summary: A resident reported that he was awoken by one of his roommate’s groping his private area over clothing while he was sleeping.

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: 021805
Date of Incident: 6/6/2024
Date Received:6/7/2024
Facility Name: Piney Ridge Treatment Center
Facility Number:203
Incident Type: Dual
Report Description: On 6/6/24 at approximately 1520,
) reported that on the weekend of 5/25/24-5/26/24 (unclear on which
day), he was awoken by groping his
private area over clothing and over his blankets while he was sleeping. noticed their
other roommate, watching the interaction from his bed. told to get
off of him and that he doesn't like that. reportedly immediately stopped and got
back in his bed with no further incident. The next morning, other roommate
approached to tell him that he was the one who told
to grope him and laughed it off like it was a joke. When and spoke with
about the incident, he denied ever engaging in SAO behavior with any resident.
Neither resident nor are reliable sources. denies knowing what the
motive would be, sexual or horseplay.
visited with late this
afternoon. denied that any sexual behavior occurred. At this point will
have a single room to be assessed at a later date. All residents involved will process with
primary therapist.
Interim Action Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: 6/11/2024 - The provider reported incident was reviewed by the
licensing specialist. Licensing specialist will obtain permission to
follow up with the facility regarding the incident. Permission received
to follow up with the facility regarding the report. 6/12/2024 - Licensing specialist
conducted a visit at the facility to review supervision and bed check q-15 documentation.
Facility will send documentation for the logged bed checks for incident dates for the report
6/13/2024 - Q15 logs have been uploaded to ELS 6/28/2024 - Findings 521 inspection report
sent to the facility for signature. 7/1/2024, Approved by Program Coordinator. Case
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: Piney Ridge Treatment Center
Facility Number: 203
Licensee Address: 2805 E ZION RD
FAYETTEVILLE AR 72703
Licensing Specialist: Jarred Parnell
Person In Charge:
Record Visit Date: 6/12/2024
Home Visit Date: 6/12/2024
Purpose of Visit: Complaint Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
6/12/2024 - A visit was conducted at the facility to speak with staff regarding case # 021805.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Licensing specialist spoke to facility staff regarding the reported incident. There is no video footage available
for review. Bed check logs were requested from the facility review. The safety plan enacted for the residents
is separation of the residents.
Licensing is not prepared to leave a finding at this time.
Provider Comments:
CCL Staff Signature : Date: 6/25/2024
Provider Signature : Date: 6/25/2024
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


state: AR

facility_name: Yellow Rock Behavioral Health (formerly Piney Ridge)

summary: Three residents eloped from the facility as they were returning from an outing off campus.

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: 021792
Date of Incident: 6/5/2024
Date Received:6/7/2024
Facility Name: Piney Ridge Treatment Center
Facility Number:203
Incident Type: Licensing
Report Description: On 6/5/24, was on an
outing to see a basketball game with staff and a few other residents, including
and was
leaning forward into the front seat messing with items in the vehicle on the drive back. and
was redirected. Once the van parked in the parking lot of PRTC,
pushed open the door and began walking off towards the Crossover building. When staff
called for them to stay by the vehicle, all 3 residents began running away from the building.
Staff and a nurse chased after them, but the residents quickly got out of eyesight.
Fayetteville police were called at 1735 to report. Staff reported that the resident and his 2
peers took the gas card from the van. Fayetteville police returned all 3 residents to the
facility at 2306. No injuries found on any resident. presented
with signs of being under the influence; urine sample was ordered. All three residents were
placed on restricted to unit and elopement precautions to be assessed daily. Primary
Therapists will process with residents. Residents will be suspended from outings.
Interim Action Narrative:
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: 6/7/2024 - The provider reported incident was reviewed by the
Licensing specialist, licensing specialist will follow up with facility in regards to the urine
sample findings and what the boys were under the influence of., and why the report was not
submitted the next business day. 6/21/2024 - Licensing specialist followed up concerning
the report being submitted late.

doc_type: Notice of Incident


summary: Officers were dispatched to the facility in response to residents who had eloped.

raw_content:
Fayetteville Police Department
Summary
Print Date/Time: 06/17/2024 14:43 Fayetteville Police Department
Login ID: bjenkins ORI Number: AR0720100
Case Number: 2024-00038764
Case
Case Number: 2024-00038764 Incident Type: Missing Person
Location: 4253 N CROSSOVER RD Occurred From: 06/05/2024 17:34
FAYETTEVILLE, AR 72703 Occurred Thru: 06/05/2024 17:34
Reporting Officer ID: 466 - BRIXEY Disposition: Investigation Complete
Disposition Date: 06/05/2024
Reported Date: 06/05/2024 17:34 Wednesday
Offenses
No. Group/ORI Crime Code Statute Description Counts
Subjects
Type No.Name Address Phone Race Sex DOB/Age
Reporting Person 1 SEXTON, TIMOTHY SHANE 4250 N VALLEY LAKE DR 10 (479)684-1998 White Male 10/26/1980
FAYETTEVILLE, AR 72703 43
Arrests
Arrest No. Name Address Date/Time Type Age
Property
Date Code Type Make Model Description Tag No.Item No.
Vehicles
No. Role Vehicle Type Year Make Model Color License Plate State
Routing:
Page: 1 of 3
Page: 1 of 1

OfficerID: bbrixey, B. Brixey/Case Narrative #2024-38764
Officer B. Brixey #466
Missing Persons
Case #2024-38764
Case Narrative
On 6/5/2024, at approximately 5:34 PM, I was dispatched to 4253 North Crossover
Road (Piney Ridge) for
On arrival, I located the subject who was last with the , Timothy Sexton
W/M 10/26/1980 (PH: 479-684-1998). Timothy stated he was transporting the
from and had given permission to throw trash away in the nearby
dumpster. Timothy said the did not attempt to throw any trash away, but
instead ran toward N. Crossover Road and did not stop. Timothy said one of the
was messing with radio controls during the trip and must have snatched
his fuel card as it was missing. Timothy stated this all occurred at approximately 5:34
PM that day (6/5/2024).
I requested records enter these as missing and release a BOLO. I
added the pictures Piney Ridge provided to missing person profile jacket.
During this incident, my BWC was active.
Processed by: A. Du Quesne
Page: 2 of 3

OfficerID: jrwatson, J. Watson/Case Supplement #2024-38764
Officer J. Watson #514
Case #2024-38764
Case Supplement
On June 5th, 2024 at 10:15 pm, I responded to 578 East Joyce Boulevard for a follow
up report. Dispatch advised were in the drive through of
McDonald’s and was not with them.
I arrived and met with in front of McDonald’s and noticed
run across East Joyce Boulevard traveling south.
stated that would not stop running because did not want
to go back to Piney Ridge. stated were ready to go back to
Piney Ridge and I proceeded to search before helping get into the rear of
my patrol vehicle.
While I was speaking with , an assisting officer was able to locate
south of the call location and convinced to go back to Piney Ridge.
The were transported to Piney Ridge without incident where custody
of the was transferred to Piney Ridge staff.
This concludes my recovery informational report.
Processed by: A. Du Quesne
Page: 3 of 3

Public Records Exemptions
Enclosed please find a copy of the response documents for your public
records request. The following information is provided to explain the
process employed to review and produce the response documents.
Reason Description Pages
1-3
1 of 1

Incident Report
Print Date/Time: 06/17/2024 14:37 Fayetteville Police Department
Login ID: bjenkins ORI Number: AR0720100
Incident: 2024-00038764
Incident Date/Time: 6/5/2024 5:34:37 PM Incident Type: MISSING PERSON
Location: 4253 N CROSSOVER RD Venue: FAYETTEVILLE
FAYETTEVILLE AR 72703
Phone Number: (479)256-4474 Source: 911
Report Required: Yes Priority: 1-High
Prior Hazards: No Status: In Progress
LE Case Number: 2024-00038764 Nature of Call:
Unit/Personnel
Unit Personnel
466 466-BRIXEY
509 509-GRAY
Person(s)
No. Role Name Address Phone Race Sex DOB
1 Caller TUCKER, DAKOTA (479)256-4474
Vehicle(s)
Role Type Year Make Model Color License State
Disposition(s)
Disposition Count Date/Time
Unit:466
Disposition Count Date/Time
01RPT 1 06/05/2024 18:36
Unit:509
Disposition Count Date/Time
02GONEONARRIVAL 1 06/05/2024 18:17
Property
Date Code Type Make Model Description Tag No. Item No.
Page: 1 of 1
Page: 1 of 2

CAD Narrative
06/05/2024:20:03:14aremickNarrative:
06/05/2024:18:33:42tkelleyNarrative:RECORDSADVTOENTERSUBJSASMISSING
06/05/2024:18:21:33bbrixeyNarrative:
06/05/2024:18:16:45jgrayNarrative:CHECKEDAREASURROUNDINGCALLLOCATIONANDTHEWHITEOAK.TALKED
WITHSEVERALPEOPLEOUTANDABOUT,NOONEHADSEEN .D2
06/05/2024:18:06:53bbrixeyNarrative:
.Lastseenwalking
southoncrossover.
06/05/2024:17:49:29mkurtzNarrative:NOWSTATINGMEETATSOUTHPARKINGLOT.SOUTHOFCIRCLEDRIVE.
06/05/2024:17:45:56mkurtzNarrative:NOC1S.
06/05/2024:17:45:36mkurtzNarrative:THE HAVEPREVIOUSLYDISCUSSEDSTEALINGCARSTOGETTOFORT
SMITH.
06/05/2024:17:44:49mkurtzNarrative:THEREAREOTHERSTAFFMEMBERSDRIVINGAROUNDLOOKING.
06/05/2024:17:44:35mkurtzNarrative:CALLERWANTSTOMEETPDOUTSIDEINTHECIRCLEDRIVE.
06/05/2024:17:44:06mkurtzNarrative: HAVERANAWAYPREVIOUSLY.PDMIGHTHAVE
PHOTOSALREADYFROMANOLDBOLO.
06/05/2024:17:43:34mkurtzNarrative:NOFRIENDSORRELATIVESINTHEAREA.
06/05/2024:17:42:57mkurtzNarrative: AREINPOSSESSIONOFTHEFACILITYGASCARD.
06/05/2024:17:42:40mkurtzNarrative:ONLYHAVEBEENMISSINGSINCECALLERSTARTEDTHE911CALL.
06/05/2024:17:42:15mkurtzNarrative:CALLERWILLHAVEDOBBACKATTHEFACILITY.
06/05/2024:17:42:08mkurtzNarrative:
06/05/2024:17:41:41mkurtzNarrative:CALLERISHEADEDBACKTOPINEYRIDGE.
06/05/2024:17:41:34mkurtzNarrative:ALLTHREEHAVE .
06/05/2024:17:39:11mkurtzNarrative:D2ATWHITEOAKPERCALLER.
06/05/2024:17:39:07mkurtzNarrative:CALLERISDRIVINGWITHANURSE.MADEITTOTHEWHITEOAKINAWHITE
TOYT4RUNNER.
06/05/2024:17:38:41mkurtzNarrative: DISCUSSEDITBEFORE.
06/05/2024:17:38:38mkurtzNarrative:POSSIBLYGOINGWHITEOAKATJOYCE/CROSSOVER.
06/05/2024:17:37:07mkurtzNarrative:CALLERLOSTSIGHT.
06/05/2024:17:36:46mkurtzNarrative:ALLAPPROX .
06/05/2024:17:36:33mkurtzNarrative:HEADEDSBCROSSOVER.
06/05/2024:17:36:11mkurtzNarrative:
06/05/2024:17:35:56jcurryNarrative:34510-4
06/05/2024:17:35:00mkurtzNarrative:
06/05/2024:17:34:54mkurtzNarrative:STAFFREPORTING ESCAPED.
Page: 2 of 2

Public Records Exemptions
Enclosed please find a copy of the response documents for your public
records request. The following information is provided to explain the
process employed to review and produce the response documents.
Reason Description Pages
2
1 of 1

doc_type: Police Report


summary: A buildings and grounds walkthrough was completed for the facility. No deficiencies cited.

raw_content:
ARKANSAS
) DEPARTMENT OF

\}v7 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: Piney Ridge Treatment Center

Facility Number: 203

Licensee Address: 2805 E ZION RD
FAYETTEVILLE AR 72703

Licensing Specialist: Jarred Parnell
Person In Charge: Ronissa Adams
Record Visit Date: 6/5/2024

Home Visit Date: 6/5/2024

Purpose of Visit: Subsequent Building and Grounds

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

Regulations Not Correctable:

Narrative:

6/5/2024 - A buildings and grounds walkthrough was conducted at the facility. A full walkthrough was
conducted of all units at the facility, north unit, south unit, east unit, west unit and the crossover unit. All areas

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

were inspected for safety and maintenance. All areas inside the units and sleeping areas were inspected as well
as electrical outlets and lighting covers.

The M.A.R-S was reviewed for the following residents - as

All records were complete upon on review.

Provider Comments:

CCL Staff Signature : Date: 6/5/2024
/ |
Provider Signature : Date: 6/5/2024

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

doc_type: Compliance Report


summary: Three residents were assisted by two of their peers in scaling and climbing the fence around the facility in order to elope.

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: 021696
Date of Incident: 6/3/2024
Date Received:6/4/2024
Facility Name: Piney Ridge Treatment Center
Facility Number:203
Incident Type: Licensing
Report Description: On 6-3-24:
at approximately 1900,
were assisted by two of their peers, in scaling and climbing the fence around the facility in
order to elope. Staff ran towards them and attempted to stop them but did not get there in
time. Fayetteville Police Department was contacted (report #: 24-38361). The police
returned all 3 residents to the facility at 2102. Contraband search was completed upon arrival
to the facility. All 3 residents admitted to smoking marijuana. returned with a
crowbar on his person. returned with a metal plate on his person. All 3
residents on elopement precautions x24 and will be RTU per MD order. Blood draw and
urine sample taken by APRN order for all 3 residents. Residents will process with primary
therapists.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 6/6/2024 - The provider reported incident was reviewed by the
Licensing specialist. Program Coordinator requested police documentation. 6/11/2024,
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

police documentation eceived. 6/20/2024 the police documentation was reviewed by the
licensing specialist.


summary: Officers responded to Piney Ridge for a missing person report.

raw_content:
Fayetteville Police Department
Summary
Print Date/Time: 06/17/2024 14:58 Fayetteville Police Department
Login ID: bjenkins ORI Number: AR0720100
Case Number: 2024-00038361
Case
Case Number: 2024-00038361 Incident Type: Missing Person
Location: 4253 N CROSSOVER RD Occurred From: 06/03/2024 19:07
FAYETTEVILLE, AR 72703 Occurred Thru: 06/03/2024 19:07
Reporting Officer ID: 462 - TOLE Disposition: Inactive
Disposition Date: 06/03/2024
Reported Date: 06/03/2024 19:07 Monday
Offenses
No. Group/ORI Crime Code Statute Description Counts
Subjects
Type No.Name Address Phone Race Sex DOB/Age
Informational 1 VASINA, STEPHANIE 4253 N CROSSOVER RD Unknown Female 01/20/1977
FAYETTEVILLE, AR 72703 47
Arrests
Arrest No. Name Address Date/Time Type Age
Property
Date Code Type Make Model Description Tag No.Item No.
Vehicles
No. Role Vehicle Type Year Make Model Color License Plate State
Routing:
Page: 1 of 2
Page: 1 of 1

OfficerID: stole, S. Tole/Case Narrative #2024-38361
Officer S. Tole #462
Missing Person
Case #2024-38361
Case Narrative
On June 3rd, 2024, at approximately 19:07, I responded to 4253 N. Crossover Road
(Piney Ridge) for the report of a missing person. Employee Stephanie Vasina
reported had been seen jumping the fence and running westbound on
E. Zion Road.
reported missing and entered in ACIC/NCIC as such. Cpl. Mills #422 and I checked
the area where the last seen but were unable to locate
At approximately, 20:45 Cpl. Bailey #267 was patrolling on E. Zion Road and located
walking along the sidewalk. Cpl. Harris #418 and I transported the
back to Piney Ridge. The returned without incident
and removed as missing.
Processed by: A. Du Quesne
Page: 2 of 2

Public Records Exemptions
Enclosed please find a copy of the response documents for your public
records request. The following information is provided to explain the
process employed to review and produce the response documents.
Reason Description Pages
1-2
1 of 1

Incident Report
Print Date/Time: 06/17/2024 14:53 Fayetteville Police Department
Login ID: bjenkins ORI Number: AR0720100
Incident: 2024-00038361
Incident Date/Time: 6/3/2024 7:07:00 PM Incident Type: MISSING PERSON
Location: 4253 N CROSSOVER RD Venue: FAYETTEVILLE
FAYETTEVILLE AR 72703
Phone Number: (316)303-4040 Source: Phone
Report Required: Yes Priority: 1-High
Prior Hazards: No Status: In Progress
LE Case Number: 2024-00038361 Nature of Call:
Unit/Personnel
Unit Personnel
422 422-MILLS
462 462-TOLE
Person(s)
No. Role Name Address Phone Race Sex DOB
FAYETTEVILLE AR 72703
4 Caller VASINA, STEPHANIE 4253 N CROSSOVER RD Unknown Female 01/20/1977
FAYETTEVILLE AR 72703
Vehicle(s)
Role Type Year Make Model Color License State
Disposition(s)
Disposition Count Date/Time
Unit:422
Disposition Count Date/Time
02GONEONARRIVAL 1 06/03/2024 19:45
Unit:462
Disposition Count Date/Time
01RPT 1 06/03/2024 19:44
Property
Date Code Type Make Model Description Tag No. Item No.
Page: 1 of 1
Page: 1 of 2

CAD Narrative
06/03/2024:19:45:02hmillsNarrative:Checkedarea.d2
06/03/2024:19:32:27mtheriaultNarrative:ALNOTIFIEDTOENTERALL3JUVENILESPER462REQ
06/03/2024:19:28:03mortizNarrative:NOALTERNATEMODEOFTRAVEL
06/03/2024:19:27:37mortizNarrative:NONOTESAYING GOINGTORUNAWAY
06/03/2024:19:27:23mortizNarrative:NOCELLPHONESNOTRACKABLEDEVICES
06/03/2024:19:27:05mortizNarrative:NOPETS
06/03/2024:19:26:56mortizNarrative:THEREAREPICS
06/03/2024:19:26:48mortizNarrative:PRIMARYLANGUAGEENGLISH
06/03/2024:19:26:27mortizNarrative:NOPERSONALBELONGINGSTAKEN
06/03/2024:19:26:15mortizNarrative:CALLERATOLDMISSOURI/CINNAMON
06/03/2024:19:24:33mortizNarrative:DOESNOTTHINK AREC1
06/03/2024:19:24:10mortizNarrative:NOTINJURED
06/03/2024:19:24:02mortizNarrative:CALLERISINASILKIASUVDRIVINGAROUNDLOOKINGFORSUBJS
06/03/2024:19:22:51mortizNarrative:
06/03/2024:19:22:33mortizNarrative:
06/03/2024:19:22:26mortizNarrative:
06/03/2024:19:21:46mortizNarrative:
06/03/2024:19:21:19mortizNarrative:
06/03/2024:19:20:55mortizNarrative:
06/03/2024:19:20:43mortizNarrative:LOTSOFWOODEDAREAIFTHEYWENTWB
06/03/2024:19:20:30mortizNarrative:
06/03/2024:19:20:10mortizNarrative:NOBACKPACKS
06/03/2024:19:20:01mortizNarrative:
06/03/2024:19:19:40mortizNarrative:
06/03/2024:19:18:59mortizNarrative:LASTSEENBYLOTSOFPEOPLE
06/03/2024:19:18:30mortizNarrative:NOSPECIALCONSIDERATIONSLASTTIME INTHEWOODS
06/03/2024:19:17:42mortizNarrative:PURPOSELYRANAWAY
06/03/2024:19:17:26mortizNarrative:
06/03/2024:19:16:34mortizNarrative:NOCELLPHONES
06/03/2024:19:15:23mortizNarrative:LASTSEEN10MINSAGO
06/03/2024:19:15:00mortizNarrative:NOC1NOTC2
06/03/2024:19:14:58mortizNarrative:NOTCARRYINGANYTHINGASFARASCALLERKNOWS
06/03/2024:19:14:20mortizNarrative:JUMPEDOVERFENCEUNKIF MADEITTOTHERDORNOT
06/03/2024:19:14:03mortizNarrative:LASTSEENGOINGWB
06/03/2024:19:13:40mortizNarrative:CALLERHELPING
06/03/2024:19:13:20mortizNarrative:
06/03/2024:19:12:24mortizNarrative:
06/03/2024:19:12:15mortizNarrative:
06/03/2024:19:11:24mortizNarrative:CALLERTELLINGMETOHANGON
06/03/2024:19:11:09mortizNarrative:
06/03/2024:19:10:54mortizNarrative:
06/03/2024:19:09:45mortizNarrative:
06/03/2024:19:09:31mortizNarrative:CALLERGETTINGBACKTOCOMPUTERFORDESCRIPTIONS
06/03/2024:19:09:19mortizNarrative:
06/03/2024:19:08:53mortizNarrative:
06/03/2024:19:08:28mortizNarrative:
06/03/2024:19:08:20jcurryNarrative:33110-4
06/03/2024:19:07:40mortizNarrative:CALLERISEMPLOYEE
06/03/2024:19:07:34mortizNarrative:
Page: 2 of 2

Public Records Exemptions
Enclosed please find a copy of the response documents for your public
records request. The following information is provided to explain the
process employed to review and produce the response documents.
Reason Description Pages
1-2
1 of 1


summary: A resident ate nonfood items while in the courtyard.

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: 021670
Date of Incident: 6/2/2024
Date Received:6/3/2024
Facility Name: Piney Ridge Treatment Center
Facility Number:203
Incident Type: Licensing
Report Description: On 6-2-24 @ 1820,
) ate nonfood items while out in the courtyard and made comments to the staff
that require her to be put on self-harm precautions x24hrs. Resident was eating random
mushrooms that were growing out on the lawn and then picked up some clay and ate it.
Also had rubber in her mouth (unknown if rubber was swallowed). C-SSRS completed (low
risk). No injuries noted. Resident will be placed on self-harm precautions x24 hrs. DON and
appropriate parties notified. No injuries noted. She will also be on a full-liquid diet for 48
hours and x-ray administered - nothing remarkable. Resident will process with primary
therapist.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 6/3/2024 - The provider reported incident was reviewed by the
Licensing specialist. Licensing specialist will inquire with the facility about the mushrooms
and weather they have been removed from areas residents could access them. 6/6/2024 an
inspection was completed at the facility. Outdoor areas were inspected for any hazards
resident may have access to while outside.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: While outside, a resident swallowed a poison ivy plant.

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: 021671
Date of Incident: 6/2/2024
Date Received:6/3/2024
Facility Name: Piney Ridge Treatment Center
Facility Number:203
Incident Type: Licensing
Report Description: On 06-2-2024@1630, ) was
outside on the west court, put a poison ivy plant into her mouth, and swallowed it. Staff did
try to get the poison ivy away from resident, but it was unsuccessful. It was also reported
that resident during the day resident had also place soap and clay in her mouth as well. One
of the nurses did give resident a 50mg Benadryl per doctor?s order. There was also an X ray
ordered for resident's abdomen along with a liquid diet X 48 hours, nothing remarkable was
noted on x-ray. Resident did not express that she was in pain or thoughts to kill self and will
be place on self-harm precautions X 24 hours. Resident will process with primary therapist.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 6/3/2024 - The provider reported incident was reviewed by the
Licensing Specialist. Licensing specialist will follow up with the facility about the presence
of poison ivy within the residents outside recreation area. 6/5/2024 - Licensing specialist
conducted a visit to inspect the outdoor area for hazards residents may encounter while
outside. 6/6/2024 - 521 sent to facility for signature. 6/7/2024 - Follow up email and resent
521 because licensing did not receive a signed copy of the 521 yet. 6/7/2024 - signed 521
received and uploaded to ELS under inspection - 075613
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident lacerated his finger while pulling at the metal plate covering the outlet in his bedroom.

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: 021673
Date of Incident: 6/2/2024
Date Received:6/3/2024
Facility Name: Piney Ridge Treatment Center
Facility Number:203
Incident Type: Licensing
Report Description: On 6-2-24 at approximately 1845, when a staff member did not sign
petition for his next level, he immediately
began pulling at the metal plate covering the outlet in bedroom and lacerated his finger.
The nurse assessed and contacted APRN and received an order to take him to Washington
Regional Medical Center via staff transportation.
While being assessed, he stated that he wanted
to die ? however he scored low on the suicide risk assessment. He was placed on self-harm
precautions to be assessed every 24 hours. He will process with his therapist
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 6/3/2024 - The provider reported incident and facility implement was
reviewed by the Licensing Specialist. 6/5/2024 - A visit was conducted at the facility to
inspect resident bedrooms for loose outlet plates and general safety and maintenance. The
outlet which cut the resident was inspected. The outlet cover was not loose or damaged at
the inspection. Licensing specialist spoke to the resident who stated he was not trying to cut
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

himself or loose the outlet and it was an accident that he was cut. The injury was observed
and the resident has no issues with the injury.


summary: A resident swallowed a quarter. An x-ray was ordered.

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: 021676
Date of Incident: 6/2/2024
Date Received:6/3/2024
Facility Name: Piney Ridge Treatment Center
Facility Number:203
Incident Type: Licensing
Report Description: On 6-2-24 at approximately, 1851
found a quarter. Which he later reported he had obtained on
pass. Staff asked the resident to give up the quarter and he refused. The resident put the
quarter in his mouth and swallowed it on accident. No injuries reported or assessed. Per
APRN, the resident was ordered an x-ray,
He was placed on a liquid diet x48 hours.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 6/3/2024 - The provider reported incident and facility incident was
reviewed by the licensing specialist.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Residents were outside with staff around 8:00 PM, when two residents ran off the property.

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: 021672
Date of Incident: 5/31/2024
Date Received:6/3/2024
Facility Name: Piney Ridge Treatment Center
Facility Number:203
Incident Type: Licensing
Report Description: On 5-31-124 at approximately 2000,
and one other
resident asked staff for a break from the Crossover unit. Staff took the resident and peers
outside of the crossover building for the break. Resident and peers convinced staff to race a
third resident, which may have been used as a brief distraction. At that moment and
ran off the property, the staff immediately redirected the residents to return, which
they did not. was found within 30 minutes by staff with no injuries. Resident will be
placed on elopement precautions x24hrs. DON and appropriate parties notified. The
Fayetteville Police Department were inadvertently not notified until 2145. was found
at a local Walmart on 6-1-24 and was given a violation of Shoplifting-Theft of Property ?
Misdemeanor. He returned to the facility at approximately 1520. Both residents were placed
on elopement precautions to be assessed daily, moved back to the main building and will
process with therapists. Education was completed with the employee that was attempting to
provide a break with the residents outside.
Interim Action Narrative:
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: 6/3/2024 - The provider reported incident was reviewed by the
licensing specialist. Licensing specialist will follow up with facility regarding supervision
during transitions. 6/5/2024 - A visit was conducted at the facility to address concerns in
the provider reported incident. The three staff who inadvertently did not call the police for 1
hour and 30 minutes was Police were
contacted and there was a possible miscommunication of when the police were called.
Offsite staff directed onsite staff to contact police at 7:36PM. Program Coordinator
requested police documentation. 6/6/2024 - Licensing specialist received proof of retraining
for staff in regards to contacting police when there has been an elopement. 6/7/2024 -
signed 521 received and uploaded to ELS.


summary: Officers were dispatched to the facility in response to a missing person report.

raw_content:
Fayetteville Police Department
Summary
Print Date/Time: 06/18/2024 13:17 Fayetteville Police Department
Login ID: bjenkins ORI Number: AR0720100
Case Number: 2024-00037656
Case
Case Number: 2024-00037656 Incident Type: Missing Person
Location: 4253 N CROSSOVER RD Occurred From: 05/31/2024 19:30
FAYETTEVILLE, AR 72703 Occurred Thru: 05/31/2024 21:53
Reporting Officer ID: 504 - STONE Disposition: Inactive
Disposition Date: 06/01/2024
Reported Date: 05/31/2024 21:53 Friday
Offenses
No. Group/ORI Crime Code Statute Description Counts
Subjects
Type No.Name Address Phone Race Sex DOB/Age
Reporting Person 1 ROPER, NICHOLAS VON 608 BLACK OAK AVE 10 (870)329-6232 White Male 09/09/1999
SPRINGDALE, AR 72764 24
Arrests
Arrest No. Name Address Date/Time Type Age
Property
Date Code Type Make Model Description Tag No.Item No.
Vehicles
No. Role Vehicle Type Year Make Model Color License Plate State
Routing:
Page: 1 of 3
Page: 1 of 1

OfficerID: sstone, S Stone / Case Narrative #2024-37656
Officer S. Stone #504
Juvenile Missing Person
Case #2024-37656
Case Narrative:
On May 31, 2024, at approximately 9:53 P.M., I was dispatched to 4253 N. Crossover
Rd. for a missing person. Upon my arrival, I made contact with the caller, who stated
that had run away from this location at around 7:30 P.M., but only
. The caller, Nicholas Roper (W/M 09/09/1999), stated he
thought staff had called the police earlier when this incident occurred.
After speaking with Nicholas, I identified the missing
is described as
I searched the area for but was unable to find . I put out a BOLO for
and added to the missing persons log.
Processed by A Raines
Page: 2 of 3

OfficerID: MPEACE, Cpl. M. Peace / Case Supplement #2024-37656
Corporal M. Peace #321
Recovery – Missing Juvenile
Case #2024-37656
Case Supplement:
On 6-1-2024 I was dispatched to Walmart located at 3919 N Mall Ave in reference to a
. On arrival I made contact with Asset Protection and a white male
later identified as .
Jeffrey Pound stated was caught attempting to leave the store with a
skateboard valued at $29.97 and refused to identify The stolen merchandise
was recovered. later identified to me and advised that had run
away from Piney Ridge (24-37656).
I provided Pound with the report number on a contact form and texted me a copy
of the receipt. I later sent him a community request for the video and statement
through Axon.
I placed under arrest for shoplifting and began contacting Piney Ridge as
well as JDC.
was later released to Piney Ridge and was cited for shoplifting (E0033656).
CDC had removed as missing and canceled the BOLO.
Processed by B Jenkins
Page: 3 of 3

Public Records Exemptions
Enclosed please find a copy of the response documents for your public
records request. The following information is provided to explain the
process employed to review and produce the response documents.
Reason Description Pages
1-3
1 of 1


summary: A resident was sent to Physician Specialty Hospital for and x-ray after complaining of right-hand pain following 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: 021210
Date of Incident: 5/12/2024
Date Received: 5/13/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: Child?s Name:
Description of report: On 05/12/2024 this resident got into a fight with
) ran up and punched in the jaw.
Afterwards he complained of pain in his right hand. Upon nursing assessment the right
hand was swollen, order was received to take him to Physician Specialty hospital where an
X-ray was done and .
. Corrective
action taken by the agency or follow up done: Residents are not in the same room, they were
both put on precautions for 24 hours.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 5/15/2024 The provider reported incident and facility implement was
reviewed by the Licensing Specialist. Licensing specialist followed up with an email
regarding events leading up to the incident, supervision, and video recording. 5/16/2024 -
Licensing Specialist received a response from the facility with the following answers Two
other residents for fighting and he inserted himself into the fight hitting a resident in the
jaw. . Staff were there trying to separate the other
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

two. He was only able to hit the resident one time. There is not viewable footage of this
incident.


summary: Four residents eloped from the facility by kicking open a gym 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: 021154
Date of Incident: 5/8/2024
Date Received: 5/9/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 5/9/24 at approximately 1733
) had been in the gym with staff members
along with a few other residents. They kicked the door from the gym leading outside to the
passageway to the front area of admin building and courtyard area between the two
buildings. They attempted to climb the fences and was not successful in the beginning.
Staff and nurses attempted to de-escalate and after about 20 minutes they climbed the fence
and went off property. The Fayetteville Police Department was then called within a minute
or two. A few staff went off grounds in an attempt to locate, however within about 25
minutes the FPD had located the residents and returned them to the facility. All residents
were placed on elopement precautions and processed with employee staff. Precautions will
be assessed every 24 hours until precautions removed. All residents will process with
therapist.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 5/10/2024 - The provider reported incident and facility implement
was reviewed by the Licensing Specialist. Licensing Specialist will follow up with the facility
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

to see if there is video footage of the incident and concerns regarding supervision.
5/13/2024, Program Coordinator requested police report. 5/13/2024 - Facility staff
responded to case inquiry stating there is no video footage outside of the building and the
incident was not recorded.


summary: A resident was sent to Children’s Hospital after swallowing a battery he took out of an audiobook.

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: 021150
Date of Incident: 5/8/2024
Date Received: 5/9/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: Child?s Name:
Description of report: On 05/07/2024 reported that
he took a battery out of an audiobook and swallowed it. This was an AA battery, x-ray was
ordered. Orders received to take him to Childrens
Hospital 05/09/2024 for evaluation. He was seen and orders given to repeat x-ray in one
week. Return to ER if he has persistent vomiting or acute abdominal pain. We will not be
using Audiobooks until we have came up with a solution to ensure not residents are able to
access the batteries.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 5/10/2024 - The provider reported incident and facility implement
was reviewed by the Licensing Specialist. Licensing Specialist will follow up with the facility
concerning electronics with batteries as well as supervision.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Officers are dispatched to search for four missing residents from Piney Ridge. Residents are located and transported back to the facility.

raw_content:
Incident Report
Print Date/Time: 05/22/2024 10:01 Fayetteville Police Department
Login ID: bjenkins ORI Number: AR0720100
Incident: 2024-00031724
Incident Date/Time: 5/8/2024 5:55:57 PM Incident Type: MISSING PERSON
Location: 4253 N CROSSOVER RD Venue: FAYETTEVILLE
FAYETTEVILLE AR 72703
Phone Number: (479)587-1408 Source: Phone
Report Required: No Priority: 1-High
Prior Hazards: No Status: In Progress
LE Case Number: Nature of Call:
Unit/Personnel
Unit Personnel
351 351-JEHL
468 468-THEODORE
494 494-WALKER
Person(s)
No. Role Name Address Phone Race Sex DOB
1 Caller UNKNOWN (479)587-1408
Vehicle(s)
Role Type Year Make Model Color License State
Disposition(s)
Disposition Count Date/Time
Unit:351
Disposition Count Date/Time
03NORPT 1 05/08/2024 18:42
Unit:468
Disposition Count Date/Time
03NORPT 1 05/08/2024 18:43
Unit:494
Disposition Count Date/Time
03NORPT 1 05/08/2024 18:29
Property
Date Code Type Make Model Description Tag No. Item No.
Page: 1 of 1
Page: 1 of 2

CAD Narrative
05/08/2024:18:29:25atheodoreNarrative:LOCATED THEWOODSBYSIGNATUREBANK.
WERETRANSPORTEDBACKTOPINEYRIDGEWITHOUTISSUE.D3
05/08/2024:18:28:55swalkerNarrative:SceneSecurity.D3
05/08/2024:18:24:14tkelleyNarrative:ADVTOBRINGSUBJSTOTHEBACKDOOR,USEENTRANCEOFFCROSSOVER
WILLBEOFFTHEEMPLOYEEPLOT
05/08/2024:18:19:38tkelleyNarrative:4681012BEHINDSIGNATUREBANK
05/08/2024:18:18:42tkelleyNarrative:CROSSINGTHESTREETEBSOUTHOFEJOYCEBLVD
05/08/2024:18:17:36tkelleyNarrative:468ADVTHATTHEYAREGOINGTHROUGHTHEWOODSBEHINDTROPICAL
SMOOTHIE
05/08/2024:18:16:08tkelleyNarrative:494CHECKINGCROSSOVERTERRACE
05/08/2024:18:11:17tkelleyNarrative:468ADVTHATHEISGOINGTOENTERTHEWOODLINEANDMOVEWESTFROM
CARLOCATIONNORTHOFSIGNATUREBANK ONEJOYCEBLVD
05/08/2024:18:09:01jcurryNarrative:MYCALLERCALLEDFROM479-866-2311DISCWHILEONHOLD
05/08/2024:18:08:03tkelleyNarrative:
05/08/2024:18:07:23tkelleyNarrative:468DENIEDNET
05/08/2024:18:07:17tkelleyNarrative:ARERUNNINGEBTHROUGHTHEWOODS
05/08/2024:18:07:10tkelleyNarrative:468ADVEYESONSUBJSSBONCROSSOVERNEARCROSSOVERTERRACE
05/08/2024:18:03:15jcurryNarrative:
05/08/2024:18:02:25jcurryNarrative:NONEOFTHEMLEFTWITHANYKINDOFBELONGINGS
05/08/2024:18:02:12jcurryNarrative:NONEOFTHEMWEREC2
05/08/2024:18:01:56jcurryNarrative:CALLERADVTHATHECANMEETOFFICERATVALLEYLAKE/ZIONTHEREARE4
SUPERVISORSOUTTHERESTILLLOOKING
05/08/2024:18:01:32jcurryNarrative: //
05/08/2024:18:00:20jcurryNarrative:NONEOFTHEMHAVEACELLPHONE
05/08/2024:18:00:01jcurryNarrative:ASFARASTHEYKNOWNONEOFTHEMKNOWANYONEFROMFAYETTEVILLE
05/08/2024:17:59:35jcurryNarrative: //NOONEHASEYESONTHEMTHEYLOSTSIGHTONCETHEYJUMPED
AFENCE
05/08/2024:17:59:34mtheriaultNarrative:THISCALLERALSODOESNOTHAVEMUCHDISCONNECTINGWILLLET
JCURRYFINISHCALL
05/08/2024:17:59:27tkelleyNarrative:34710-4
05/08/2024:17:59:08mtheriaultNarrative:NOC1ONTHEM
05/08/2024:17:59:06jcurryNarrative:UNKWHATALLTHEIRLASTNAMESARESINCETHEY'RENOTINFRONTOF
THEIRFILES
05/08/2024:17:59:06mtheriaultNarrative:
05/08/2024:17:58:44jcurryNarrative:THEYRANOVERTOVALLEYLAKEDRCALLERNEAR4250
05/08/2024:17:58:29mtheriaultNarrative:
05/08/2024:17:58:23jcurryNarrative:
05/08/2024:17:56:46mtheriaultNarrative:CALLERHAS0INFORMATIONASKINGTOSPEAKWITHSOMEONEELSE
05/08/2024:17:56:17mtheriaultNarrative:STAFFAREOUTLOOKINGFORTHEM
05/08/2024:17:56:12mtheriaultNarrative:
Page: 2 of 2

Public Records Exemptions
Enclosed please find a copy of the response documents for your public
records request. The following information is provided to explain the
process employed to review and produce the response documents.
Reason Description Pages
2
1 of 1


summary: A resident reported swallowing a plastic bottle cap on accident. An x-ray was ordered.

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: 021121
Date of Incident: 5/7/2024
Date Received: 5/8/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: Child?s Name: ,
Description of report: On 05/07/2024 the resident was on an outing when he
reported swallowing a plastic bottle cap on accident. He was assessed on site and once
cleared medically he then brought back to the facility. We did an x-ray and
. He will follow-up with our APRN on 05/08/2024. Date of occurrence:
05/07/2024 Corrective action taken by the agency or follow up done: X-ray completed in
house,
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 5/9/2024 - The provider reported incident and facility implement was
reviewed by the Licensing Specialist.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was taken to Physician Specialty Hospital 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: 021063
Date of Incident: 5/3/2024
Date Received: 5/6/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: Child?s Name:
Description of report: On 05/03/2024 these
two resident got into an altercation in the gym. shoved who in return hit
in the face. Staff was able to quickly separate the two residents. They were taken to the
nurses station to be assessed, had no injuries. reported pain and had swelling
to his l side of his jaw. He was taken to PHS where they did an x-ray
We have called to set this up and awaiting a call back. Date of occurrence:
05/03/2024 Corrective action taken by the agency or follow up done: We are waiting on a
follow-up appointment. is on soft foods. They two residents were put on assault
precautions and had a 6 foot no interaction.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 5/6/2024- The provider reported incident was reviewed by the
licensing specialist. Licensing Specialist contacted the facility in order to review the video
footage of this incident. 5/8/2024 - Licensing Specialist received a response from the facility
which stated you could not see the incident. Therefore the video was not saved. Information
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

regarding the incident can be discussed with facility staff. Licensing Specialist will follow
up medical information from the follow up doctor's visit and assault precautions and
supervision. 5/15/2024 - Licensing specialist received information from the facility
regarding the incident. The residents were supervised by two staff for 12 residents in
addition to the Certified Recreational Therapist and Activities Coordinator. On 5-8-24 ?
Resident had . He
has a follow-up today at noon. Assault Precautions are precautionary measures
implemented when a resident exhibits or threatens physical aggression towards another
individual and/or property. The staff member assigned will maintain on Observation Flow
Sheet documenting visual inspection of the resident, any activities the resident is engaged
in, the location of the resident, the position the resident is sleeping (during night shift), at
least every fifteen (15) minutes. The documentation is to occur at the time immediately
following the visual check. The resident?s ability to attend school, off-site medical
appointments, therapeutic activities, and have visitation will be determined on an individual
basis by nursing, and/or therapist. Pre-cautions are assessed at least daily.


summary: A resident was taken to Washington Regional Medical Center for a CT of his jaw after he was kicked in the face by 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: 020755
Date of Incident: 4/20/2024
Date Received: 4/22/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: on 04/20/2024 he
was in the floor playing with Lincoln Logs when he and resident
got into an altercation where bit said after
this was over he went back to the Lincoln logs when resident
walked up and kicked him in the face. When he kicked him, he was right next
to staff and head hit the staff's leg. He reported pain in his right side of his jaw. X-
ray was done in house and show no acute findings but recommends CT for follow-up. On
4/21/2024 he was taken to WRMC by Nurse and another staff. CT was complete and they
find no fractures or dislocations. He was sent home with a muscle relaxer to take BID for 15
days and follow-up as needed by PCP. At present time resident denies any pain, no swelling
noted and he is able to eat and drink without difficulty.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 4/23/2024 - The provider reported incident and facility implement
was reviewed by the Licensing Specialist. Licensing Specialist will reach out to the facility
for the safety plan regarding these two residents. 4/25/2024 - Licensing Specialist received a
response from the facility for the safety plan "So was placed on assault precautions
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

to be reviewed daily, was placed on assault precautions to be reviewed daily for
kicking


summary: A resident reported pain to his left hand due to hitting a ball with the end of his finger. An x-ray was ordered.

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: 020758
Date of Incident: 4/19/2024
Date Received: 4/22/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: on 4/19/24 at 1820
Resident reported pain to his left hand. He reports hurting it when he hit the ball with the
end of his finger. X-ray was ordered by APRN and shows small chip fracture to the base of
the 4th middle phalanx. The fingers were buddy taped together and order given to follow-up
with Ozark Orthopedics early next week.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 4/23/2024 The provider reported incident and facility implement was
reviewed by the Licensing Specialist.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was taken to Ozark Orthopedics after an x-ray showed he had fractured his finger by 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
Notice of Serious Incident
Case Number: 020757
Date of Incident: 4/17/2024
Date Received: 4/22/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 2/17/24 ) c/o
hand pain after punching a wall 2-3 days ago : X-ray was complete in house and shows
fracture to the 5th metacarpal. He was taken to Ozark Orthopedics on Thursday
04/18/2024, he had a splint placed for one week then will follow-up with Ozark Orthopedics
(will likely transition to cast at that time) We will give Tylenol and Ibuprofen as needed for
pain.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 4/23/2024 - The provider reported incident and facility implement
was reviewed by the Licensing Specialist.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A visit was conducted for the facility’s annual policy review.

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: Piney Ridge Treatment Center
Facility Number: 203
Licensee Address: 2805 E ZION RD
FAYETTEVILLE AR 72703
Licensing Specialist: Jarred Parnell
Person In Charge: Ronissa Adams
Record Visit Date: 4/16/2024
Home Visit Date: 4/16/2024
Purpose of Visit: Monitor Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
4/24/2024- A visit was conducted for the facility's annual policy review.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 3

Policies reviewed during visit;
Personnel polices
Volunteer policy
Student intern policy
Admission policy
Intake policy
Behavior management policy
Crisis management policy
Child maltreatment/mandated reporter policy.
Child exploitation policy
Visitation policy
Family therapy or therapeutic pass policy
Admission health assessments policy
Target population and admission, exclusion, and discharge criteria policy
The agency shall have a written program description that is available to residents and parents/guardians that
should include:
Program philosophy and mission
Services and treatment modalities
Treatment planning procedures
Behavior management program and expectations of each child
Levels and privileges (if applicable)
Admission, exclusion, and discharge criteria
Aftercare services.
Provider Comments:
CCL Staff Signature : Date: 4/16/2024
Provider Signature : Date: 4/16/2024
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


summary: A resident reported that he injured his right hand while playing football. An x-ray was ordered.

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: 020583
Date of Incident: 4/12/2024
Date Received: 4/15/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 4/12/24 resident reported to the
nursing department that he had injured his right hand earlier in the week playing football.
Nursing on duty contacted APRN, Karen Reynolds for further orders. APRN ordered an x-
ray of the right hand. Significant findings found and reported to nursing. X-ray found a type
II non-displaced fracture of distal fifth phalanx. Findings suggest that the fracture is healing
at this time. was sent to Washington Regional Medical Care in Fayetteville, AR on
4/13/24 and received a splint. He is to follow up with an orthopedic specialist.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 4/16/2024 - Licensing Specialist reviewed the report and the safety
plan implement.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was transported to Washington Regional Medical Center after an x-ray showed a fracture from rolling his ankle while playing basketball.

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: 020584
Date of Incident: 4/12/2024
Date Received: 4/15/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 4/12/24 : This
resident reported to the nursing department that on April 5th or April 6th this resident was
playing basketball and 'rolled' his ankle two or three times. Nursing on duty contacted
Karen Reynolds, APRN for orders. APRN ordered an X-RAY of the resident's right ankle.
He was diagnosed with a small acute nondisplaced fracture of the distal fibular metaphysis.
On 4/13/24 the resident was taken to Washington Regional Medical Center and received a
walking boot and was referred to an orthopedist specialist.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 4/16/2024 Licensing Specialist reviewed the incident and safety plans
put in place for the resident.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was transported to Washington Regional Medical Center for treatment of a laceration 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: 020380
Date of Incident: 4/5/2024
Date Received: 4/8/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: At approximately 1145 on 4/5/24
was transitioning to the cafeteria with peers. Outside the cafe door the
resident got into a verbal argument with a peer
about the line order while getting lunch. and got into a physical
altercation. Staff was able to intervene and stepped between the resident and peer. The
resident attempted to punch the peer multiple times, but the staff was using her body to
shield the peer and she was hit multiple times. Another peer,
while was focused on attempting to hit and struck
the resident in the left side of the head on the ear. Another staff member was able to get the
resident away from the altercation. The resident was assessed by nursing and was found to
have a laceration on the pinna of left ear. Wound was cleaned and sterile dressing was
applied. Ibuprofen was given for comfort and APRN was notified. Orders were received to
to the Washington Regional Medical Center ER for evaluation and treatment, where
he received 3 sutures.
Interim Action Narrative:
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: 4/9/2024 - The provider reported incident was reviewed by Licensing
Specialist Jarred Parnell.


summary: A resident reported that his peer started to talk sexually, showed the resident his penis, briefly placed his hand on the resident’s clothed crotch area, and then “made” the resident touch his penis (which was outside his pants). 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: 020308
Date of Incident: 4/3/2024
Date Received: 4/4/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Dual
Report Description: On 4/3/24 at approximately 1410, resident
was sitting in the classroom and beside him resident
was sitting. reported that started to talk
sexual, showed his penis, briefly placed his hand on clothed crotch area and
then talked sexual and "made" me touch his penis (which was outside his pants)
briefly. Staff turned around and saw buttoning up his pants. Residents were separated,
will be at the facility this
afternoon. has a disruption in place, a meeting is occurring at 1300 with his team to
discuss removal, referrals will be sent out to Acute facilities and will not be sleeping in
patient bedrooms. He is on additional observation that will be assessed every 24 hours. Re-
education will occur with staff.
Interim Action Narrative: Residents were placed on safety precautions to prevent further
contact with one another. The alleged offender will be separated from other youth as to not
have a roommate.
Maltreatment Narrative: Resident accused peer of sexual misconduct while in the
classroom. Resident accused peer of sexual misconduct while in the classroom.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: 4/16/2024 - The provider reported incident was reviewed by Licensing
Specialist Jarred Parnell. Licensing Specialist conducted a visit at the facility to review video
footage of the provider reported incident. Video footage was reviewed for 4/3/2024 - at 14:06
- 14:07:39 The two residents in the report can be seen in the classroom in the back corner.
Seated in front of the residents is a staff person. Another staff person is seated at the front of
the class, facing directly at the two residents. The staff in the front goes to the door to speak
with someone. During this time resident proceeds to reach over to under his desk.
It is unclear what he is reaching for or what he is doing with his hand under the desk.
can be seen looking around the room and then leans his head towards pelvic region. He
does this twice for a brief moment. It is unclear in the video what the purpose of this action
is. The incident lasted a total of 1 minute and 39 seconds. The interactions were very brief,
approximately 1-2 seconds. After the incident the staff person seated directly in front of the
boys can hear them interacting and turned to see what was going on and said was
messing with his pants so the boys were separated. The safety plan enacted for this incident
is has been given a disruption and the facility is trying to find treatment more suited to
needs. It was added had other difficulties and behaviors unrelated to this incident
which were not conducive to the facility. Supervision was increased for and he was
removed from his room and no longer able to sleep with other residents. sleeps in the
hallway or NPR room with doctor's orders until he is discharged from the facility. Re-
education and training was conducted for staff concerning classroom supervision and
expectations. 4/17/2024 - Licensing Specialist sent findings 521 Inspection report sent to
the facility, awaiting signatures.


summary: A resident complained of facial pain after an altercation with peers. An x-ray was ordered.

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
Date of Incident: 3/11/2024
Date Received by DCCECE: 3/12/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 3/10/24 started to
antagonize other peers and he and two other residents
started a physical altercation with one
another. was hit by one of the residents in the face. Staff body blocked and defused
the situation. complained of pain in face and an x-ray was ordered by APRN which
he received on 3/11/2024. He had no acute fracture and additional medical care was not
ordered.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 3/15/2024 - The provider reported incident was reviewed by Licensing
Specialist Jarred Parnell.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident reported left wrist pain after running into a wall during recreational activities. An x-ray was ordered.

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: 019612
Date of Incident: 3/4/2024
Date Received by DCCECE: 3/5/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 3/4/2024,
reported that he had ran into the wall during RT on Saturday and today his L wrist is
hurting. X-ray done in house with results showing possible buckle fracture. Resident was
taken to Ozark Orthopedics and fracture was confirmed to L wrist. He has a soft splint on
and will follow-up in 1-2 weeks.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 3/5/2024 - The provider reported incident was reviewed by Licensing
Specialist Jarred Parnell.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident notified staff that he ‘jammed’ his right thumb while playing basketball. An x-ray was ordered.

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
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: 019412
Date of Incident: 2/22/2024
Date Received by PRLU: 2/26/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 2/23/24 (DOB Oklahoma private) notified staff
and nurses that while playing basketball on 02.22.2024 he 'jammed' his right thumb. Karen
Reynolds, APRN notified, and an x-ray was ordered of the right hand. The results of the x-ray were
a fracture of the right thumb. The resident's guardian, notified via telephone at
@2045. Karen Reynolds, APRN notified and ordered to refer the resident to orthopedics for further
treatment. We are awaiting confirmation of appointment at this time.
Interim Action Narrative:
______________________________________________________________________________
Maltreatment Narrative:
Licensing Narrative: 2/26/2024 - The provider reported incident was reviewed by licensing
specialist Jarred Parnell
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Physician Specialty Hospital after reporting shaking or tremors and falling outside.

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
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: 019361
Date of Incident: 2/22/2024
Date Received by PRLU: 2/23/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 2/22/2024 (DOB Arkansas private) reported
shaking or tremors and falling outside. She was assessed and had no injuries, APRN was called and
gave order to send resident to Physician Specialty Hospital. She came back with new order to
discontinue Cogentin and to follow up next week with Psychiatrist. Guardian called and she stated
that her daughter used to do that to get attention from others. She followed up with APRN on
2/23/24.
Interim Action Narrative:
______________________________________________________________________________
Maltreatment Narrative:
Licensing Narrative: 2/26/2024 - The provider reported incident was reviewed by Licensing
Specialist Jarred Parnell.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident reported that he hurt his ankle after he tripped while reaching for a frisbee. An x-ray was ordered.

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
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: 019359
Date of Incident: 2/21/2024
Date Received by PRLU: 2/23/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: (DOB DCFS) On 2/21/24
resident was in the gym and reported that he hurt his ankle while reaching for a frisbee and tripping.
X-ray was performed in house showing fracture to right ankle. He was seen by Ozark Orthopedics
02/22/24 and confirmed dx of fracture ankle. He was placed in a soft cast with crutches and will
return on 02/28/2024 to see specialist.
Interim Action Narrative:
______________________________________________________________________________
Maltreatment Narrative:
Licensing Narrative: 2/26/2024 - The provider reported incident was reviewed by Licensing
Specialist Jarred Parnell.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was transported to Arkansas Children’s Hospital after she was found unresponsive in the gym.

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
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: 019315
Date of Incident: 2/20/2024
Date Received by PRLU: 2/21/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: (DOB out of state DCFS) Description of
report: At approx. 0830 on 2/20/24 staff reported that resident was having an allergic reaction in
the gym. Nurse found resident laying down, face up, she was breathing but not responding to verbal
stimuli. EPipen was administered, and EMS was called. Patient was taken via EMS to Arkansas's
Childrens Hospital in Springdale under an abundance of caution. She was assessed at the hospital,
was given IV fluids. The physician did not think it was an allergic reaction. She returned to facility
and will follow-up with APRN here on 02/21/2024.
Interim Action Narrative:
______________________________________________________________________________
Maltreatment Narrative:
Licensing Narrative: 2/22/2024 - The provider reported incident was review by licensing
specialist Jarred Parnell. 2/26/2024 - The following correspondence was received from the facility in
regards to the incident,. She saw APRN on 2/21 Subjective Pt reported a food allergy to berries on
admit. She had an episode in the cafeteria on j2-20-24 with syncopal episodes and was sent to ER.
ACH declined an "allergic reaction response" but no documentation to support. Mother and DHS
declined a history of food allergies. She reports these people "know nothing about me." She looks
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

good. She is febrile with no chills, rash, or n/v She denies swelling of her throat and no difficulty
chewing or swallowing food.


summary: A Bilateral x-ray was ordered due to swelling in a resident’s fingers.

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
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: 018970
Date of Incident: 2/2/2024
Date Received by PRLU: 2/5/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 02/02/24 DHHR custody) @1543 a
bilateral x-ray was ordered due to swelling in the fingers by APRN. The resident stated he was
playing football on 2/1/24. X-ray results: Left hand- acute 3rd distal phalanx fracture. APRN
ordered resident to be taken to Ozark Orthopaedics. The resident reported 2/10 pain and was given
400mg PO Ibuprofen. Resident transported to Ozark Orthopaedics by PRTC transport and
returned with a splint and resident to follow up in one week.
Interim Action Narrative:
______________________________________________________________________________
Maltreatment Narrative:
Licensing Narrative: 2/5/2024 - The provider reported incident was reviewed by Licensing
Specialist Jarred Parnell. Licensing Specialist reached out to the facility for the resident's D.O.B
which was not included in the report. The residents D.O.B was provided by the facility -
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was transported to Arkansas Children’s Hospital after falling and struggling to keep his eyes open.

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
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: 018971
Date of Incident: 2/2/2024
Date Received by PRLU: 2/5/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 2-2-24 at approximately 0720 (DOB Arkansas
Private) Resident was walking to get milk when he dropped his food in the cafeteria. Resident then
started to walk back and forth. Staff asked resident to go back to the serving line to get a new tray.
As resident was walking back, resident fell backwards and was struggling to keep his eyes open. Staff
called for nurses. Nurses arrived to the cafeteria and assessed resident. APRN contacted and ordered
resident be sent to Arkansas Children's Hospital for an evaluation. Resident was transported to
Arkansas Children's Hospital by PRTC and returned back to PRTC on 2/2/24. Arkansas Children's
diagnosed resident with Orthostatic syncope and encouraged resident to drink more water.
Interim Action Narrative:
______________________________________________________________________________
Maltreatment Narrative:
Licensing Narrative: 2/5/2024 - The provider reported incident was reviewed by Licensing
Specialist Jarred Parnell.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident reported pain in his nose from being hit in the nose with a ball and finger pain from hitting a wall.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 018924
Date of Incident: 1/31/2024
Date Received by DCCECE: 2/2/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 1/31/2024 reported
that a resident tried to hit him in the nose with a ball and said he nose hurt. He also said
that his finger hurt as he hit the wall on an unknown day. He has a boxer fracture of the
right hand and will receive necessary treatment.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 2/5/2024 - The provider reported incident was reviewed by Licensing
Specialist Jarred Parnell.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident reported hand pain from falling while playing basketball. An x-ray was ordered.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 018837
Date of Incident: 1/27/2024
Date Received by DCCECE: 1/30/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: Child?s Name:
Description of report: Resident reported to nursing that on Saturday he was
playing basketball and fell on his hand. On Sunday night it started hurting. X-ray was
completed on Monday morning, X-ray shows acute of right hand, fifth proximal phalanx.
Date of occurrence: Original accident was 01/27/2024 Corrective action taken by the agency
or follow up done: He was taken Ozark Orthopedics on 01/29/24, they placed a soft cast on
his right hand and he will be seeing a hand specialist on 2/2/24.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 2/1/2024 The provider reported incident was reviewed by Licensing
Specialist Jarred Parnell
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A complaint received reported allegations of issues with peers stealing from other residents, fights between residents, staff abusing residents, and insects in the facility. The facility was cited 905.4.c and 109.1.g as a result of this complaint. The complaint was FOUNDED by Licensing.

raw_content:
DHS Placement and Residential Licensing Unit
Office of the Secretary
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: 018781
Date of Incident: 1/18/2024
Date Received by PRLU: 1/28/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: My son is currently a patient and I as well as my son who is 12, is and has had
issues with peers stealing from him, kids fighting kids, my son said that a nurse I have her
information as well as the kid this nurse physically assaulted in front of my son information and she
called him a dumbass. My son has reported unsafe environment that there is roaches and the staff
has yelled at him a lot, I have heard grown adults screaming at kids while we was talking on set days,
I need help please ??
Interim Action Narrative:
______________________________________________________________________________
Maltreatment Narrative:
Licensing Narrative: 1/29/2024 - The provider reported incident was reviewed by Licensing
Specialist Jarred Parnell. Licensing Specialist contacted the reported to obtain additional information
regarding the report. The following inquiries were made while speaking to the reporter: What is the
residents first and last name? - What is the residents DOB? ? What is
his guardianship (does she have custody or was he placed by DCFS) ? - parent When
was he admitted ? December 21, 2023 Is he still there? yes What was stolen ? 2-3 pairs of shoes,
toiletries, beanie, North-pole jacket, Have you been told he has been in fights? Who told you? Yes ,
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

the nurses - January 4th was the date of the fights. He was in two fights the same date, according to
the nurse. What is the name of the nurse mentioned in the complaint? She doesn?t know the name,
but the nurse called around 2 - 3:00 PM. Did the nurse assault someone or did an assault happen in
front of the nurse? When? An assault happened in front of stated he witness a
nurse named shove another resident named to the ground and called him a dumbass.
Did anyone witness the nurse call her son a dumbass? Not sure Where has her son seen roaches at?
What unit is he in? She doesn?t know. 1/30/2024 - A visit was conducted to the facility to speak
with residents regarding the complaint report. Residents , , . and . were spoken to
at the facility. Both . and . said the evening nurse " pushed . and cursed while
yelling at the resident. Licensing Specialist made a hotline report concerning this information. The
report was screen out. A building and grounds walkthrough was completed of all boys units and girls
units. Rooms were inspected for signs of pests. There were no pests present during the walkthrough.
2/1/2024 - Licensing Specialist conducted a follow up visit at the facility to speak with staff about
the complaint. Facility staff stated after looking into the complaint they spoke with two other
residents that were not interviewed at the first visit. The two residents . . The residents both
remember the incident. , told staff that the nurse yelled and cursed at and "shoulder-
checked" into the door jam. said he heard curse and yell at , but is unsure how
she pushed because of the angle he was sitting at. Licensing Specialist told facility staff nurse
would need to be interviewed as part of the complaint. Staff said Nurse is out of
work on leave due to a personal family matter and will return Sunday. Licensing Specialist will
contact the facility Monday 2/4/2024 to speak with Nurse regarding the situation. Facility
administration said as corrective action they will either be retraining on resident interaction,
or she will be terminated based on the information received while meeting with her. 2/5/2024 -
Licensing Specialist reached out the facility to inquire about Nurse in regards to the report.
The facility responded saying she was fired from the facility. The facility provided her phone
number. Licensing Specialist attempted to call at the number provided . she
did not answer, A voicemail was left. 2/6/2024 - Licensing Specialist spoke with former staff
member over the phone. states she was terminated from Piney Ridge for the
incident which was reported to licensing. disclosed that she was doing rounds as the charge
nurse during her shift around hygiene time. She came to room and was inquiring about the
bunk beds and why the residents had switched bunks. . became argumentative. disclosed
the resident got close to her and postured like he was going to begin an altercation. states
she thinks she shoulder checked and cursed at the resident saying "dammit", but does not fully
remember the altercation. states she was fired for this because Piney has a zero tolerance
policy for this behavior.


summary: A resident eloped from the facility by jumping a fence and climbing up to the roof.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 018448
Date of Incident: 1/7/2024
Date Received by DCCECE: 1/8/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 1/7/2024 at approximately 1700 resident
was outside and jumped the fence by the garden area and he then climbed
up the roof and went to the gas station by Vantage Point on Zion and Crossover St. The
police caught and staff caught up with him at this gas station and he was returned to PRTC
within approximately 20 minutes.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 1/8/2024 - The provider reported incident was reviewed by Licensing
Specialist Jarred Parnell.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident reported that he bent his finger back while playing basketball. An x-ray was ordered.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 018439
Date of Incident: 1/4/2024
Date Received by DCCECE: 1/8/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: Resident reported to APRN that
he bent his finger back while playing basketball. X-ray was done in house. Resident's X-ray
of his right 5th finger came back positive for fracture, APRN notified and gave order to send
patient Ozark Ortho to evaluate and treat, injury happened yesterday when Resident hit the
ball with his fingers as per APRN assessments. He went to Ozark Ortho on same day and
the placed a soft splint on two fingers.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 1/8/2024 - The provider reported incident was reviewed by Licensing
Specialist Jarred Parnell.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: An x-ray was ordered after a resident was hit in the face during an altercation with his peer.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 12/17/2023
Date Received by DCCECE: 12/19/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 12/17/23 at approximately 1810
and started a verbal
altercation with another and faced each other. was antagonizing and hit the
peer in the face, and they stated hitting each other. Staff was able to separate, and was
restrained for safety and the other resident was escorted off of the unit. The next day
reported to APRN facial pain, so he received an x-ray on grounds of his nose on 12/18/2023
which was negative for fracture. Both residents were placed on precautions to be reassessed
in 24 hours. No additional follow up was ordered at this time.
Interim Action Narrative:
:
Licensing Narrative: 12/20/2023 - The provider reported incident was reviewed by
Licensing Specialist Jarred Parnell.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: An x-ray was ordered after a resident reported hand pain from hitting a wall.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 12/14/2023
Date Received by DCCECE: 12/15/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 12-14-23 became
angry at a resident and hit the wall aggressively. He reported pain in his hand and obtained
an x-ray that did not show a fracture. However, because of the swelling, the x-ray will be
repeated in a week.
Interim Action Narrative:
Licensing Narrative: 12/18/2023 - The provider reported incident was reviewed by
Licensing Specialist Jarred Parnell. 12/18/2023 - Licensing Specialist contacted the facility
to inquire about the resident's actual birthdate. It is
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


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

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Piney Ridge Treatment Center
Facility Number: 203
Licensee Address: 2805 E ZION RD
FAYETTEVILLE AR 72703
Licensing Specialist: Clayton DeBoer
Person In Charge:
Record Visit Date: 12/12/2023
Home Visit Date: 12/12/2023
Purpose of Visit: Monitor Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
Buildings & Grounds conducted for Piney Ridge Annex (Crossover Unit) Building 12/12/23 from
8:00AM-9:30AM. Census: 0
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 3

901.3-Posted Children’s Rights observed.
1014.2-Continuous supply of drinking water.
1014.4-No cooking area.
10.14.5-Fire extinguishers observed.
1014.6-Emergency escape plan diagrams posted.
1010.1-Grounds clean and free of safety hazards.
1011.7-Buildings & furnishings safe, clean and in good repair.
1011.13-Room temperature is a between 65 and 85 degrees.
1012.2-Separate toilet, bathtub, or shower and sink for each 6 children.
1012.3-Adequate supply of hot and cold running water.
1012.4-Bathroom clean and sanitary.
1012.6-Adequate supply of soap, towels, and tissue.
1013.3-No more than four children per bedroom and each child should have at 50 square feet of floor space.
1013.6-Sleeping areas furnished with a mattress. Per Justin Hoover of Piney Ridge, bedding (sheets, pillows,
covers) will be provided prior to occupancy.
1013.11 & 1013.12-Beds positioned to ensure that all children can easily exit the room in case of emergency
and to minimize opportunity for physical contact between children.
1013.2-Children placed in individual bedrooms unless their treatment plan specifically approves them to share
a bedroom. Bedrooms can be shared by 3-4 residents with a safety plan in effect.
1008.5-Med area-Yes. All medications kept securely locked and stored according to pharmaceutical
recommendations. 1008.6-Keys readily available.
908.6-Controlled substance area-Yes. Controlled substances kept under double lock.
1015.1-Agency available transportation that is in safe working condition.
1014.1-Operable telephone or comparable communication device.
No noted issues other thanPer Justin Hoover of Piney Ridge, bedding (sheets, pillows, covers) will be
provided prior to occupancy.
Provider Comments:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 3

CCL Staff Signature : Date: 12/12/2023
Provider Signature : Date: 12/12/2023
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 3 of 3


summary: A resident was taken to Physician’s Specialty Hospital due to complaints of hand pain from hitting walls while upset.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 12/9/2023
Date Received by DCCECE: 12/11/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: Arkansas resident in parental
custody, reported that he was having pain 8/10 to his right hand. It was reported that he was
upset, hitting walls. Nursing notified APRN, x-ray was obtained in house and findings show
. Orders received to take resident to
Physician specialty for confirmation. Resident was taken via our staff to hospital.
was confirmed and soft cast applied to right hand. Resident to follow-up with Dr. David
Yakin in 1-2 weeks. We will treat with Tylenol PRN for pain.
Interim Action Narrative:
:
Licensing Narrative: 12/11/2023 - The provider reported incident was reviewed by
Licensing Specialist Jarred Parnell.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was taken to Children’s Hospital after smashing his finger in a door.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 12/8/2023
Date Received by DCCECE: 12/11/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: , Arkansas resident in parental custody.
He got his finger smashed in a door on the unit accidently. He was taken to Childrens'
Hospital with our transportation team and staff, where it was . A
soft cast was placed before resident returned to the facility. He will be given Ibuprofen as
needed for pain. He will follow-up with APRN on site and then we will schedule follow-up
at Ozark orthopedics as she directs.
Interim Action Narrative:
Licensing Narrative: 12/11/2023 - The provider reported incident was reviewed by
Licensing Specialist Jarred Parnell.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was transported to Arkansas Children’s Hospital after she started drawing obscene pictures, making obscene statements, stripped in the classroom, and urinated on the teacher’s chair.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 12/4/2023
Date Received by DCCECE: 12/5/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 12/4/23 at approximately 1219,
started disrupting the class and other residents were ushered out of the
classroom. She started drawing obscene pictures, making obscene statements, stripped in
the classroom, state in the teacher's chair and forced herself to urinate on the chair and
because this has been a continuation of behaviors, the medical director was contacted and
he directed that she be assessed at Arkansas Children's Hospital in Springdale, AR. Because
we determined that it was not safe for staff to transport the resident by company vehicle,
EMS was contacted and they along with a staff member transported the resident to ACH.
While at ACH she started to make comments to kill herself and was eventually admitted and
transported to Conway Behavioral Health for acute care. It is not anticipated that she will
return to PRTC.
Interim Action Narrative:
:
Licensing Narrative: 12/6/2023 - The provider reported incident was reviewed by Licensing
Specialist Jarred Parnell.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Arkansas Children’s Hospital after drinking soap and deodorant and swallowing a zipper.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 12/2/2023
Date Received by DCCECE: 12/4/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 12/2/23 was upset
with a direction from staff, she attempted to lock herself into the bathroom, staff redirected
and opened the door and resident had started to drink some soap and the soap was
taken away. She reported that she drank the soap and some deodorant, and she was placed
on self-harm precautions after assessed. A little while later she broke her zipper and
swallowed part of it before staff could retrieve it. APRN was notified and ordered an x-ray. A
little while later she had received the x-ray, she was complaining of her stomach hurting.
Results of x-ray came back and showed APRN was notified and she
ordered that resident be taken to ACH ER. X-ray completed at ER, and she was discharged
at 0017 on 12/3/23. She is to follow up with APRN, be on liquid diet to be assessed daily,
she was placed self-harm and soap to be placed on wash cloth to be assessed every 24 hours.
In addition, guardian was notified, and resident will process with primary therapist.
Interim Action Narrative:
:
Licensing Narrative: 12/5/2023 - The provider reported incident was reviewed by Licensing
Specialist Jarred Parnell.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: An x-ray was ordered after a resident was injured during an altercation with a peer.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 12/1/2023
Date Received by DCCECE: 12/4/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 12-1-23 at approximately 1530
was attempting to antagonize
by being close to him. became upset and hit in the nose.
The were hitting each other while staff members were physically intervening for safety.
nose bled and the APRN was notified and ordered an x-ray and the x-ray was
. He will follow up with the APRN today
related to this injury.
Interim Action Narrative:
Licensing Narrative: 12/5/2023 - The provider reported incident was reviewed by Licensing
Specialist Jarred Parnell.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: An x-ray was ordered after a resident rolled his ankle while playing outside.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 11/29/2023
Date Received by DCCECE:11/30/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 11/29/2023 (DOB Arkansas private) rolled
his left ankle while playing outside. No bruising or swelling noted. An x-ray was ordered
and on 11/30/23 the results were negative for fracture. No additional treatment needed at
this time.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 12/1/2023 -The provider reported incident was reviewed by Licensing
Specialist Jarred Parnell.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: An x-ray was ordered after a resident was kicked in the face by a peer.

raw_content:
AR KAN S A S&S
DEPARTMENT OF

+4 HUMAN
<a¥ SERVICES

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

Notice of Serious Incident

Date of Incident: 11/26/2023

Date Received by DCCECE:11/28/2023

Facility Name: Piney Ridge Treatment Center
Facility Number: 203

Incident Type: Licensing

Report Description: On 11/26/23 i (DOB IY Arkansas private) and

(DOB m7 Illinois private) were playing basketball and they stated to
push each other. Then kicked on the face at that time staff stepped in
between and body blocked both resident and peer until they both was calm. Residents will
be placed on twenty-four-hour assault precaution. Guardians were notified and J's
stated that he had a hairline fracture from ear to ear in the past and wanted us to keep an
eye on it. APRN was notified and requested an x-ray. A mobile x-ray was performed on
11/27/23 and was negative for fracture and he followed up with APRN. No further follow up
needed.

Interim Action Narrative:

Maltreatment Narrative:

Licensing Narrative: 11/28/2023 - The provider reported incident was reviewed by
Licensing Specialist Jarred Parnell.

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


summary: A resident reported that a peer digitally penetrated her while in the dayroom. Camera review showed what appeared to be consensual sexual behavior.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 11/25/2023
Date Received by DCCECE:11/28/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 11/25/23 (DOB Arkansas Private) reported
that earlier that day at around 1230 that she and resident (DOB
Arkansas DCFS) were sitting beside each other on in the dayroom and performed
digital penetration on her by putting her finger down her pants. She also reported that it
occurred briefly again about an hour later on the unit. Internal review including camera
footage shows what appears to be consensual sexual behavior to include touching and a few
kisses. and were placed on no interactions, e was placed on a 6-foot
intervention with staff. Both resident's primary therapist was made aware of the allegation
and guardians. made statements that she did not want to engage in the sexual
behavior and it was not consensual. The was
contacted on 11/28/23 and it was accepted for investigation to CACD and the r
. At approximately 1030 on 11/28/23 Deidre Uselton from ASP came to
the facility and viewed camera footage and interviewed . She stated that she would
be unable to substantiate the behavior as non-consensual. Counseling will occur with the
staff members on the unit at the time of the incident. In addition, the Program Manager will
teach additional training on active observation with new hires and review with present
employees during daily safety huddle debriefings.
Interim Action Narrative:
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: 11/28/2023 - The provider reported incident was reviewed by
Licensing Specialist Jarred Parnell. Licensing specialist contacted the facility to ensure
video footage was saved to review for supervision concerns. A visit will be conducted
11/29/2023 to review the incident and discuss the safety plan with the facility. 11/29/2023 -
Licensing Specialist Jarred Parnell conducted a visit at the facility review camera footage for
provider reported complaint. Times reviewed were on 11/25/2023 at 12:24 - 12:28 and 13:20 -
13:24 for case # 017746 Video footage reviewed shows the two residents and sitting in
the day room in chairs doing an activity on dry erase boards. The staff person supervising
the residents can be seen behind the residents approximately 7 feet away. proceeds to
engage in sexual interaction with by placing her hand on her thigh and then down the
front of her pants. The residents have their backs to the staff person and use the dry erase
boards to conceal their actions. During the incident the staff person can be seen doing
visual checks on the residents. The staff person could not see the sexual contact as the
residents are heavy set and were blocking her view from the back, and utilizing the dry erase
boards to to conceal their actions from the front. Video footage for another incident
involving the two residents was reviewed. The video footage shows the two residents seated
against the wall with the supervising staff approximately 4 feet away. leans into and
kisses her on the mouth. The staff person did not see the interaction because she was
speaking with another resident and 's head was blocking her field of view. Staff can be
seen interacting with the residents and actively supervising.


summary: An x-ray was ordered after a resident complained of pain in his hand from hitting a wall.

raw_content:
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Date of Incident: 11/19/2023
Date Received by DCCECE:11/22/2023
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: (DOB 0 Arkansas private) On 11/19/23 at
approx. 1800, resident reported pain in his right hand after he got upset and hit a wall.
Nursing assessed and he was treated for the pain and given ice for swelling. APRN was
notified and we received an order for an x-ray. Mobile x-ray came to facility to perform x-ray
and late on 11/20/23 he was diagnosed with an a
. Corrective action taken by the agency or follow up done: X-ray of the
right hand showed angulated acute small finger fracture. We will take resident to Ozark
Orthopedics today, 11/22/23 as a walk-in for additional treatment.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 11/22/2023 The provider reported incident was reviewed by Licensing
Specialist Jarred Parnell.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov