and provide hospital discharge
paperwork. 1/13/25-Hospital Discharge paperwork sent to licensing. Client returned to
facility 1/12/25.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A complaint received states that a resident snorted medication she found in a staff member’s jacket. The resident reported that she provided pills to other residents on the unit. The facility was cited 907.5 for a staff member seen sleeping during a video review.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 026702
Date of Incident: 1/9/2025
Date Received: 1/9/2025
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type:
Report Description: We were made aware involving
, ) where she stated that she got pills from a
staff members' jacket and took them.
Interim Action Narrative: A/O unknown.
Narrative: AV is . AO is unknown. PRFC is .
is a child currently placed at Millcreek Behavioral Health in Fordyce,
AR. Her primary case manager is Brittney Vaughan. Her primary therapist is Deirdre
Holladay. Today and I had a family therapy session held via Zoom with her therapist,
Ms. Deirdre. proceeded to tell me that she had recently snorted some pills that she
found in a staff person's jacket that was left unsupervised on the treatment unit.
alleges that the medication was Benadryl, however, the facility has not provided an incident
report regarding this nor did they reach out to inform me, her legal guardian, that the
incident occurred. This is a serious concern as has previously had access to a vape pen
that was left in a staff person's jacket unsupervised. shared that she also provided pills
to the other girls on the unit who also snorted them. I have formally requested the incident
report--however, it is likely that the incident occurred in the last 14 days as we meet bi-
weekly via Zoom and today is the first that I've heard of this incident. 2/20/25-Unfounded
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing reviewed complaint for licensing concerns. Program
Coordinator
. Licensing requested an ICA from the facility.
Facility reported they did not have a staff member by the name provided for an ICA.
Licensing emailed and inquired if a staff member's name was provided.
reported the offender is unknown and that there certainly an issue with
employees medication being left unattended. Licensing inquired if staff members will be
trained. Facility reported: they previously conducted training on the importance of securing
OTC medications and will provide additional training to reinforce this critical safety
practice. The leadership team conducts multiple daily rounds to address various safety
concerns, including ensuring all doors are properly closed and locked. 1/14/2025, Program
Coordinator received a notice , and it has been uploaded. Licensing
Specialist informed. 1/17/25-Facility visited with . Video
reviewed. has interviewed A/V , and clients and . All 3 clients will be
.
. Licensing cannot make a finding at this
time. 1/24/25-Facility visited again for this complaint. Ms. Harper interviewed clients:
and staff Zakiya W. Licensing cannot make a finding at this time.
. 2/20/25-Licensing informed was
. This complaint has been unfounded by licensing. Case reviewed and
complete.

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: Millcreek of Arkansas PRTF
Facility Number: 233
Licensee Address: 1828 INDUSTRIAL DR
FORDYCE AR 71742-7110
Licensing Specialist: Clayton DeBoer
Person In Charge:
Record Visit Date: 2/20/2025
Home Visit Date: 2/20/2025
Purpose of Visit: Revisit Complaint
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
This is to document that Case#026702 was investigated and determined to be unfounded.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Provider Comments:
CCL Staff Signature : Date: 2/20/2025
Provider Signature : Date: 2/20/2025
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident was sent for a chest x-ray due to cough and congestion. The x-ray showed no negative findings.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 026610
Date of Incident: 1/3/2025
Date Received: 1/6/2025
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: ) was sent to
for a chest x-ray due to cough and congestion. The x-ray
revealed no negative findings. returned to Millcreek with no new orders.
Interim Action Narrative: Client sent for chest x-ray. No negative findings.
Narrative:
Licensing Narrative: 1/6/25-Reviewed for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: An x-ray was ordered after a resident punched a wall while upset.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 026533
Date of Incident: 12/31/2024
Date Received: 1/2/2025
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: , ) got
upset due to grandmother not answering the phone and punched the wall. went to
for an x-ray of her right hand. The x-ray revealed no fractures
or abnormalities.
Interim Action Narrative:
Narrative:
Licensing Narrative: 1/2/2025-Reviewed for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: The facility medical director sent a resident for a different x-ray view due to the initial x-ray performed not being the correct view of the area in question.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 026493
Date of Incident: 12/30/2024
Date Received: 12/31/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: The medical director sent ,
for a different x-ray view due to the initial x-ray
not being the correct view t The new x-ray shows that
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 12/31/2024-Reviewed and related to case 026423.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Dallas County Medical Center for an x-ray due to complaining of lower rib pain after an altercation with a peer.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 026423
Date of Incident: 12/26/2024
Date Received: 12/27/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: was in
an altercation with a peer. complained of lower rib pain. He stated that he had
broken ribs before he came here (caseworker stated she didn't know about this). Took
to Dallas County Medical Center for an x-ray and found .
was sent back to Millcreek. was placed on a different unit for the night to
separate him and peer he got in an altercation with.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 12/27/24-Reviewed for licensing concerns. Peers in altercation
separated. Email sent to facility to ascertain if there is video of the altercation. 12/30/24-
Recieved email altercation occurred outside of the gym and there is no camera footage.
Email sent to facility to ascertain the following: Staff/client ratio at the time of incident Any
and all witness statements of incident ER discharge paperwork for client 12/30/24-
Received ER discharge paperwork for from facility. Staff/client ratio: 2:10. Facility does
not have witness statements to this altercation at this time. Witness statements will be sent
later in the week, as some of the staff present for the altercation will not be on site until later
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

in the week. 12/31/24-Received 2nd X-ray for . 1/6/24-
Witness statements sent to licensing.


summary: A resident was sent to Dallas County Medical Center for assessment and x-ray after being pushed over a chair by a peer.

raw_content:
AR KANS A S&S
DEPARTMENT OF

i¢ SaRVICES

Placement and Residential Licensing Unit
P.O. Box 1437, Slot $140, Little Rock, AR 72203-1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550

Notice of Serious Incident
Case Number: 026405
Date of Incident: 12/25/2024

Date Received: 12/26/2024

Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233

Incident Type: Licensing

Report Description was sent to
Dallas Co Medical Center for assessment and outpatient x-ray after being pushed over a

chair by a peer. Doctor?s report indicate

Interim Action Narrative:

Maltreatment Narrative:

Licensing Narrative: 12/26/24-Reviewed for licensing concerns. 12/30/24-Phone call made
to Emily Burris of Millcreek. Safety plan for Bwas that he and peer in the altercation were
placed in separate cottages for the day. When it was deemed safe for Jjto return to
cottage, he was returned later in the evening.

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


summary: A resident eloped from the facility by taking a staff member’s keys, running away from staff as he was escorted to the nurse, and driving off in the staff member’s car. Police officers located the resident and transported him back to the facility. 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
R
Notice of Serious Incident
Case Number: 026375
Date of Incident: 12/21/2024
Date Received: 12/23/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: stole
worker J. Thompson?s keys. was searched but they did not locate the keys.
admitted to Risk today that he had the keys hidden in his shorts? pocket that was
underneath his jeans. was moved to a different unit (Pine Ridge at 17:37) due to
targeting staff J. Thompson. While on the unit told worker he needed to go see the
nurse. As the worker was escorting to the nurse he ran and got in staff J.
Thompson?s car (18:02). drove the car and pulled over at Wal-mart (0.9 miles away)
due to the car smoking. Cops were notified by nursing staff as soon an got in
staff?s car and left. Supervisor followed to Wal-Mart. When he arrived at Wal-Mart
jumped out of the car and ran into Wal-Mart. Police got and brought him
back to Millcreek at 18:35.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: Police documentation requested. 12/26/24-Reviewed for licensing
concerns. Email sent to facility to ascertain procedure on staff car keys being secured as so
clients cannot obtain them. Received email from Chris Butler of Millcreek as follows:
During the initial orientation class, we request that staff secure personal belongings in the
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

living unit office, which is to remain locked. We are doing a campus wide in-service to
remind all employees about this practice. 1/1/2025, police documentation received, and
Licensing Specialist informed. 1/5/24-Police report reviewed.


summary: A resident was sent to Dallas County Medical Center for an x-ray of his right hand after he got mad and punched a wall.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 026268
Date of Incident: 12/18/2024
Date Received: 12/19/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: got
mad and punched the wall. He went to Dallas County Medical Center for an x-ray of his
right hand. The x-ray revealed
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 12/20/24-Reviewed for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Dallas County Medical Center for an x-ray of his nose after an altercation with a peer.

raw_content:
AR KANS A S&S
DEPARTMENT OF

i¢ SaRVICES

Placement and Residential Licensing Unit
P.O. Box 1437, Slot $140, Little Rock, AR 72203-1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550

Notice of Serious Incident
Case Number: 026221
Date of Incident: 12/17/2024

Date Received: 12/18/2024

Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233

Incident Type: Licensing

Report Description: went to Dallas
County Medical Center for an x-ray of his nose after an altercation with his peer. The x-ray

revealed 25 peer were separated and will be

monitored.

Interim Action Narrative:

Maltreatment Narrative:

Licensing Narrative: 12/18/24-Reviewed for licensing concerns. Safety plan in place.

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


summary: Licensing visited the facility to interview residents.

raw_content:
521 Visit Compliance Report

Licensee: Millcreek of Arkansas PRTF

Facility Number: 233

Licensee Address: 1828 INDUSTRIAL DR
FORDYCE AR 71742-7110

Licensing Specialist: Arlene Horton
Person In Charge:

Record Visit Date: 12/13/2024
Home Visit Date: 12/13/2024

Purpose of Visit: Monitor Visit

Regulations Out of Compliance:

Regulations Needing Technical Assistance:

Regulation Not Applicable:

Regulations Not Correctable:

Narrative:

Time: 11:30 a.m. 12:30 p.m.

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: 151

PY appeared alert and very responsive
Po slow speech, appeared sleepy, tired
Po high spirits, energetic
PY responsive, talkative
al. and responsive

PF responsive, calm

PF very alert, talkative

PF responsive, looked sleepy

fF alert, talkative

Po responsive, talkative

fF calm, attentive

PF alert, responsive
ES tesponsive, alert

Provider Comments:

CCL Staff Signature :
F ‘
A We Thi,

Provider Signature :

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

Date: 12/13/2024

Date: 12/13/2024

PRTF facility A) Middle Creek children that I met today. I do not recall speaking with J
PY but his name is on the list that Chris provided to me.

Page 2 of 2

doc_type: Compliance Report


summary: A resident complained of arm pain after an altercation with a peer. The residents were separated, and an x-ray was ordered for the resident’s arm.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 026076
Date of Incident: 12/10/2024
Date Received: 12/11/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description:
complained of arm pain after getting into an altercation with a peer. went for an x-
ray of his right arm. The x-ray revealed and peer
were separated and ended up being moved to another unit.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 12/15/24-Reviewed for licensing concerns. Safety plan in place for
clients.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Licensing completed a Buildings and Grounds walkthrough for the Cafeteria, Gym, and facility grounds. No deficiencies cited.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Millcreek of Arkansas PRTF
Facility Number: 233
Licensee Address: 1828 INDUSTRIAL DR
FORDYCE AR 71742-7110
Licensing Specialist: Clayton DeBoer
Person In Charge: Emerald Burris
Record Visit Date: 12/10/2024
Home Visit Date: 12/10/2024
Purpose of Visit: Subsequent Building and Grounds
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Buildings & Grounds conducted of Cafeteria, Gym and facility grounds.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Gym staff/client ratio: 3:18
Client group walking to cafeteria: staff/client ratio 3:12
Gym clean and free of safety hazards. Clients playing kickball. Cafeteria clean and sanitary. Bathrooms for
cafeteria clean and sanitary. Kitchen clean and fire extinguisher observed. Lunch was about to be served.
Grounds observed for upper facility campus to be clean, well-kept and free of safety hazards.
Provider Comments:
CCL Staff Signature : Date: 12/10/2024
Provider Signature : Date: 12/10/2024
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident complaint of pain to the right hand after an altercation with a peer. The resident was sent to Dallas County Medical Center for an x-ray.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 026005
Date of Incident: 12/9/2024
Date Received: 12/10/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description:
complained of right-hand pain after an altercation with a peer. went to Dallas County
Medical Center for an x-ray of hand. The x-ray showed and peer
were separated and being monitored.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 12/10/24-Reviewed for licensing concerns. Safety plan in place.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Dallas County Emergency Room for a CT scan due to hitting her head when she fell over during what appeared to be a seizure.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 025980
Date of Incident: 12/8/2024
Date Received: 12/9/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: was on
the unit eating a snack. fell over and started having what appeared to be a seizure.
Code was called and nurse arrived on unit. Staff and nurse turned patient on side and 911
was called. seized for approximately 5 minutes. was taken to Dallas County
ER. She received a head CT due to hitting her head when she fell over. Diagnosis
. returned to Millcreek the same day. She has a follow
up appointment with her PCP on Tuesday 12/10/24.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 12/9/24-Reviewed for licensing concerns. Client has follow-up
appointment with her PCP regarding this incident.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: An x-ray was ordered of a resident’s right foot due to complaints of pain. The injury occurred while the resident was playing football.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 025849
Date of Incident: 11/28/2024
Date Received: 12/3/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: had
an x-ray of his right foot after complaining of pain. stated that he hurt his foot playing
football. X-ray found
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 12/3/24-Reviewed for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident got mad and punched a door after a peer ran up to him and hit him in the mouth. The resident was taken to Dallas County Medical Center for an x-ray of his hand.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 025732
Date of Incident: 11/23/2024
Date Received: 11/25/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: was in
the hallway trying to calm down. Another peer ran up to him and hit him in the mouth.
got mad and punched the door hurting his hand. was taken to Dallas County
Medical Center for an x-ray of his right hand. The x-ray revealed that there are
was sent back to Millcreek with no new orders.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 11/25/24-Reviewed for licensing concerns. X-ray results received from
facility. Email sent to ascertain in clients were put on any restrictions, separations, or safety
plans. Received email that clients were placed on assault precautions.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Dallas County Medical Center for an abdominal CT scan due to abdominal 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
R
Notice of Serious Incident
Case Number: 025654
Date of Incident: 11/20/2024
Date Received: 11/21/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description:
went to Dallas County Medical Center for an abdominal CT due to abdominal pain. CT
revealed . She was sent back to Millcreek.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 11/21/24-Reviewed for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A Medicaid Inspection of Care review was triggered by a complaint against the facility.

raw_content:
UPDATED: December 4, 2024
November 25, 2024
Arkansas Foundation for Medical Care (AFMC) performs Inspections of Care (IOC) reviews of the Behavioral
Health Agencies for the Division of Provider Services and Quality Assurance with the Arkansas Department of
Humans Services. The Arkansas Department of Human Services Division of Behavioral Health Services
Licensure Standards for Inpatient Psychiatric Services for Under 21. The Medicaid Manual for Inpatient
Psychiatric Services for Under Age 21 was used in the completion of this report
An incident occurred at the following service site that prompted an order for an additional review. Upon review
of the policies relevant to the incident, the findings are noted below:
Habilitation Center, LLC
1810 Industrial Drive
Fordyce, AR 71742-7110
Onsite Inspection Date: November 20, 2024
Onsite Inspection Time: 8:56 AM
A summary of the policies reviewed, and findings are noted below:
Inspection of Care Summary
Health and Safety-Policy Review
This additionally ordered inspection was triggered by a complaint against Habilitation Center, LLC. Based on the
nature of the incident, the following were requested for review:
• Policies
o Restraint Policy
o Restraint Log for October 2024 and November 2024
o Incident Reporting Policy
o Critical Incident Reporting Policy
o Incident Report and any surrounding documentation regarding this complaint Facility provided
the following documentation:
▪ Incident Report dated October 25, 2024
▪ Arkansas Mandated Reporter Form
▪ Employee Disciplinary Action Report
▪ 521 Visit Compliance Report
• Client file of the alleged victim
• Employee File Review
Observation:
Upon arrival at the facility, AFMC staff were promptly greeted at the entrance by a Habilitation Center, LLC
receptionist in the main lobby. AFMC staff signed the visitor log. AFMC staff were immediately taken to a
conference room where they were met by the Chief Operations Officer. AFMC staff were given the completed
and signed consent form listing approval for access to the AFMC portal. Facility staff were given the Document
Request Form and AFMC staff discussed the requirements for the Inspection of Care.

Personnel Records – Licenses, Certifications, Training:
Based on the nature of the incident, personnel records were reviewed. There were no deficiencies noted.
Upon the review of the alleged offenders personnel record, the following was noted:
• 08/05/24- initial staff hire date
• 10/25/24- alleged incident
• 10/31/24- attended annual training of Therapeutic Crisis Intervention System (TCI)
• 11/05/24- termination of offender
Clinical Review Deficiencies:
AFMC was provided with the alleged victim’s file for review.
The provider uploaded records which were then reviewed for compliance with licensure standards. Based on the
review of clinical components of licensure requirements, there were no deficiencies noted.
Summary of Findings and Resolution:
Below is a summary of observations from the chart review of the alleged victim:
• Client was admitted to Habilitation Center LLC on 2024, at 2:50 p.m. and was still a client in
the facility on the date of the additionally ordered Inspection of Care.
• Client had multiple episodes documented in the nursing notes and staff observation notes detailing the
client’s behaviors that included the following:
o Self-harming behaviors including biting self and banging head on wall
o Non-compliance with structured activities and classroom work
o Yelling/screaming at staff, teachers, and peers
o Hitting staff and peers
o Provoking/agitating other clients in an attempt to fight
o Running away from staff and threatening to elope
o Threats of killing self
o Use of inappropriate language toward peers and staff
o Use of sexually inappropriate gestures and statements to staff
o Injuring self when banging head on wall and threatening to blame staff for injuries to “get them
fired”
• On September 24, 2024, October 5, 2024, and November 12, 2024, the client was placed on unit
restrictions due to continuous disruptive behaviors.
• On September 24, 2024, from 12:42 p.m. until 12:52 p.m. the client was placed in a physical hold due to
biting self and hitting other peers. Restraint documentation was reviewed, and all elements of required
documentation were met.
• On October 23, 2024, at 1:00 p.m. there was documentation by a Behavioral Health Assistant on the daily
observation sheet that stated the client was provoking peers and was aggressive. Clients were separated.
The client ran inside the unit banging head on hallway doors. The client was removed from the area by
staff and noted to have a scratch on finger on right hand. The client stated they were going to say staff did
it. Staff had to do a safety protocol and escorted the client from the door due to self-harming behavior.
• On October 25, 2024, at 7:55 p.m. there was documentation by a Behavioral Health Assistant on the daily
observation sheet that stated the client asked a Staff Member A ‘why they were so mean and mad.’ Staff
Member A told client they are ‘a provoker and messy.’ Staff Member A and client continued to argue,
and Staff Member B told the client to go color in another spot to calm down. Staff Member A then called
client “gay lil boy” and client called staff a ‘bitch’. Staff Member A then ‘jacked patient up by shirt against
the wall’. The client and Staff Member A started getting physically aggressive. Staff Member B told Staff
Member A to “stop and chillout and go get a breather.” The nursing staff documentation did not document
the incident.
Habilitation Center, LLC – Fordyce, AR – IOC Report 2 | P ag e

• On November 12, 2024, at 11:45 a.m. there was documentation by a Behavioral Health Assistant on the
daily observation sheet that stated the client was non-compliant and ran away from staff toward the
highway. The client was escorted back to the unit. The client stated they were going to lie and said all the
staff had hit the client. The client punched themselves in the forehead. At 12:00 p.m. the client ran out of
the assigned area again and was escorted back to the unit. The client began screaming “they are hurting
me.” The client stated that they would keep doing it to “get staff in trouble.”
• On November 17, 2024, at 5:17 p.m. there was documentation by a Behavioral Health Assistant on the
daily observation sheet that stated the client was choking themselves and attempted to run away from
staff. Staff redirected client. At 5:32 p.m. staff asked the client to use coping mechanisms. The client took
a marker from a peer and bit the end of the marker off and swallowed it. The staff reported this to the
nurse. At 5:32 p.m. Behavioral Health Tech documented that the client “made a false allegation against a
staff member” about a staff member inappropriately touching the client and upsetting the other clients
with the allegation. The client was confronted with the allegation in front of the other clients and the client
stated, “I lied, she didn’t. I just wanted to get someone fired.”
• No other documentation for this client was submitted for review after November 20, 2024, due to AFMC
conducting Inspection of Care on this date.
Policy and Procedure Review:
There were no deficiencies noted during the review. The following is a summary of observations from the request
documents and policy and procedure review:
• Restraint and Seclusion Policy
o Facility does not utilize seclusion but does utilize physical holds and chemical restraints.
o Noteworthy statements from Restraint and Seclusion Policy:
▪ Millcreek uses the Therapeutic Crisis Intervention System (TCI) developed by Cornell
University. TCI is a crisis prevention and intervention model for residential childcare
facilities.
▪ The PRTF Individualized Behavioral Contingencies policy provided includes staff
training requirements for staff involved in restraints. The policy states "all direct care
staff, staff involved in the use of restraint, and those authorized to initiate restraint, will
receive initial and ongoing training. Millcreek Leadership will conduct this training
during the initial orientation, annually, and at any other time deemed necessary." "Staff
members must demonstrate competency in both a written and physical skills test for
TCI. All TCI trained employees must attend a semi-annual TCI refresher training which
last for four hours. This refresher training is conducted every six months from the date
of original training."
• October 2024 Restraint Log observations:
o There were 54 incidents of restraints documented for the entire month of October.
▪ 48 out of 54 incidents of physical holds only
▪ 6 out of 54 incidents had both a physical hold and chemical restraint
o There were 32 incidents involving restraints that were not able to be reviewed on the security
camera system due to restraints occurring where there was no camera coverage or due to technical
difficulties with camera system.
• November 2024 Restraint Log observations:
o There were 50 incidents of restraints documented from November 1, 2024, through November
19, 2024.
▪ 36 out of 50 incidents of physical holds only
▪ 14 out of 50 incidents had both a physical hold and chemical restraint
o No reviews of any restraints for November have been completed at the time of IOC.
• Review of the Incident Report observations:
o Incident occurred on October 25, 2024, at 7:51 p.m.
o The incident was reported by the alleged victim’s guardian after the alleged victim disclosed the
information to the guardian via telephone call.
Habilitation Center, LLC – Fordyce, AR – IOC Report 3 | P ag e

o The facility was notified via email on November 4, 2024, of the incident. The email was sent to
the facility on the evening of November 3, 2024. The incident report does not disclose who sent
the email.
o The incident report includes initial corrective actions including:
▪ External reporting to the Arkansas Department of Human Services through the
Mandated Reporting Portal.
▪ Coordination with local law enforcement by proactively contacting the Dallas County
Sheriff’s Office. According to the incident report the facility expressed their intent to
fully cooperate with any investigations or procedures initiated by external authorities.
▪ An internal investigation process to ensure all necessary steps are being taken to
address the incident.
• Employee Disciplinary Report observations:
o Employee was counselled regarding unsatisfactory job performance and patient abuse and
neglect: improper Therapeutic Crisis Intervention.
o Employee was terminated on November 5, 2024.
• Arkansas Mandated Reporter Form observations:
o Per the Chief Operations Officer the incident was not accepted.
• 521 Visit Compliance Form observations:
o Regulation Number 100.109.1.g and 100.110.9.c found out of compliance.
Respectfully,
Inspection of Care Team
InspectionTeam@afmc.org
1020 W. 4TH ST., SUITE 300
LITTLE ROCK, AR 72201 • afmc.org
Habilitation Center, LLC – Fordyce, AR – IOC Report 4 | P ag e

doc_type: IOC Report


summary: A complaint received stated that a resident was receiving multiple medications that cause sedation and that one of the medications treats diagnoses that the resident does not have. The complaint has been UNFOUNDED by Licensing.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 025648
Date of Incident: 11/19/2024
Date Received: 11/20/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Dual
Report Description: We have received a new report with the following allegations on
AV is She is considered to be in the custody of the
She is currently at Mill Creek in Fordyce.
reviewed the list of medications being given to at Mill Creek. She is
taking Atarax (25 miligrams, 3 times a day), Seroquel (400 milligrams, 1 time a day),
terazosin (2 milligrams at bedtime), Depakote (1500 milligrams a day), and Zyrtec (10
milligrams, 1 time a day). She has been diagnosed with
. concern is that all the medications listed above can
cause sedation. Seroquel would normally be prescribed for bipolar disorder or
schizophrenia, and does not have those diagnoses. Her treatment summaries from
Mill Creek indicate that she is observed sleeping a lot instead of engaging in daily activities
such as school. The medications were prescribed to her by Dr. John Tharp of Mill Creek.
Someone from plans to meet with someone from Mill Creek to try to plan to
get out of Mill Creek. It has been observed by that multiple children
placed at Mill Creek have been given the same medications as even though they
do not have diagnoses that warrant it. All of these children have been observed to be
lethargic.
Interim Action Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

.
Licensing Narrative: 11/20/2024- PRLU management was made aware
PRLU and will be working in conjunction to address the
concerns expressed by the guardian. 12/12/24 the following documents were reviewed for
the following areas. Licensing has investigated this case for violations related to the
following standards: 904.1.(o)"The agency shall keep a confidential case record for each
child that includes the following: (o) Medication and physician's orders" 904.1.(q) "The
agency shall keep a confidential case record for each child that includes the following: (q)
Physician notes" 905.11 "Chemical restraints shall be used only if ordered by a physician. A
chemical restraint is an emergency behavioral intervention that uses pharmaceuticals by
topical application, oral administration, injection, or other means to modify a child?s
behavior. Prescribed treatment medications that have a secondary effect on the child?s
behavior are not considered chemical restraint." 905.12 "Seclusion, mechanical, or physical
restraints shall be used only if ordered by a physician." 905.17 "Documentation of all
restraints shall be maintained and shall include the child?s name, date, time, reason, staff
involved, and measures taken prior to restraint." 906.1.a "A physician currently licensed by
the Arkansas State Medical Board who has experience in the practice of psychiatry" 908.8
"The administering of all medications, including over the counter, shall be logged by the
person administering the medication at the time that the medication is given." 908.9 (a-d)
"The medication log shall include: (a) The child?s name (b) Time and date (c) Medication
dosage (d) Initials of the person administering the medication. No licensing violations were
found. The complaint case has been closed as unfounded. 1/17/2025, requested
documentation has been uploaded. This case has been unfounded by licensing. Case
complete.


summary: A resident was sent to Dallas County Medical Center for an x-ray of his right hand after he fell on his hand while outside.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 025584
Date of Incident: 11/16/2024
Date Received: 11/18/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: went
to Dallas County Medical Center for an x-ray on his right hand. stated that he fell
on it while outside. We do not have the x-ray results back yet, as the hospital stated that
their system is down.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 11/19/24-Reviewed for licensing concerns. Email sent to facility to
notify licensing of x-ray findings upon receipt.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 025595
Date of Incident: 11/16/2024
Date Received: 11/19/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: Received x-ray results back from Dallas County Medical Center today
for X-ray revealed
This incident was reported on 11/18/24, but hospital's system was down and we
were unable to get results until this morning.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 11/19/24-Reviewed for licensing concerns. This report is a follow up
to Case#025584.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Dallas County Medical Center for a chest x-ray.

raw_content:
AR KANS A S&S
DEPARTMENT OF

i¢ SaRVICES

Placement and Residential Licensing Unit
P.O. Box 1437, Slot $140, Little Rock, AR 72203-1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550

Notice of Serious Incident
Case Number: 025519
Date of Incident: 11/14/2024

Date Received: 11/15/2024

Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233

Incident Type: Licensing

Report Description: was
sent to Dallas county Medical Center for a chest x-ray. It was found that has
was sent back to Millcreek and discharged home as

planned on 11/15/24.

Interim Action Narrative: Resident was evaluated at Dallas County Medical Center.

Maltreatment Narrative:

Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns.

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


raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 025520
Date of Incident: 11/14/2024
Date Received: 11/15/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: was
sent to Dallas County Medical Center for a chest x-ray. It was found that has
. He was sent back to Millcreek with an antibiotic change.
Interim Action Narrative: Resident was evaluated at Dallas County Medical Center.
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Dallas County Medical Center for an x-ray of his right hand. He complained of pain after getting angry and punching a wall.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 025521
Date of Incident: 11/14/2024
Date Received: 11/15/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description:
went to Dallas County Medical Center for an x-ray of his right hand. complained
of pain after getting angry and punching a wall. The x-ray revealed
. A follow up appointment with Children's will be made.
Interim Action Narrative: Resident was evaluated at Dallas County Medical Center.
Maltreatment Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Program Coordinator requested docuemntation for this provider reported incident. Facility
provided documentation.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Dallas County Medical Center for an x-ray of his right hand due to complaints of pain after an altercation with a peer.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 025375
Date of Incident: 11/8/2024
Date Received: 11/11/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: went to
Dallas County Medical Center for an x-ray of his right hand after complaining of pain after
an altercation with a peer. The x-ray was
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 11/12/24-Reviewed for licensing concerns. Email sent to facility to
request nursing note and discharge summary from medical facility. Email sent to facility to
inquire if clients involved in altercation were placed on any safety precautions. Received
nursing note and medical facility documentation. Received email for safety plan as follows:
Patients were separated and watched. No issues since.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was admitted to Dallas County Medical Center due to his condition declining despite a previous antibiotics change.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 025351
Date of Incident: 11/7/2024
Date Received: 11/8/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: was
admitted to Dallas County Medical Center on 11/7/2024 due
Interim Action Narrative: Resident was admitted into Dallas. Co. Medical Center.
Maltreatment Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Program Coordiantor inquired about a timeframe of resident's stay at DCMC. Per facility,
resident was diagnosed with Wednesday and the doctor changed his
antibiotics to a stronger one. Due to the resident condition declining he was admitted. The
facility will keep licensing updated. 11/11/2024, facility reported resident returned to the
facility.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Dallas County Medical Center for an x-ray due to a worsening cold despite being on antibiotics.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 025300
Date of Incident: 11/6/2024
Date Received: 11/7/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: was sent
to Dallas County Medical Center for an x-ray due to continued worsening of cold despite
antibiotics. It was found that he has . PCP changed his antibiotic
to levaquin.
Interim Action Narrative: Resident was evaluated at Dallas Co. Medical Center.
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns. Facility provided documentation for this incident.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Dallas County Medical Center for an abdomen and pelvic CT due to complaints of rectal bleeding.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 025301
Date of Incident: 11/6/2024
Date Received: 11/7/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: was sent
to Dallas County Medical Center for an abdomen and pelvis CT due to complaints of rectal
bleeding. Ct
Interim Action Narrative: Resident was evaluated at Dallas Co. Medical Center.
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provder reported incident for licensing
concerns. Facility provided docuemntation for this incident.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent for a scheduled scrotal ultrasound due to complaints of 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
R
Notice of Serious Incident
Case Number: 025248
Date of Incident: 11/5/2024
Date Received: 11/6/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: went
for a scheduled scrotal ultrasound due to complaints of pain. The ultrasound
. was sent back to Millcreek.
Interim Action Narrative: Resident was evaluated and sent out for an ultrasound.
Maltreatment Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Program Coordinator requested documentation for this provider reported incident. Facility
provided documentation.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was taken to Dallas County Medical Center for an x-ray due to reported pain after injuring her finger while playing basketball.

raw_content:
AR KANS A S&S
DEPARTMENT OF

i¢ SERVICES

Placement and Residential Licensing Unit
P.O. Box 1437, Slot $140, Little Rock, AR 72203-1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550

Notice of Serious Incident
Case Number: 025223
Date of Incident: 11/4/2024

Date Received: 11/5/2024

Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233

Incident Type: Licensing

Report Description:
injured her finger while playing basketball. She was taken to Dallas County Medical Center

for an x-ray of her right hand. The x-ray revealed ee

Interim Action Narrative: Resident was evaluated at Dallas County Medical Center.

Maltreatment Narrative:

Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Program Coordinator requested documentation for this incident. Facility provided
documentation.

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


summary: A resident was sent to Dallas County Medical Center for an x-ray of his foot after a peer stepped on it.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 025222
Date of Incident: 11/4/2024
Date Received: 11/5/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description:
told staff that his foot was hurting after a peer stepped on it. He was sent to Dallas County
Medical Center for an x-ray of his left foot. The x-ray revealed .
Interim Action Narrative: Resident was evaluated at Dallas County Medical Center.
Maltreatment Narrative:
Licensing Narrative: Program Coordinator reviewed provider reported incident for
licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A complaint received states that a staff member called a resident a “gay lil bitch boy,” grabbed him by the collar, and pushed him against the wall. The facility was cited 109.1.g and 110.9.c and the staff member was terminated 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
R
Notice of Serious Incident
Case Number: 025249
Date of Incident: 10/31/2024
Date Received: 11/5/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Dual
Report Description: Resident, , asked Mr. CJ if he could sit at the
table and color. came over and told resident to get up so she could clean the table.
Resident responded that he had permission to be there. called the resident "A gay
lil bitch boy" and grabbed him by the collar and pushed him against the wall, Mr. CJ
intervened. On 11/4/2024, resident called his guardian and informed guardian of the
incident. Ms. Kiyah was monitoring phone calls and stated for resident to tell his guardian
the incident was reported. Guardian completed the phone call and called back and spoke
with Ms. Kiyah and Mr. CJ. Mr. CJ informed guardian of the incident and stated that
was still employed and that the incident was reported. Guardian stated an email was
sent to Ms. Shay (therapist) and requested contact information for someone to provide
additional information. Chris Butler reached out to the guardian and reported that
had been terminated and apologized for the incident not being reported to the guardian
sooner Mr. Butler reported things had been really busy.
normally works 3rd shift but came in
earl y to relieve Mr. CJ. Resident normally calls guardian everyday but prior to yesterday.
Resident has not spoken to guardian since last Wednesday. Guardian was made aware that
resident had been involved in a episode on that day but is not sure why the resident has
been restricted from phone calls since last Thursday.
Interim Action Narrative: Facilty reported staff members were terminated.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing reviewed complaint for licensing concerns. 11/6/2024,
Program Coordinator requested permission from the to contact the facility.
Permission granted. 11/7/2024, Program Coordinator met at the facility,
reviewed camera footage, and sat in on the interview with the resident. Per facility, resident
is an Arkansas resident. There is not a nursing note for this incident. Program Coordinator
requested witness statements from the staff members that were present during this incident.
This complaint has been founded. Facility cited 109.1.g and 110.9.c. Program Coordinator
suggested for staff members to be retrained in mandated reporting and to provide
documentation of training. Facility provided witness statements. The COO reported that
phone calls are not taken away as a form of punishment. Residents are allowed phone calls
twice during the week and on the weekends are free days to make phone calls. 11/8/2024,
Program Coordinator talked with guardian who expressed her concerns regarding the
incident. Program Coordinator provided guardian with contact information for guardian to
provide documentation. 11/10/2024, guardian provided documentation for this complaint.
Documentation reviewed by Program Coordinator. 11/20/2024, facility provided training
documentation and uploaded. 12/26/2024, Program Coordinator checked
12/27/2024, Program Coordinator submitted founded 521 to facility
and signed 521 returned. Case reviewed, approved, and closed.

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: Millcreek of Arkansas PRTF
Facility Number: 233
Licensee Address: 1828 INDUSTRIAL DR
FORDYCE AR 71742-7110
Licensing Specialist: Kendra Slade
Person In Charge: Emerald Burris
Record Visit Date: 11/7/2024
Home Visit Date: 11/7/2024
Purpose of Visit: Complaint Visit
Regulations Out of Compliance:
Regulation Number: 100.109.1.g
Regulation Description: Unprofessional conduct in the practice of child welfare activities shall include, but not
limited to the following:
Finding Description: The female staff member was observed placing her hands around the resident’s shoulder
area and continued while he was up against the wall.
Action Due Date:
Action Due Description: Staff member was terminated.
Comply Date:
Sub-Regulation Level 1 Description: Engaging in behavior that could be viewed as sexual, dangerous,
exploitative, or physically harmful to children.
Action Due Description: Staff member was terminated.
Regulation Number: 100.110.9.c
Regulation Description: Any owner, operator, employee, foster parent, or volunteer in a child welfare agency
shall immediately notify the Child Abuse Hotline if they have reasonable cause to suspect that a child has
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 3

Finding Description: Staff members observed the staff member placed her hands around the resident’s shoulder
area against the wall and did not make a child abuse hotline report.
Action Due Date:
Action Due Description:
Comply Date:
Sub-Regulation Level 1 Description: If they observe a child being subjected to conditions or circumstances that
would reasonably result in child maltreatment.
Action Due Description:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Time of visit: 10:15 am to 11:30 am
Census: 160
Licensing received a complaint on 11/4/2024 for ELS Case #025249.
Program Coordinator Slade and Investigator Flint spoke with Ms. Burris and Mr. Butler. Mr. Butler provided
camera footage for this incident. The location of this incident was at Rockhill in the dayroom area. There were
three (3) staff members present. The residents were watching television and walking around the area. One
staff member was sweeping the floor, one male staff member was observed in the corner of the dayroom
talking with residents, and the other male staff member was in and out of camera view.
Per camera footage reviewed, the incident happened on 10/25/2024 around 7:51 pm. The actual timeframe of
the incident was possibly 2 minutes. Program Coordinator observed the staff member named in this complaint
sweeping the floor in the dayroom area. The resident was observed coming from the side of the room where
the staff member was sweeping. It appeared that the resident said something to the staff member.
The staff member was observed walking toward the resident and placed her hands around the resident’s
shoulder area. The resident appeared to be up against the wall in the dayroom area and words were exchanged
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 3

again between the staff member and resident. The staff member removed her hands from the resident’s
shoulder area and walked away. The resident was observed walking toward the staff member and the staff
member walked back toward the resident.
It appeared that both the staff member and resident exchanged words. The staff member walked away from
the resident. As the resident was walking toward the staff member, a peer was observed blocking the resident
from moving forward. A male staff member was observed guiding the resident from the dayroom area toward
his bedroom.
The facility will be cited for:109.1.gThe female staff member was observed placing her hands around the
resident’s shoulder area and continued while he was up against the wall and110.9.cStaff member/s observed
the staff member placed her hands around the resident’s shoulder area against the wall and did not make a
child abuse hotline report.
Per facility, the staff member named in this complaint has been terminated.
Provider Comments:
This incident does not reflect the high standards and de-escalation techniques that Millcreek Behavioral Health is
dedicated to upholding. Our facility provides comprehensive training to ensure staff are fully equipped to interact with
and support our residents with compassion, safety, and professionalism. The actions cited were taken by an individual
staff member who disregarded the established training and protocols we implement to safeguard resident well-being.
We take incidents of this nature and resident safety with the utmost seriousness. All staff members are trained as
mandated reporters, and we stress the critical responsibility each team member has in identifying and reporting any
behavior or incident that could compromise the safety or dignity of our residents. Any deviation from these
responsibilities undermines the trust placed in us by residents and their families.
As this individual’s actions fell outside their assigned responsibilities and violated our policies, we have made the
decision to terminate their employment. They will not be eligible for rehire at any time. Millcreek Behavioral Health
remains firmly committed to upholding the rigorous standards and practices our residents deserve, and we will
continue to emphasize the importance of mandated reporting to protect those in our care.
CCL Staff Signature : Date: 11/7/2024
Provider Signature : Date: 11/7/2024
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 3 of 3

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Millcreek of Arkansas PRTF
Facility Number: 233
Licensee Address: 1828 INDUSTRIAL DR
FORDYCE AR 71742-7110
Licensing Specialist: Kendra Slade
Person In Charge: Emerald Burris
Record Visit Date: 12/27/2024
Home Visit Date: 12/27/2024
Purpose of Visit: Revisit Complaint
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
No in-person licensing visit was completed on 12/27/2024.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Licensing received a complaint on 10/31/2024 for ELS Case #025249.
This complaint wasFOUNDEDby Licensing and the facility was cited for 109.1.g and 110.9.c on 11/13/2024.
The other staff members were on trained mandated reporter responsibility on 11/13/2024.
Provider Comments:
At Millcreek Behavioral Health, we hold ourselves to the highest standards of care, safety, and
professionalism in serving our residents. We are committed to maintaining an environment that prioritizes the
well-being and dignity of every individual entrusted to our care.
This incident does not reflect the standard practices or the de-escalation techniques that our facility rigorously
implements to train staff in resident interaction and management. The actions mentioned in the citation were
conducted by an individual staff member who strayed from the extensive training and established protocols of
our facility.
We take incidents of this nature, as well as patient safety, with the utmost seriousness. After a thorough
review, it was determined that the actions of this employee were outside of their assigned responsibilities and
deviated significantly from our company policies. As a result, we made the decision to terminate their
employment to reinforce our unwavering commitment to safety and integrity.
Millcreek Behavioral Health will continue to evaluate and enhance our training programs and protocols to
ensure that incidents like this are avoided in the future. Our focus remains on providing exceptional care and
support for the residents we serve.
CCL Staff Signature : Date: 12/27/2024
Provider Signature : Date: 12/27/2024
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident was taken to Dallas County Medical Center for an x-ray after jamming his finger.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 025109
Date of Incident: 10/30/2024
Date Received: 10/31/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: was
taken to Dallas County Medical Center for an x-ray of his finger. injured his finger
trying to grab something out of a peers hand and jammed his finger. X-ray showed
This could represent if there is pain at the base of the fifth
proximal phalanx. A follow up appointment is being made with ortho.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 10/31/24-Reviewed for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Dallas County Medical Center for an x-ray of his left foot. The resident complained of swelling and bruising after kicking a soccer ball.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 024987
Date of Incident: 10/25/2024
Date Received: 10/28/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: was sent
to Dallas County Medical Center for an x-ray left foot. Patient is complaining of swelling
and bruising after kicking a soccer ball. X-ray revealed . Returned back to
Millcreek.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 10/28/24-Reviewed for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Complaint AR00035145 was in compliance. Complaint AR00035775 was in compliance.

raw_content:
Division of Provider Services
& Quality Assurance
P.O. Box 8059, Slot S404
Little Rock, AR 72203-8059
October 31, 2024
Brady Serafin, Administrator
Habilitation Center, Llc
P.O. Box 727
Fordyce, AR 71742
Dear Mr.. Serafin:
A Complaint Investigation survey was conducted on October 24, 2024. We are pleased to inform you
that no deficiencies were cited during the survey and that your facility was in compliance with the
requirements of 42 CFR Part 483, Subpart G, Requirements for Psychiatric Residential Treatment
Facilities. Your certification remains in effect unless terminated due to non-compliance with program
requirements or voluntary withdrawal from the program.
We have enclosed form CMS 2567, “Statement of Deficiencies and Plan of Correction” for the October
24, 2024, Complaint Investigation survey conducted at your facility for participation in the Medicaid
program. The CMS 2567 is enclosed, indicating your facility's compliance status. Please sign and
date the 2567 and email to Theresa.Forrest@dhs.arkansas.gov.
If you have any questions please contact your reviewer at 501-320-6235.
Sincerely,
for Jeff Rosenbaum
DPSQA/Office of Long Term Care
Survey and Certification Section
tf
cc: DRA
Brady Serafin - Habilitation Center, Llc - 10/31/2024- (AOLTC - PRTF No Def) Page 1]

PRINTED: 10/31/2024
DEPARTMENT OF HEALTH AND HUMAN SERVICES FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED
A. BUILDING ______________________
C
04L103 B. WING _____________________________ 10/24/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1810 INDUSTRIAL DRIVE
HABILITATION CENTER, LLC
FORDYCE, AR 71742
(X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5)
PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETION
TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE
DEFICIENCY)
N 000 Initial Comments N 000
Note: The CMS-2567 (Statement of Deficiencies)
is an official, legal document. All information must
remain unchanged except for entering the plan of
correction, correction dates, and the signature
space. Any discrepancy in the original deficiency
citation(s) will be reported to the Dallas Regional
Office (RO) for referral to the Office of the
Inspector General (OIG) for possible fraud. If
information is inadvertently changed by the
provider/supplier, the State Survey Agency (SA)
should be notified immediately.
AR00035145 was in compliance.
AR00035775 was in compliance.
The facility was in compliance with §483, Subpart
G - Conditions of Participation for Psychiatric
Residential Treatment Center.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that
other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days
following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14
days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued
program participation.
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID:NL8X11 Facility ID: 3002 If continuation sheet Page 1 of 1


summary: A complaint received stated that the complainant was concerned a resident was being over-medicated. The resident was observed as groggy, incoherent, and drooling. The complaint was UNFOUNDED by Licensing.

raw_content:
records since admission, and the facility restraint log for Sep. and Oct. 2024. 12/13/224,
Licensing Specialst Horton visited the facility and observed the WV residents. 1/17/2025,
requested documentation has been uploaded. This case has been unfounded by licensing.
Case complete.


summary: A complaint was received that Millcreek clients are being overmedicated.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 024853
Date of Incident: 10/22/2024
Date Received: 10/22/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: Received complaint that Millcreek clients, specifically
are being overmedicated.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 10/22/24-Staffed with Program Coordinator and Program
Administrator. Licensing is waiting to coordinate visit with Nurse Neilsen. 10/23/24-
Facility visited by Licensing Specialist Clayton DeBoer and Program Coordinator Kendra
Rice accompanied by Cheryl Neilsen from OLTC. Facility provided licensing with every
West Virginia client file. WV client's vital stats, restraints and incidents for Sept and Oct of
2024 received. Millcreek client list breakdown by number of clients and what state and
Millcreek WV client list by name provided to licensing. Client interviewed. All
documents provided to licensing reviewed. 10/24/24-Facility visited with Melissa West and
Cheryl Nielson. 11//2024, Program Coordinator requested state agency agreements.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Office of Placement and Residential Licensing Unit
Division of Provider Services & Quality Assurance
P.O. Box 1437, Slot S530, Little Rock, AR 72203-1437
P: 501.682.8590
521 Visit Compliance Report
Licensee: Millcreek of Arkansas PRTF
Facility Number: 233
Licensee Address: 1828 INDUSTRIAL DR
FORDYCE AR 71742-7110
Licensing Specialist: Chelsea Vardell
Person In Charge: Ben Beasley
Record Visit Date: 12/30/2024
Home Visit Date: 12/30/2024
Purpose of Visit: Complaint Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Complaint case 024853 involving a resident from West Virginia.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Licensing has investigated this case for violations in the following standards:
904.1.(o) "The agency shall keep a confidential case record for each child that includes the following: (o)
Medication and physician's orders"
904.1.(q) "The agency shall keep a confidential case record for each child that includes the following: (q)
Physician notes"
905.11 "Chemical restraints shall be used only if ordered by a physician. A chemical restraint is an emergency
behavioral intervention that uses pharmaceuticals by topical application, oral administration, injection, or other
means to modify a child’s behavior. Prescribed treatment medications that have a secondary effect on the
child’s behavior are not considered chemical restraint."
905.12 "Seclusion, mechanical, or physical restraints shall be used only if ordered by a physician."
905.17 "Documentation of all restraints shall be maintained and shall include the child’s name, date, time,
reason, staff involved, and measures taken prior to restraint."
906.1.a "A physician currently licensed by the Arkansas State Medical Board who has experience in the
practice of psychiatry"
908.8 "The administering of all medications, including over the counter, shall be logged by the person
administering the medication at the time that the medication is given."
908.9 (a-d) "The medication log shall include: (a) The child’s name (b) Time and date (c) Medication dosage
(d)Initials of the person administering the medication.
Licensing visited the facility in regard to this case on 10/23/2024, 10/24/2024, and 12/13/2024.
Documentation for the following was reviewed:
•Pest control services for September and October 2024
•Restraint packet and nursing notes for 10/21/2024.
•MARs record for September and October 2024
•Physican orders and Physican progress reports for September and October 2024
•Health vital stat sheet from admission to present
•Facility restraint log for the months of September and October 2024
•Incident reports involving this resident from September and October 2024.
•Verification of the prescribing physician's professional licensure.
No violations to the licensing standards above were discovered during the course of the investigation.
Licensing complaint is closed as unfounded.
***** Pursuant to A.C.A. § 9-24-406(e)(3-4): If you believe that the Department’s notice of noncompliance is
in error, you may ask for reconsideration. The request for reconsideration must be in writing and delivered to
the Department by certified mail within twenty (20) business days of receipt of the notice of noncompliance.
The request must specify the parts of the notice that are alleged to be in error, explain why you believe those
parts are in error, and include documentation to support the allegation of error. Once received the Department
shall issue a decision on your request within twenty (20) days after receipt of the request.
Provider Comments:
CCL Staff Signature : Date: 12/30/2024
Provider Signature : Date: 01/13/2025
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident eloped from the facility while outside playing football. The resident was returned to the facility approximately 3.5 hours later.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 024880
Date of Incident: 10/22/2024
Date Received: 10/23/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: was outside
playing football and when told it was time to come inside, he ran and went under the fence
and took off running. Staff immediately called code orange. Police were notified. Code
orange called at approximately 17:00. returned to Millcreek at 20:35
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 10/23/24-Reviewed for licensing concerns. is on elopement
precautions. Per conversation with Ben Beasley of Millcreek, client did not go "under" the
fence but "over".
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident reported that roaches were observed in the cafeteria of the facility, that staff yells and cusses at the residents, and that the units are “nasty”.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 024920
Date of Incident: 10/21/2024
Date Received: 10/23/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: Resident reported that there were roaches in the cafeteria and that they
had killed one several days ago and it was still in the same spot. Resident said that there was
a dead rat in front of one of her peer's doors. Resident stated that staff yells and cusses at
the residents and talks to them any kind of way. Resident said the admin building was nice
but the units are nasty.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: Program Coordiniator informed of complaint via Teams Meeting and
email. .Licensing, DCFS, and OLTC nurse walked the grounds and observed seven unists
and the cafeteria. No evidence of pests was observed during the walkthrough except for a
waterbug observed in a bathroom. CEO Beasley removed the bug from the floor and flused
it down the toilet. CEO Beasley reported that pest controls comes out monthly and proivded
copies of the invoices for the last 3 months. 10/24/2024, Program Coordinator created a 521
finding.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident reported that his roommate touched his private area and tried to pull his pants down.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 024841
Date of Incident: 10/20/2024
Date Received: 10/21/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: stated
that last night about 9:00 pm, his roommate,
came up and tried to pull his pants down, but he stopped him. When asked
if he was touched, stated that touched his private area. When asked if over
or under the clothes, stated that it was over his clothes. was asked if
said anything to him and he stated no. When risk director spoke to he
stated that he had no idea what I was talking about. I asked him about his roommate and if
anything happened last night and stated no. stated that there was a fight
in the day area and went in there. stated that by the time came
back to the room he was already asleep. When asked what time the fight happened,
stated that it was probably between 8:30-9:00. The boys will be separated and will
not be roommates anymore.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 10/21/24-Reviewed for licensing concerns. Phone call made to Emily
Burris of Millcreek who stated that she had not received notification back yet
As soon as she is notified, she will email licensing. Received email
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

that . Clients are now assigned separate
cottages.


summary: At approximately 17:00, a unit supervisor received a call from Fordyce Police Department reporting that a patient had broken into a house and they needed to return him back to Millcreek. The facility was cited 907.2 and a staff member was terminated 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
R
Notice of Serious Incident
Case Number: 024712
Date of Incident: 10/13/2024
Date Received: 10/14/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: At approximately 17:00 unit supervisor received a call from Fordyce
Police Department reporting that a patient
had broken into a house and they needed to return him back to Millcreek. Staff
went to the residence and found patient sitting in a vehicle. Patient stated that the car
battery was dead, so he was just sitting in it. Patient stated that he crawled under the fence
while the unit was outside and staff weren?t looking. Patient was returned to Millcreek and
searched for contraband. Patient has been placed on suicide precaution due to patient
stating that he wanted to kill himself. Staff that was assigned to will be terminated on
10/14.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 10/14/24-Reviewed for licensing concerns. Visit scheduled for
10/15/24 to address 907.2. Phone call made to Emily Burris of Millcreek. To clarify, was
sitting in a vehicle at the house he had broken into. Fordyce PD only will notify Millcreek of
Millcreek clients' whereabouts, not physically intervene. Staff responsible for supervising
was who has been terminated from employment. 10/15/24-Facility visited and
cited 907.2.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Dallas County Medical Center for an injury to his lip after being involved in an altercation with a peer.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 024659
Date of Incident: 10/10/2024
Date Received: 10/11/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: While outside playing basketball,
went up to
and confronted him about a missing watch. They started talking
and got angry and swung and hit on the lip causing his lip to bleed. Staff
intervened and separated patients. was sent to Dallas County ER where he
received 5 sutures in his lip.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 10/14/23-Reviewed for licensing concerns. Email sent to facility
requesting nursing notes and ER discharge. Nursing note and ER discharge sent to
licensing.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Children’s Records reviewed for multiple residents. All required items present in hard copy file.

raw_content:
521 Visit Compliance Report

Licensee: Millcreek of Arkansas PRTF

Facility Number: 233

Licensee Address: 1828 INDUSTRIAL DR
FORDYCE AR 71742-7110

Licensing Specialist: Clayton DeBoer
Person In Charge:

Record Visit Date: 10/8/2024

Home Visit Date: 10/8/2024

Purpose of Visit: Child Record Review Visit

Regulations Out of Compliance:

Regulations Needing Technical Assistance:

Regulation Not Applicable:

Regulations Not Correctable:

Narrative:

Children's Records Reviewed for:

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

ARKANSAS
) DEPARTMENT OF

|\-7 HUMAN
» "2 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

y

Page 1 of 2

All required items present in hard copy file.

Provider Comments:

CCL Staff Signature :

Provider Signature :

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

Date: 10/8/2024

Date: 10/8/2024


summary: A resident was sent to Dallas County Medical Center for an x-ray of his right hand due to pain after punching a wall.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 024549
Date of Incident: 10/4/2024
Date Received: 10/7/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: went to
Dallas County Medical Center for an x-ray of his right hand due to pain after punching a
wall. The x-ray .
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 10/7/24-Reviewed for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov