summary: A recertification survey was conducted at this facility. This survey found the facility had deficiencies requiring correction/substantial correction.

raw_content:
Division of Provider Services
& Quality Assurance
P.O. Box 8059, Slot S404
Little Rock, AR 72203-8059
August 5, 2024
Kenisha Hoard, Administrator
Millcreek Of Arkansas
P.O. Box 727
Fordyce, AR 71742
Dear Ms. Hoard:
On July 25, 2024 a Recertification survey was conducted at your facility by the Office of Long Term
Care to determine if your facility was in compliance with Federal requirements for Intermediate Care
Facilities for Individuals with Intellectual Disabilities participating in the Medicaid (Title XIX)
Program. This survey found that your facility had deficiencies requiring correction/substantial
correction prior to a revisit as specified in the attached CMS-2567.
Plan of Correction
A POC must be submitted within 10 calendar days of your receipt of the Statement of
Deficiencies. Failure to submit a POC may result in termination. Include a completion date for each
deficiency cited.
Theresa Forrest, Reviewer
OLTC, Survey & Certification Section
PO Box 8059, Slot S404
Little Rock, AR 72201-4608
(501) 320-6235
email to Theresa.Forrest@dhs.arkansas.gov.
Your Plan of Correction must also include the following:
a.Address how the corrective action will be accomplished for those residents found to have been
affected by the deficient practice;
b.Address how the facility will identify other residents having the potential to be affected by the same
deficient practice;
c.Address what measures will be put into place or systemic changes will be made to ensure that the
deficient practice will not recur;
d.Indicate how the facility plans to monitor its performance to make sure that solutions are sustained.
The facility must develop plan for ensuring that correction is achieved and sustained. This plan must
be implemented, and the corrective action evaluated for its effectiveness.
Kenisha Hoard - Millcreek Of Arkansas - 08/05/2024 - (AOLTC -100) Page 1 ]

e. Include dates when corrective action will be completed. The corrective action completion dates must
be acceptable to the State. Your facility is ultimately accountable for its own compliance. The plan of
correction will serve as the facility’s allegation of compliance. Unless otherwise stated on the PoC, the
last completion date will be the date of alleged compliance.
Informal Dispute Resolution
In accordance with 42 CFR § 488.331, you have one opportunity to question deficiencies through an
informal dispute resolution (IDR) process. To obtain an IDR, you must send your written request to
Health Facility Services, Arkansas Department of Health within ten (10) calendar days from receipt of
the Statement of Deficiencies. The request must state the specific deficiencies the facility wishes to
challenge. The request should also state whether the facility wants the IDR to be performed by a
telephone conference call, record review, or a face-to-face meeting.
An incomplete informal dispute resolution procedure will not delay the effective date of any
enforcement action or the requirement for timely submission of an acceptable plan of correction.
Informal dispute resolution in no way is to be construed as a formal evidentiary hearing. It is an
informal administrative process to discuss the findings.
Please submit your request to:
IDR/IIDR Program Coordinator
Health Facilities Services
5800 West 10th Street, Suite 400
Little Rock, AR 72204
Phone: 501-661-2201
ADH.HFS@Arkansas.gov
If you have any questions, please call your Reviewer.
Sincerely,
DPSQA/Office of Long Term Care
Survey & Certification Section
tf
cc: DRA
DDS
Kenisha Hoard - Millcreek Of Arkansas - 08/05/2024 - (AOLTC -100) Page 2 ]

PRINTED: 08/05/2024
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 ______________________
04G011 B. WING _____________________________ 07/25/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1828 INDUSTRIAL DRIVE
MILLCREEK OF ARKANSAS
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)
W 000 INITIAL COMMENTS W 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.
The findings on this statement of deficiencies
demonstrate non-compliance with the
requirements of 42 CFR, Part 483, subpart I, for
Intermediate Care Facilities for Individuals with
Intellectual Disabilities.
W 104 GOVERNING BODY W 104
CFR(s): 483.410(a)(1)
The governing body must exercise general policy,
budget, and operating direction over the facility.
This STANDARD is not met as evidenced by:
Based on observation, interview, and record
review, the facility failed to ensure a
well-maintained homelike environment.
The findings are:
1. During environmental rounds at Oak Creek
House on 07/23/2024 from 7:32 AM through 7:49
AM, the following concerns were identified:
a. The first door to the left down the long hall had
a crack with an indention on the upper right-hand
side of the door on the second panel down from
the top.
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:WMME11 Facility ID: 2019 If continuation sheet Page 1 of 13

PRINTED: 08/05/2024
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 ______________________
04G011 B. WING _____________________________ 07/25/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1828 INDUSTRIAL DRIVE
MILLCREEK OF ARKANSAS
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)
W 104 Continued From page 1 W 104
b. The wall behind and to the right of the toilet in
bathroom #2 had yellow staining along the trim at
the base of the wall.
c. Bathroom #1 had a toilet observed with wet
yellow fluid on the base around the bolt, and
yellow staining over the floor trim, to the right and
behind the toilet.
d. Room #8, on the room side of the door, the
upper right-hand panel, second from the top was
cracked and indented.
e. Room #4, on the hall side of the door, the
middle-left panel had cracking, 12 inches in
diameter, with cracks coming off of the main
crack.
f. A towel was observed behind the dryer on the
floor.
g. The lower door handle on the black refrigerator
in the kitchen was broken on the bottom.
2. Environmental rounds at the Boys Ranch on
07/23/2024 from 8:43 AM through 8:51 AM
revealed the following concerns:
a. Room #5's bathroom door had a 4 inch crack
on the upper right-hand side of the inside of the
door. The shower in the room had a crack in the
wall next to the shower, head high and 3 inches
long.
b. There was a piece of clothing behind the dryer
on the floor.
c. Bathroom #1 had paint peeled off the wall next
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID:WMME11 Facility ID: 2019 If continuation sheet Page 2 of 13

PRINTED: 08/05/2024
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 ______________________
04G011 B. WING _____________________________ 07/25/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1828 INDUSTRIAL DRIVE
MILLCREEK OF ARKANSAS
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)
W 104 Continued From page 2 W 104
to the toilet in several places with the largest area
8 inches long by 4 inches wide. On the wall to the
left of the sink, paint had been peeled from the
wall board from an area 3 feet by 12 inches.
d. On 07/24/2024 at 10:29 AM, the Chief
Operating Officer (CEO) stated that the doors
had been replaced.
3. During observations in the Main Kitchen on
07/24/2024 from 1:03 PM, through 1:30 PM, the
following concerns were identified:
a. In the entry hall and main eating area there
were 14 cracked or broken 18 inches by 18 inch
tiles.
b. A ceiling tile over the serving area next to the
air vent had brown staining and what looked like
new wet brown stain. It was raining outside.
4. During environmental rounds at Haley house
on 07/23/2024 from 9:24 AM, through 10:15 AM,
the following concerns were identified:
A. On the boys' hallway, 5 out of 6 fluorescent
light covers had debris and bugs visible in the
covers. The fluorescent light covers, in the dining
area, kitchen, and girls' hallways, had varying
degrees of debris including bugs and flies visible
in the covers.
B. In the backyard, in the corner closest to the
Administration building were 5 used tires in a pile
by the privacy fence with grass and weeds
growing up and around the tires.
C. On the back corner of the roof, closest to the
Administration building, a light fixture with 2 light
reflectors/shades was in disrepair with one lamp
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID:WMME11 Facility ID: 2019 If continuation sheet Page 3 of 13

PRINTED: 08/05/2024
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 ______________________
04G011 B. WING _____________________________ 07/25/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1828 INDUSTRIAL DRIVE
MILLCREEK OF ARKANSAS
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)
W 104 Continued From page 3 W 104
holder and reflector hanging only by wires.
5. On 07/24/2024, a "document" of the open
maintenance requests was supplied by the facility
Chief Executive Officer (CEO) and reviewed,
which revealed an open maintenance request for
item A that had been submitted on 07/24/2024 at
7:59 AM per the CEO. There were no open
maintenance requests for items B and C per
document. No maintenance policy was provided.
Items A through C were discussed with the CEO.
W 369 DRUG ADMINISTRATION W 369
CFR(s): 483.460(k)(2)
The system for drug administration must assure
that all drugs, including those that are
self-administered, are administered without error.
This STANDARD is not met as evidenced by:
Based on observation, interview, and record
review, the facility failed to ensure medications
were administered without errors for 1 (Client #7)
case mix sample.
The findings are:
Client #7's "Physician's Orders" dated 03/05/2024
were reviewed and read in part, "Miralax 17 gm
[grams] PO [by mouth] BID [twice a day] for
constipation."
a. On 07/23/2024 at 8:04 AM, during observation
of the medication administration, Licensed
Practical Nurse (LPN) #1 poured the medication
out into the cap at about the halfway point and
stated that was 17 grams.
b. The inside of the medication lid had a white
inner cap that had a raised arrow indicator
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID:WMME11 Facility ID: 2019 If continuation sheet Page 4 of 13

PRINTED: 08/05/2024
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 ______________________
04G011 B. WING _____________________________ 07/25/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1828 INDUSTRIAL DRIVE
MILLCREEK OF ARKANSAS
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)
W 369 Continued From page 4 W 369
pointing to the upper lip of the white cap, and "17
gm [grams]" next to the arrow.
c. Licensed Practical Nurse (LPN) #1 was asked
to observe the medication lid and the arrow
indicator for the 17 gram dose. LPN #1 stated, "I
see, it should have been to the top."
d. A "Medication Management" policy with a
revised date of 12/2023 received from the Chief
Executive Officer (CEO) on 07/24/2024 at 10:29
AM. The policy was reviewed and read in part,
"Preparing and Dispensing..., Medications are
dispensed by the designated pharmacy upon
receiving a written, telephone, or verbal order
from an approved prescriber as listed on the
authorized list of prescribers..., the pharmacy
dispenses the medications and delivers them to
the nurse on duty..."
W 390 DRUG LABELING W 390
CFR(s): 483.460(m)(2)(i)
The facility must remove from use outdated
drugs.
This STANDARD is not met as evidenced by:
Based on observation, interview and record
review the facility failed to remove medication that
was beyond the expiration date in 1 of 1
medication room.
The findings are:
On 07/28/2024 at 12:25 PM, in Willow Creek
House, in the medication cabinet, where the
over-the-counter medications were kept, the
following item was found: A bottle of artificial tears
with an expiration date of 03/2024. Licensed
Practical Nurse (LPN) #1 confirmed the expiration
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID:WMME11 Facility ID: 2019 If continuation sheet Page 5 of 13

PRINTED: 08/05/2024
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 ______________________
04G011 B. WING _____________________________ 07/25/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1828 INDUSTRIAL DRIVE
MILLCREEK OF ARKANSAS
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)
W 390 Continued From page 5 W 390
date and threw away the bottle. When asked who
was responsible for checking medications
expiration dates, LPN #1 reported the nurses
were responsible for checking their assigned
houses and throwing expired medications away.
On 07/24/2024 at 10:29 AM, review of a facility
"policy" titled, "Medication Management," in part
specified, "...Medication Disposal" Medications
that have been discontinued, expired, damaged
and/or contaminated are removed from individual
patient/resident bins and/or stock medication
supply and stored in a separate cabinet of the
medication room. These non-controlled
substances are disposed of a minimum of one
time per month by placing into a separate
container..."
W 454 INFECTION CONTROL W 454
CFR(s): 483.470(l)(1)
The facility must provide a sanitary environment
to avoid sources and transmission of infections.
This STANDARD is not met as evidenced by:
Based on observation, interview, and record
review, the facility failed to ensure food items
were stored properly, sealed, labeled, and dated
to maintain freshness and palatability to minimize
the potential for food borne illness; hair covering
was worn at all times in the kitchen; and expired
foods were promptly removed from stock, dented
cans were discarded; the ice machine was
maintained in a clean manner and equipment
used to cut medication in half was cleaned
between clients (Clients #2, #8, and #9).
The findings are:
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID:WMME11 Facility ID: 2019 If continuation sheet Page 6 of 13

PRINTED: 08/05/2024
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 ______________________
04G011 B. WING _____________________________ 07/25/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1828 INDUSTRIAL DRIVE
MILLCREEK OF ARKANSAS
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)
W 454 Continued From page 6 W 454
Haley House:
On 07/23/2024 beginning at 7:20 AM, the
morning meal preparation and subsequent
serving of the meal was observed. House Staff #1
and Life Skills Teacher (LST) #1 were transferring
food from large serving dishes supplied by the
main kitchen into smaller serving dishes via
serving utensils and placing serving dishes on
individual tables for client consumption. House
Staff #1 and LST #1's hair was braided, neither of
the staff members were wearing hairnets. A client
worker who had a long ponytail, was not wearing
a hairnet was setting the table, carrying glasses
of liquid and carrying food items to the other
clients' tables.
On 07/23/2024 at 8:23 AM, Life Skills Teacher
(LST) #1 verified that hairnets are supposed to be
worn when working in the kitchen during meals
and that hairnets were available in the office for
use by staff and clients. LST #1 confirmed that
she had not worn a hairnet, "...today, it slipped my
mind...". At 8:28 AM, House Staff #1 verbally
confirmed that hairnets are supposed to be worn
while serving meals and stated, "...but I forgot
today..."
On 07/23/2024, during a tour of the kitchen and
pantry at Haley House that began at 8:45 AM, the
following observations were made in the pantry:
-A 6-pound 11 ounce can of cheese sauce had a
dent approximately 2.5 inches long by 1 inch wide
and ½ inch from the top seal.
-A 16 ounce can of vanilla frosting with best use
by date of "Jun [June] 26, 24 [2024]"; 2 cans of
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID:WMME11 Facility ID: 2019 If continuation sheet Page 7 of 13

PRINTED: 08/05/2024
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 ______________________
04G011 B. WING _____________________________ 07/25/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1828 INDUSTRIAL DRIVE
MILLCREEK OF ARKANSAS
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)
W 454 Continued From page 7 W 454
lemon frosting with a best use by date of "Jun 16,
2024"; and 2 cans of cookie flavor frosting with a
best use date by of "Jun 16, 2024."
-A 56-ounce container of powder coffee creamer
with an opened date of "10-1-22 [10/01/2024]"
with a best use by date of "Jul [July] 16, 2024."
-A small glass container containing a white
granular substance with no content label or date,
1/5 full.
-A 32-ounce jar of strawberry jam, 1/2 full, with an
open date of "2-14-24 [02/14/2024]" with label
directions containing, "Refrigerate after opening."
-A 15-ounce jar of sandwich spread, 3/4 full, with
an expiration date of "20 Dec [December] 2023",
and an opened date of "6-23-23 [06/23/2023]."
The manufacturer label directions contained the
statement, "Refrigerate after opening."
Life Skills Teacher (LST) #1 was present during
the above kitchen tour and verbally confirmed the
food contained in the dented cans would be used
as well as the other food in the pantry would for
client consumption, and the findings noted above
were confirmed. LST #1 began to throw away the
outdated items and the items that required
refrigeration after opening from the pantry. When
asked who was responsible for checking the
pantry for expired items and how often the pantry
was checked, LST #1 stated, "I am ...every
week."
On 7/23/2024 at 10:19 AM Life Skills Teacher
(LST) #1 accompanied the Surveyor to the
outside storage shed where the ice machine was
located, upon request, LST #1 opened the lid and
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID:WMME11 Facility ID: 2019 If continuation sheet Page 8 of 13

PRINTED: 08/05/2024
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 ______________________
04G011 B. WING _____________________________ 07/25/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1828 INDUSTRIAL DRIVE
MILLCREEK OF ARKANSAS
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)
W 454 Continued From page 8 W 454
used a white paper towel to wipe the inside of the
ice machine at the top of the lid opening. A
medium amount of brown residue was noted on
the paper towel after the procedure. When the
Surveyor asked how often the ice machine was
cleaned, LST #1 reported "once a week ...I
cleaned it last Wednesday."
A facility "policy" titled, "Infection Control", with a
reviewed/revised date of 2023 was received and
reviewed on 07/24/2024 at 12:23 PM, and
specified in part, "To prevent the transmission of
infection in the dining area through education of
staff and residents to good personal hygiene and
proper dining area habits...b. Personal Hygiene:
Personnel should also be aware of the necessity
of wearing clean clothes daily as well as
hairnets/gloves."
The "Nutrition Services", "policies" with a
reviewed/revised: 09/2019 date was received and
reviewed on 7/24/2024 at 10:29 AM, and read in
part, "...POLICY: Receiving Food and Supplies
PURPOSE: To prevent food spoilage and product
breakdown during the handing and storage of all
items...4. b. Do not accept but return to the
supplier, any item that is...2. Indented, rusty,
damaged cans ...6. All perishable products are to
be dated. All stock must be rotated with each new
order received..., ...POLICY: Sanitation
Standards: Equipment/Physical Plant ...3.
Temperatures of all refrigerators and freezers
must be checked and recorded daily. POLICY:
Cleaning Schedules...DAILY ...I. Ice
Scoop/Bucket, J. Ice machine-wipe down and
around door and outside; POLICY: Equipment
Temperature Log on Daily Journal PURPOSE: In
order to insure that refrigerator and freezers are
in proper working order and to assist in the
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID:WMME11 Facility ID: 2019 If continuation sheet Page 9 of 13

PRINTED: 08/05/2024
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 ______________________
04G011 B. WING _____________________________ 07/25/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1828 INDUSTRIAL DRIVE
MILLCREEK OF ARKANSAS
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)
W 454 Continued From page 9 W 454
prevention of food borne illness,
refrigerator/freezer temperatures will be recorded
twice per day in dietary. PROCEDURE:
Refrigerator/Freezer: Our refrigerators/freezers
have been identified name of cottage and
correspond with the equipment temperature log.
Each refrigerator/freezer contains a working
thermometer..."
Review of the "Patient Information Sheet" noted
Client #2 had diagnoses including unspecified
intellectual disabilities, reactive attachment
disorder of childhood, and posttraumatic stress
disorder.
Review of the "physician orders" dated
07/19/2024, read in part, " ...Tenex 1 mg
[milligram]...tab [tablet]...@ [at] 8AM [8:00 AM]
and 1/2 tab at 12 N [12:00 noon]..."
Review of the "Patient Information Sheet" noted,
Client #8 had diagnoses including mild intellectual
disability, disruptive mood dysregulation disorder,
reactive attachment disorder, attention deficit
hyperactivity disorder, and separation anxiety
disorder.
Review of the "Medication Administration Record"
dated 06/21/2024 read in part, "...Clonidine 0.1mg
[milligram] 1/2 tab [tablet]...Q [every] 8AM [8:00
AM] and 12N [12:00 Noon] 2 tabs Q HS [hour of
sleep] for impulse..."
Review of the "Patient Information Sheet" noted,
Client #9 had diagnoses including mild intellectual
disabilities, conduct disorder and attention deficit
hyperactivity disorder.
Review of the "Medication Administration Record"
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID:WMME11 Facility ID: 2019 If continuation sheet Page 10 of 13

PRINTED: 08/05/2024
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 ______________________
04G011 B. WING _____________________________ 07/25/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1828 INDUSTRIAL DRIVE
MILLCREEK OF ARKANSAS
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)
W 454 Continued From page 10 W 454
dated 05/17/2024, read in part, "...Clonidine 0.1
mg [milligram]...1/2 tab [8:00 AM] and 12N [12:00
Noon] ...Haldol 10 mg...1/2 tab at [8:00 AM] and
12N [12:00 Noon]..."
On 07/23/2024 at 11:50 AM, the Surveyor
observed Licensed Practical Nurse (LPN) #1
during the noon medication pass at Willow Creek
House. At 12:01 PM, LPN #1 obtained Client #8's
Clonidine 0.1mg (milligram) tablet from the
prescription bottle and used a pill cutter that was
on the counter to cut the tablet in half. LPN #1 put
1/2 of the tablet into a medicine cup and
transferred the other 1/2 back to the prescription
bottle. The 1/2 tablet in the medicine cup was
then administered to Client #8. LPN #1 put the pill
cutter back on the cabinet without cleaning it.
On 07/23/2024 at 12:10 PM, Licensed Practical
Nurse (LPN) #1 obtained Client #2's Tenex 1mg
tablet from the prescription bottle and used the
pill cutter that was on the counter to cut the tablet
in half. Licensed Practical Nurse (LPN) #1 put 1/2
of the tablet into a medicine cup and transferred
the other 1/2 back to the prescription bottle. The
1/2 tablet in the medicine cup was then
administered to Client #2. LPN #1 put the pill
cutter back on the cabinet without cleaning it
before or after use.
On 07/23/2024 at 12:23 PM, Licensed Practical
Nurse (LPN) #1 obtained Client #9's Clonidine 0.1
mg (milligram) tablet from the prescription bottle
and used the same pill cutter to cut Client #9's
tablet in half that was on the counter that had
been used for cutting Client #2 and Client #8's
medication. LPN #1 put 1/2 of the tablet into a
medicine cup and transferred the other 1/2 back
to the prescription bottle. LPN #1 repeated the
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID:WMME11 Facility ID: 2019 If continuation sheet Page 11 of 13

PRINTED: 08/05/2024
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 ______________________
04G011 B. WING _____________________________ 07/25/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1828 INDUSTRIAL DRIVE
MILLCREEK OF ARKANSAS
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)
W 454 Continued From page 11 W 454
process with Client #9's Haloperidol 10mg tablet
cutting the 10 mg tablet in half. The two 1/2
tablets in the medicine cup were then
administered to Client #9. LPN #1 put the pill
cutter back on the cabinet without cleaning it
before or after use.
On 07/23/2024, during an interview at 12:30 PM,
Licensed Practical Nurse (LPN) #1 confirmed that
the same pill cutter was used for all three clients
and that clients do not have individual pill cutters.
When asked, LPN #1 confirmed that the pill
cutter was not cleaned between clients and
reported that it is cleaned weekly. LPN #1
showed a monitoring log posted on the wall for
the cleaning schedule of equipment that included
"Pill Cutter" with dates of "07/02/24, 07/10/24 and
7/16/24".
On 07/25/2024 at 9:45 AM, during an interview
the Assistant Director of Nursing (ADON) stated
to the Surveyor that pill cutters should be cleaned
"after each use and PRN [as needed]" The
Surveyor asked if the pill cutter should be cleaned
between each client, the ADON replied, "Yes."
On 07/24/2024 at 10:29 the Chief Executive
Officer provided a facility policy titled, "Medication
management" with a revised date of 12/2023, that
specified in part, Section "Infection Control in
Medication Administration ...The nurse will
transfer the medication from the closed container
it is stored in (blister pack or bottle) to the inside
of the medication cup without contaminating the
medication. The medication will be considered
contaminated if it comes in contact with any
surface other than the inside of the closed
container it is stored in or the inside of the
medication cup it will be administered from."
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID:WMME11 Facility ID: 2019 If continuation sheet Page 12 of 13

PRINTED: 08/05/2024
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 ______________________
04G011 B. WING _____________________________ 07/25/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1828 INDUSTRIAL DRIVE
MILLCREEK OF ARKANSAS
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)
W 454 Continued From page 12 W 454
During observations in the main kitchen on
07/24/2024 from 1:03 PM through 1:30 PM, the
following concerns were identified:
a. The milk box contained 26 pints of expired 2%
milk dated, "Jul [July] 23", the milk box did not
contain a thermometer. Cook #1 looked through
the case, moving crates of milk to verify there
was no thermometer, none was found. Cook #1
retrieved a thermometer and placed it in the milk
box. Cook #1 was asked if the milk box should
have a thermometer in it. Cook #1 stated yes it
should have a thermometer.
FORM CMS-2567(02-99) Previous Versions Obsolete Event ID:WMME11 Facility ID: 2019 If continuation sheet Page 13 of 13

Division of Provider Services
& Quality Assurance
P.O. Box 8059, Slot S404
Little Rock, AR 72203-8059
January 28, 2025
Kenisha Hoard, Administrator
Millcreek Of Arkansas
P.O. Box 727
Fordyce, AR 71742
Dear Ms. Hoard:
Based on the approval of the Plan of Correction for the Recertification survey conducted on July 25,
2024, your facility was found to be in substantial compliance with program requirements. Your
certification remains in effect unless terminated due to non-compliance with program requirements or
voluntary withdrawal from the program.
If you have any questions, please contact your reviewer: Breanna Marengo at 501-320-6280 or email
to breanna.marengo@dhs.arkansas.gov.
Sincerely,
for Jeff Rosenbaum
DPSQA/Office of Long Term Care
Survey and Certification Section
bbm

APOC 08/23/24
TF

doc_type: Recertification Survey


state: AR

facility_name: Millcreek Behavioral Health / Habilitation Center, Inc.

summary: The facility was in compliance with Title 42, Code of Federal Regulations 483.90 (a), life safety from fire.

raw_content:
PRINTED: 08/05/2024
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 01
04G011 B. WING _____________________________ 07/25/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
1828 INDUSTRIAL DRIVE
MILLCREEK OF ARKANSAS
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)
E 000 Initial Comments E 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.
The facility was in compliance with §483.475 -
Emergency Preparedness Conditions of
Participation for Intermediate Care Facilities for
Individuals with Intellectual Disabilities.
K 000 INITIAL COMMENTS K 000
The facility is in compliance with Title 42, Code of
Federal Regulations §483.90 (a), life safety from
fire.
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:WMME21 Facility ID: 2019 If continuation sheet Page 1 of 1

doc_type: Safety Code Survey


summary: After an intervention, a resident reported that he was pinched on his chest and scratched on his shoulder. The accused staff member chose to resign immediately after the report. The facility was cited 109.1.g and 905.4.g as a result of this incident.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 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: 7/25/2024
Home Visit Date: 7/25/2024
Purpose of Visit: Complaint Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
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: Staff pinched client leaving a bruise.
Action Due Date: 2024-07-24
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 3

Action Due Description: Staff resigned pending certain termination.
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 resigned pending certain termination.
Regulation Number: 900.905.4.g
Regulation Description: The following actions shall not be used, including as discipline:
Finding Description: Staff pinched client leaving a bruise.
Action Due Date: 2024-07-24
Action Due Description: Staff resigned pending certain termination.
Comply Date:
Sub-Regulation Level 1 Description: Physical injury or threat of bodily harm;
Action Due Description: Staff resigned pending certain termination.
Narrative:
7/25/24-Facility visited in response to complaint involving and Camera footage reviewed which
shows staff pinch client after throws a chair down. Nursing note indicates that sustained a bruise from
this pinch. Facility cited 109.1g and 905.4g. Staff resigned 7/24/24 pending certain termination.
Provider Comments:
This incident does not reflect the standard practices or the de-escalation techniques that our facility rigorously
implements to train staff in the interaction and management of residents in our care. The actions mentioned in this
citation were conducted by an individual staff member who strayed from the extensive training and protocols our
facility has established. We take incidents of this nature and patient safety with utmost seriousness. The actions
taken by this employee were outside of their assigned responsibilities. Our facility made the decision to terminate
the employee due to their actions deviating from our company policies. He chose to resign effective immediately.
His resignation was accepted and he will not be eligible for rehire at any time.
CCL Staff Signature : Date: 7/25/2024
Provider Signature : Date: 7/25/2024
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 3

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

doc_type: Notice of Incident


summary: Officers were dispatched to Millcreek regarding an assault of a resident by a staff member.

raw_content:
Incident # 24-00331 Fordyce Police Department Report Date 07/25/24
Page 1 of 3 Incident Report Report Time 4:10 PM
Status Exception Clearance Date Reporting Officer ORI/Agency
Not Applicable 303 Byrne, River AR0200100
Active
Assigned Officer Entered By Approving Officer
Byrne, River RByrne Hogan, Wesley
Assisting Officers
Complainant
SSN/ID/TIN Title Name DOB Age Sex Resident Status
Ms 29 F Unknown
Race White Ethnicity DL (#, ST) Email
Unknown
Home Phone Work Phone Other Phone Personal Cell Work Cell
US Citizen Legal Alien Doc Type Immig Doc # Nationality
Yes
Home Address Employer
Work Address Occupation
Offenses
Incident Location Zone
1828 Industrial DR Fordyce, AR 71742
Earliest Possible Date Time Latest Possible Date Time
07/24/2024 15:07 07/25/2024 17:11
# Statute/Code Description Fel/Misd Att/Comp Loc Bias Wpn CATypes
1 5-27-202 Misd Completed 25 88 99
ENDANGER WELFARE OF AN INCOMPETANT-2ND DEGREE-KNOWINGLY RISKS SERIOUS PHYSICAL/MENTAL HARM
2 5-13-203A(1) Misd Completed 25 88 99
BATTERY - 3RD DEGREE / PURPOSE OF CAUSING INJURY, CAUSES INJURY
MO Method Of Entry # Prems
n/a 0
Location Types 13 Hway/Road/Alley 37 Abandoned/Condemned 48 Industrial Site Bias Motivation Codes
14 Hotel/Motel Structure 49 Military Installation 43Lesbian, Gay, Bisexual,
0 0 0 0 0 0 0 0 0 1 1 1 1 2 3 4 5 6 7 8 9 0 1 2 A B B C C C C D D F G G i i a a h o o o e r o r e r u o n r / u m n n p v l B / g d c k N t r s v t / m / e c u / / t e P D S W i S r h r s g n e u u y t i & / / s h r o i S r c T / b e / S c c L t o D t r l y n i i o i C a u o d a c n r c u i p n s l l a n e O / u B n e O g S b t T l f S r d / f f m S i T / e f t t g H o e t r B e a o m r o m l r e r d s k e i p n g p e l a t e l 1 1 1 1 1 F 2 2 2 2 2 5 6 7 8 9 0 1 3 4 5 a c J L L P R R R S S U i a l a i a e p e e e n i q t i k r r e y n s s k l u / k v e i t c n P t o d i a i a / i n c o W r r a e u l e i g w s S l n S r t / a a o y n G L c t t t o n n o / e o e S a O r t r / t r e s a t H / w t o G h g S o r a e a e e m t y r a ra e ti g o e n 3 3 g 4 4 N 4 4 4 M 4 4 8 9 r 0 1 2 4 5 6 7 e o o w A A A C D D F G d u A a a / n r T u a a o a U m e l r d t M m y c m o m n T s s u c k a p e b e / a / s D S C W F / / d l r e r S C i e e m e n a o m h p a t a g c l a i F i a a l n e m s i e d l a r r i a e n r f t i a p c / y u s l u t F t g i h m m P e l r i r i t e o a p y / f F r i u r g o k a n h m i d r t/ Bank 5 5 5 C 5 E 5 M 5 5 5 5 0 1 2 3 4 5 6 7 8 l o i e s l C m l s P R S S S S T C e i y r e o g a c c h h e o i b h h b n n e r e o s m e k o o a t / / t l p t a H U / r m o o e l A P p s r o n L l l r i p y u r l n a m i e - - a / - a n v g S y a n c e i e g t e d M e y r l r c e s s o C a o i s t u l y n s e l n d n d a te ry r A 1 1 A 1 A 1 1 1 O 2 2 N 1 2 3 4 5 6 1 2 m l t a h T W M J C B A A s e e N e k I l m s r a r u a h - a i w a i c t P l a c i e t h t t a i i N i k n e s v a r o - n i r h e c a c l o a i i a c t r f c H i i n v c e A a e s I f I w n r s , i d a c l G a a i i a i n r a n o n d n u e o p o r r r 2 2 2 2 2 3 3 3 L 4 4 3 4 5 6 7 1 2 3 a 1 2 t P I O M A A G L H N in s e r t r i o l t a o u h s o a a h s t y l p e t b m e b t H e i a i ( - r i s s i a m r i n c R s t e t n / i a a p A l c ( e i M n g l a g l e o i t i n g u n o ) r i i s o u c L o l s s a i n o m t t i g r i c n ) ro o up o G 4 4 5 5 6 6 7 7 8 9 r 4 5 1 2 1 2 1 2 8 9 r o T H B P M M F T G N U u r e r i h a e o n e e a p s a m y n t n k n n l e n e e ( s n s e d t x L a s r a g o o e u D G l g l e e w s r a e i D B s n e l N n n a i T d x s d o b e u ) a e n i r a l b r - , i l t C i M y li o ty i n xe fo d rming
Facility/Casino/Race Track
Suspected Of Using Criminal Activity Types Weapon Type(s) 20 Knife/Cutting Instr 65 Fire/Incendiary Device
None B P B P u o y s i s n e g s / s R in e g ce /C iv o in n g cealing C O C O u p l e ti r v a a t t in in g g / / P M ro a m nu o f t / i P n u g b /A li s s s h i i s n t g ing 1 1 1 2 F H i a re n a d r g m u n (A (A ut u o t ) o) 3 3 0 5 B M l o u t n o t r O V b e j h e i c c t le 7 8 0 5 D As ru p g h s y / x N ia a t r i c o . n /Sleeping Pills
D Distributing/Selling T Transport/Import/Transmit 13 Rifle (Auto) 40 Personal Weapons 90 Other
E Exploiting Children U Using/Consuming 14 Shotgun (Auto) 50 Poison 95 Unknown
15 Other Firearm 60 Explosives 99 None
A Simple/Gross Neglect I Intentional Abuse & Torment
F Organized Abuse S Sexual Animal Abuse
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 8/19/2024 11:14:26 AM

Incident # 24-00331 Fordyce Police Department Report Date 07/25/24
Page 3 of 3 Incident Report Report Time 4:10 PM
Narrative & Statements
Narrative - Byrne, River - 7/25/2024 4:38:53 PM (Initial)
Byrne advised that she needed to come to the police department when
she comes to fordyce to pick up her son so that an interview could be
done.
Copyright Relativity Inc.© - RPS(Relativity Public Safety)
Printed : 8/19/2024 11:14:26 AM

doc_type: Police Report


summary: A resident was sent to Dallas County Medical Center’s ER for outpatient X-rays after reporting ongoing pain and swelling in her left ankle for about two weeks.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 022729
Date of Incident: 7/19/2024
Date Received: 7/22/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: )was sent to Dallas
County Medical Center's ER for outpatient X-rays after reporting ongoing pain and swelling
in her left ankle for about two weeks. She had not previously sought assessment for this
issue. The nurse's initial impression was that it could be fatty tissue with possible fluid
retention. The X-ray report . The patient was
then released to return to the facility without any restriction or need for treatment.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 7/22/24-Reviewed for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was taken to Dallas County Medical Center for an x-ray of his knee after kicking a door.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 022685
Date of Incident: 7/18/2024
Date Received: 7/19/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: was
upset at another peer and kicked the door. complained of knee pain and there was
swelling. He was taken to Dallas County Medical Center and received an x-ray of his knee.
. He returned to
MOA same day.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 7/22/24-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 jaw 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
Notice of Serious Incident
Case Number: 022470
Date of Incident: 7/8/2024
Date Received: 7/9/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description:
was in an altercation with a peer on 07/07/24. was having behaviors and throwing
the water cooler, a peer walked up to and hit him in the face. Staff immediately
separated. THe next morning, complained of jaw pain. was sent to
Dallas County Medical Center for an x-ray of his jaw.
. returned to Millcreek.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 7/9/24-Reviewed for licensing concerns. Staff immediately separated
altercation. Altercation resulted in no serious injuries. 7/10/24-Email sent to facility to
inquire if there is video footage of altercation. Received email that there is video. Visit
scheduled for 7/11/24. 7/11/24-Facility visited. Video reviewed. No citations.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: 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: 7/11/2024
Home Visit Date: 7/11/2024
Purpose of Visit: Self Report Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Facility visited in response to self-report incident that client was taken for an X-ray due to an altercation.
X-ray yielded no fractures or abnormalities. Video reviewed of altercation. Client was sitting in the floor
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

when a peer punched him in the face. Staff were present and immediately intervened. Peer who assaulted
did not persist with assault after punch. No restraint, hold or physical action was taken by staff during this
incident.
Provider Comments:
CCL Staff Signature : Date: 7/11/2024
Provider Signature : Date: 7/11/2024
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 evaluation after hurting his knee playing on waterslides.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 022423
Date of Incident: 7/5/2024
Date Received: 7/5/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: woke up this
morning (7/5/24) complaining of knee pain. stated that he hurt his knee playing on the
waterslides yesterday. was taken to Dallas County Medical Center and
He was instructed to rest and elevate x 3 days. He was sent back to
Millcreek.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 7/8/24-Reviewed for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Buildings & Grounds conducted for Flamingo and Zebra Hall. The facility was cited 907.3 for being out of staffing ratio.

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: 7/3/2024
Home Visit Date: 7/3/2024
Purpose of Visit: Subsequent Building and Grounds
Regulations Out of Compliance:
Regulation Number: 900.907.3
Regulation Description: Staff/child ratio shall be at least 1:6 during waking hours and 1:8 during sleeping hours.
Finding Description: Zebra staff/client ratio was 2:16.
Action Due Date: 2024-07-03
Action Due Description: 3rd staff member was notified and seen entering Zebra Hall making the ratio 3:16.
Comply Date:
Action Due Description: 3rd staff member was notified and seen entering Zebra Hall making the ratio 3:16.
Regulations Needing Technical Assistance:
Regulation Not Applicable:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 3

Regulations Not Correctable:
Narrative:
Buildings & Grounds conducted for Flamingo and Zebra Hall.
Flamingo staff/client ratio: 4:16. Sleeping areas furnished, clean, safe and in good repair. Bathrooms clean
and sanitary. Client rights and emergency escape diagrams observed.
Zebra staff/client ratio: 2:16. 2 present staff were asked where 3rd staff member was as Zebra is staffed for 3
Behavioral Health Associates. 3rd staff member was reported to be outside of Zebra door making a phone
call. Outside area observed and 3rd staff member was not seen. Radio call was made, and later 3rd staff
member was seen entering Zebra Hall. Facility cited 907.3.Sleeping areas furnished, clean, safe and in good
repair. Bathrooms clean and sanitary. Client rights and emergency escape diagrams observed.
MAR checked for:
All initialed and up to date.
Provider Comments:
CCL Staff Signature : Date: 7/3/2024
Provider Signature : Date: 7/3/2024
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 3

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

doc_type: Compliance Report


summary: Buildings and Grounds were completed for Penguin Hall, Eagle Hall, and the outdoor area. No deficiencies cited.

raw_content:
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

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: 6/26/2024

Home Visit Date: 6/26/2024

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 for Penguin Hall, Eagle Hall and outdoor area.

www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Outdoor picnic area staff/client ratio: 4:20. Grounds clean and free of safety hazards.

Eagle Hall staff/client ratio 4:11. Building area clean, safe and in good repair. Bathrooms clean and sanitary
with functioning sinks, showers and toilets. Client rights and emergency escape diagrams observed.

Penguin Hall clients outside.Building area clean, safe and in good repair. Bathrooms clean and sanitary with
functioning sinks, showers and toilets. Client rights and emergency escape diagrams observed.

MAR checked for:

All initialed and up to date.

Provider Comments:

CCL Staff Signature : Date: 6/26/2024
Provider Signature : Date: 6/26/2024

YUVY

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


summary: A resident eloped while staff were dealing with another patient. The resident was located by staff about 1.5 hours later and returned to the facility.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 022203
Date of Incident: 6/22/2024
Date Received:6/24/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number:233
Incident Type: Licensing
Report Description: While staff were dealing with another patient and his behavior,
eloped. Code Orange was called, but
another patient helped him over the fence. Police were notified. was located by staff
about an hour and a half later and brought back to unit without incident.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 6/25/24-Reviewed for licensing concerns. Staff were immediately
aware of elopement and followed protocol.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Two residents eloped through a door during bedtime. One resident was found on campus and returned to the unit. The other resident was located hours later and transported back to the facility.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 022135
Date of Incident: 6/19/2024
Date Received:6/20/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number:233
Incident Type: Licensing
Report Description: walked out of
his room fully clothed. Staff asked why he was fully clothed and what he was doing. (Staff
had just made rounds and all boys were in bed) stated he needed some water.
started to bend down to act like he was going to get water and then jumped up and busted
through the back door. As soon as
heard bust through the door, he came running out of his room through the
door as well. Staff immediately called code orange and police were notified. was found
still on campus and returned to the unit, was not. jumped the fence and ran into
the woods. Several teams of 3-4 staff looked for all night. was finally located at
an ATM at approximately 4:20 am. While out on elopement, busted a car window and
stole a wallet. Police were notified due having another person?s wallet and cards on
him. was brought back to the facility. Still waiting on Fordyce Police Department to
decide if charges will be filed.
Interim Action Narrative:
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: 6/21/24-Reviewed for licensing concerns. Staff were immediately
aware of elopement and followed protocol. Email sent to facility to ascertain safety plan for
clients. Police report requested for review. Safety plans for and received from facility.


summary: A resident was taken to Dallas County Medical Center for an x-ray after hurting his hand playing kickball.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 022093
Date of Incident: 6/18/2024
Date Received:6/19/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number:233
Incident Type: Licensing
Report Description: ) was playing
kickball and hurt his right hand. was taken to Dallas County Medical Center for an x-
ray and .
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 6/19/24-Reviewed for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was transported to Dallas County Medical Center for an x-ray of the right hand after punching a wall several times.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 022092
Date of Incident: 6/18/2024
Date Received:6/19/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number:233
Incident Type: Licensing
Report Description: got
angry and punched the wall several times. He was transported to Dallas County Medical
Center for an x-ray of right hand. .
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 6/19/24-Reviewed for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A recertification survey was conducted at the facility. No deficiencies were cited.

raw_content:
Division of Provider Services
& Quality Assurance
P.O. Box 8059, Slot S404
Little Rock, AR 72203-8059
June 20, 2024
Brady Serafin, Administrator
Habilitation Center, LLC
P.O. Box 727
Fordyce, AR 71742
Dear Mr. Serafin:
A Recertification survey was conducted on June 13, 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 June
13, 2024, Recertification 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 Theresa.Forrest@dhs.arkansas.gov.
If you have any questions, please contact your reviewer at 501-320-6235.
Sincerely,
DPSQA/Office of Long Term Care
Survey and Certification Section
tf
cc: DRA
Brady Serafin - Habilitation Center, Llc - 06/20/2024- (AOLTC - PRTF No Def) Page 1]

PRINTED: 06/20/2024
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 ______________________
04L103 B. WING _____________________________ 06/13/2024
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.
A Validation Survey was conducted from
06/11/2024 to 06/13/2024.
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:7CMJ11 Facility ID: 3002 If continuation sheet Page 1 of 1


summary: A resident was taken to Dallas County Medical Center Emergency Department for an x-ray of his right knee after complaining 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
Notice of Serious Incident
Case Number: 021935
Date of Incident: 6/12/2024
Date Received:6/13/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number:233
Incident Type: Licensing
Report Description: was sitting on
his knees in the floor playing a game. stated that when he went to get up his knee
popped and began hurting. was taken to Dallas County Medical Center ER for an x-ray
of right knee. . He was
He was discharged back to Millcreek same day.
Interim Action Narrative: Resident was sent to the emergency room for x-ray.
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 taken to Dallas County Medical Center for an x-ray of her left foot.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 021861
Date of Incident: 6/7/2024
Date Received:6/10/2024
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 her left foot. stated that she
hurt her foot prior to coming to Millcreek (she admitted on 06/05/24).
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 6/10/24-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 a scheduled CT of the head and thyroid.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 021862
Date of Incident: 6/7/2024
Date Received:6/10/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number:233
Incident Type: Licensing
Report Description: went to
Dallas County Medical Center for a scheduled CT of head and US thyroid that was ordered
by due to recent "fainting" spells. Patient reports that she often blacks out when
she gets anxious.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 6/10/24-Reviewed for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident reported that a staff member stepped on her feet to keep her in place and pulled out 6 of her braids. The complaint was 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
Notice of Serious Incident
Case Number: 021868
Date of Incident: 6/7/2024
Date Received:6/10/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number:233
Incident Type: Dual
Report Description: . resides with her
is an out of home /staff member,
Unknown at Millcreek of Arkansas in Fordyce. On 6/7/24, got mad and hit
then stepped on feet at the same time to keep her in place. pushed
her off and then grabbed hair and pulled 6 braids out of her head. Staff
didn't follow proper protocol. They didn't follow-up with a nurse or send an incident report
to therapist. has a history with aggressive behaviors which is why she is
at Millcreek. Staff at the facility are saying that the cameras were being worked on and were
not working at the time of the altercation. Staff also changed the story that pulled
her own braids out of her head.
Interim Action Narrative: Unable to determine as of 6/10/24. 6/11/24- Staff
placed on adminstrative leave .
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: 6/10/24-Reviewed for licensing concerns.
. 6/11/2024,
Program Coordinator requested permission to contact the facility. Permission granted.
6/11/24-Facility visited. Staff placed on administrative leave
Licensing cannot make a finding at this time. 6/20/24-Witness statements
from incident reviewed all of which support client pulling her own hair out.\ 7/16/24-
Phone call made to of Millcreek who stated that staff will be
retrained today, and training completion will be provided to licensing.

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: 7/16/2024
Home Visit Date: 7/16/2024
Purpose of Visit: Revisit Complaint
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

This is to document that Case#021868 has been investigated and determined to be unfounded. As a
precautionary measure, A/O received in-service training from facility and completion was provided to
licensing 7/16/24.
Provider Comments:
CCL Staff Signature : Date: 7/16/2024
Provider Signature : Date: 7/16/2024
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: Buildings and Grounds were completed for Kangaroo and Tiger Hall. No deficiencies cited.

raw_content:
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

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: 6/4/2024

Home Visit Date: 6/4/2024

Purpose of Visit: Monitor Visit

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

Regulations Not Correctable:

Narrative:

Buildings & Grounds conducted for Kangaroo and Tiger Hall.

www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Kangaroo staff/client ratio: 2:12. Sleeping areas and dayroom clean, free of graffiti, safe and in good repair.
Bathrooms clean and sanitary with functioning sinks, showers and toilets. Client rights and emergency escape

diagrams observed.

Tiger Hall staff/client ratio: 3:18.Sleeping areas and dayroom clean, free of graffiti, safe and in good repair.
Bathrooms clean and sanitary with functioning sinks, showers and toilets. Client rights and emergency escape

diagrams observed.

MAR checked for:

All initialed and up to date.

Provider Comments:

CCL Staff Signature :

Provider Signature :

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

Date: 6/4/2024

Date: 6/4/2024

Page 2 of 2


summary: A resident was sent to Dallas County Medical Center for an x-ray of the left ankle after falling while playing.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 021669
Date of Incident: 5/31/2024
Date Received:6/3/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number:233
Incident Type: Licensing
Report Description: was outside
playing and running. fell and rolled her ankle. went to Dallas County Medical
Center on 05/31/24 for an x-ray of left ankle. .
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 6/3/24-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 evaluation due to having an altered mental status 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
Notice of Serious Incident
Case Number: 021620
Date of Incident: 5/30/2024
Date Received: 5/31/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description:
was sent to Dallas County Medical Center ER for evaluation due to altered mental
status after an altercation with a peer. was returned to Millcreek same day with the
.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 5/31/24-Reviewed for licensing concerns. Email sent to facility to
inquire if there is video. Received email that there is no video of the incident. Safety plan for
resident sent to licensing.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was transported to Dallas County Medical Center after informing staff members that she took Ibuprofen out of a staff member’s bag and swallowed 3 handfuls.  The facility was cited 910.1 for personal medication being left in an unlocked location.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 021561
Date of Incident: 5/28/2024
Date Received: 5/29/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: went to
staff and told them that she got Ibuprofen out of the staff?s bag and took it. was
taken to Dallas County Medical Center ER for evaluation.
She returned to Millcreek same day. states that she took 3
handfuls, staff state that the bottle was almost empty and there were not 3 handfuls of pills
in the bottle.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 5/29/24-Reviewed for licensing concerns. 908.4 and 910.1 reviewed.
According to report, staff reported having Ibuprofen not securely locked, but was only a few
Ibuprofens, not enough to be a safety hazard, for personal use. Visit scheduled for 5/30/24.
5/30/24-Facility visited and given T/A for 910.1.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was transported to Dallas County Medical Center after not being able to remove a marker cap she put into her vagina.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 021533
Date of Incident: 5/25/2024
Date Received: 5/28/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: put a cap
off of a marker into her vagina. Nursing tried to talk her through removing it but was
unsuccessful. was taken to Dallas County Medical Center ER
Patient was discharged back to Millcreek with no new orders.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 5/29/24-Reviewed for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident reported that she was in a physical altercation with a staff member. This complaint was 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: 021581
Date of Incident: 5/22/2024
Date Received: 5/29/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Dual
Report Description: A/v is . . She is
in residential treatment at Millcreek of Arkansas in Fordyce. female
staff member unknown. On 5/22/24,
was
then put in restraints. On Friday, she was put in restraints again and she ended up getting
scratched again. The reporter is working on getting transported to a different facility.
doesn't have any visible injuries.
Interim Action Narrative: 5/29/24-When report was received no A/O was named. 5/30/24-
It was determined that Staff has been placed on administrative
leave 6/14/24-Recived email that , not
. Email sent to facility that staff
.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: 5/29/24-Reviewed for licensing concerns.
Visit scheduled for 5/30/24. 5/30/24-
Facility visited. Licensing is not prepared to make a finding at this time. Per phone
conversation with 6/17/24-
Recieved email from facility forwarded from that
This was confirmed by Program Manager
Chelsea Vardell. Email sent to facility that staff
Staff will need to be
retrained on restraints/holds. 6/18/24-Training for provided to licensing.
6/20/2024, Program Coordinator checked CHRIS, case still pending.

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: 7/22/2024
Home Visit Date: 7/22/2024
Purpose of Visit: Revisit Complaint
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

No site visit conducted. This is to document that Case#021581 has been investigated and determined to be
unfounded. As a precautionary measure, staff Niteasha H will need to be retrained on restraint techniques.
Training completion will be provided to licensing.
Provider Comments:
CCL Staff Signature : Date: 7/22/2024
Provider Signature : Date: 7/22/2024
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: Licensing visited the facility to review personnel records. The facility was cited 103.3 for late child maltreatment registry checks.

raw_content:
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

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: 5/22/2024

Home Visit Date: 5/22/2024

Purpose of Visit: Personnel Records

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

Regulations Not Correctable:

Regulation Number: 100.103.3

Regulation Description: Persons required to have the Child Maltreatment Central Registry Check shall repeat
the check every two (2) years.

Finding Description: Staff 9 child maltreatment was last completed 5/3/22. Today is 5/22/24.
Action Due Date: 2024-06-05

www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Action Due Description: Child Maltreatment will be ran for staff iijand placed in employee file.
Comply Date:

Action Due Description: Child Maltreatment will be ran for staff JJ and placed in employee file.

Narrative:

Personnel Records completed for:

All personnel records for this annual year completed today. Staff J IJ child maltreatment was last
completed 5/3/22. Today's date is 5/22/24. Facility cited 103.3: The Child Maltreatment Registry Check shall
be repeated every 2 years.

Provider Comments:

CCL Staff Signature : Date: 5/22/2024
/ pv
Provider Signature : Date: 5/22/2024

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 after complaining of rib pain following a physical altercation with two peers.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 021357
Date of Incident: 5/19/2024
Date Received: 5/20/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description:
was being disruptive. Staff were talking with when 2 patients ran up to and
kicked him in the face and side. Staff immediately separated and called nursing for
evaluation. complained of rib pain and was taken to DCMC ER for evaluation and
was sent home with no activity limitations.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 5/20/24-Reviewed for licensing concerns. Staff reported to be present
during altercation. No supervision issues noted from report. Email sent to facility to
ascertain if there is video of incident. Received response there is video. Visit scheduled for
5/22/24 to review video. Email sent to facility to outline safety plan for client Safety plan
received. 5/22/24-Facility visited. No citations.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Dallas County Medical Center after sustaining an injury while horseplaying 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
Notice of Serious Incident
Case Number: 021324
Date of Incident: 5/17/2024
Date Received: 5/17/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description:
and another peer were horse playing and . was
sent to Dallas County ER and .
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 5/20/24-Reviewed for licensing concerns. Facility contacted for
further detail on horseplaying. of Millcreek stated that after further
investigation, it was determined that the clients involved were playing a game call "30's",
meaning thirty seconds of play fighting with no punching in the face. Facility policy would
not permit staff to allow this type of horseplay. Facility staff stated they do not allow this
type of horseplay. A unit wide in-service training was initiated 5/17/24 on staff not
permitting horseplay that would endanger the safety and well-being of the clients. Facility
visit scheduled for 5/22/24 to interview clients to ascertain if "30's" was permitted by staff.
5/22/24-Facility visited. No citations.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Personnel Records Review. Technical Assistance provided for 105.15h for missing references.

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: Joretha Bragg
Record Visit Date: 5/15/2024

Home Visit Date: 5/15/2024

Purpose of Visit: Personnel Records

Regulations Out of Compliance:

Regulations Needing Technical Assistance:

Regulation Not Applicable:

Regulations Not Correctable:

Narrative:

Personnel Records Review completed for:

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

All items accounted for except aa i had two positive personal references from relatives. Two positive
personal references from non-relatives added to file before the conclusion of today's visit. T/A provided for
105.15h.

Provider Comments:

CCL Staff Signature : Date: 5/15/2024

a)
fn 5

A il ¥]
VLA

Provider Signature : Date: 5/15/2024

WHYS | hay

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


summary: A resident was sent to Dallas County Medical Center for evaluation due to being lethargic and complaining of shortness of breath.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 021173
Date of Incident: 5/9/2024
Date Received: 5/10/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description:
was sent to the Dallas County ER for evaluation due to being lethargic and complaining of
shortness of breath. was diagnosed and discharged to Millcreek
with no limitations and no new orders.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 5/13/24-Reviewed for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent for a follow up CT scan for continued hip and leg pain.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 021174
Date of Incident: 5/9/2024
Date Received: 5/10/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: This is a follow up to case # 020960 that was reported on 5/1/2024.
was sent for a follow
up CT scan of hip and leg since pain has continued even though x-rays CT
found that had a
was sent to AR Children's hospital
will be discharged with
. will receive this evening at the
hospital and discharge will be discussed after that.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 5/13/24-Reviewed for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was injured while horseplaying with a staff member. The resident was sent to Dallas County ER for evaluation. The facility was cited 109.1.g and 907.2 as a result of this incident. Three staff members were 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
Notice of Serious Incident
Case Number: 021071
Date of Incident: 5/4/2024
Date Received: 5/6/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Dual
Report Description:
stated that him and a staff were horseplaying. He stated that he snuck up behind staff and
staff turned around real quick and her keys on her lanyard swung out and cut him under his
eye. Aiden was sent to Dallas County ER for medical follow up where
He was released to return to facility without restrictions.
Interim Action Narrative: Staff involved and two staff present all terminated.
.
Licensing Narrative: 5/7/24-Reviewed for licensing concerns. Email sent to facility to
inquire if there is video footage of this incident. Email received that there is video footage of
incident which will be reviewed next visit. 5/8/24-Facility visited and camera footage
reviewed. Facility cited 109.1g and 907.2. Staff who participated in incident and two staff
present for incident have all been terminated from employment at Millcreek 5/6/24.
.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Dallas County Medical Center for an ultrasound of her gallbladder.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 021018
Date of Incident: 5/2/2024
Date Received: 5/3/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description: had an
come back and was sent out to Dallas County Medical Center for an
ultrasound of her gallbladder. Results are still pending.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 5/6/24-Reviewed for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was transported to Dallas County Medical Center for x-rays after complaining of right hip and leg pain.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 020960
Date of Incident: 4/30/2024
Date Received: 5/1/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description:
complained of right hip and leg pain. stated that it's been hurting since before he
came to MillCreek, but it's gotten worse. was taken to the Dallas County Medical
Center on 4.30.2024, for x-rays of right hip and femur. No fractures or dislocations found.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 5/1/24-Reviewed for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Buildings & Grounds conducted for Deerfield and School buildings. No deficiencies cited.

raw_content:
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

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: 4/30/2024

Home Visit Date: 4/30/2024

Purpose of Visit: Monitor Visit

Regulations Out of Compliance:

Regulations Needing Technical Assistance:

Regulation Not Applicable:

Regulations Not Correctable:

Narrative:

Buildings & Grounds conducted for Deerfield and School buildings. Pine Ridge and Rock Hill currently under
remodel, to be followed by Deerfield next.

www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Deerfield building clean, safe and in good repair except baseboard trim purposely removed for sleeping areas
due to upcoming paint job. Client rights observed. Bathrooms clean and sanitary with functioning sinks,
showers and toilets. Grounds clean and free of safety hazards.

School clean, safe and in good repair. Classroom ratios: 4:14, 4:10, 2:7, 5:16, and 5:15. One staff escorting
one client out of building. Staff seen escorting clients across the campus, staff/client ratio: 2:9.

MAR checked for:

All initialed and up to date.

Provider Comments:

CCL Staff Signature : Date: 4/30/2024
Ina
{4
Provider Signature : Date: 4/30/2024
ih} |)

Vy

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 a tetanus shot after stepping on a nail while outside 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
Notice of Serious Incident
Case Number: 020847
Date of Incident: 4/24/2024
Date Received: 4/25/2024
Facility Name: Millcreek of Arkansas PRTF
Facility Number: 233
Incident Type: Licensing
Report Description:
was outside playing football in the field behind the barn and stepped on a nail. was
taken to Dallas County Medical Center to receive a tetanus shot. There has been no recent
construction in the area. Maintenance is running a magnet through the field to check for
any other objects that might have washed up during the recent rainstorms.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 4/25/24-Reviewed for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov