summary: A resident became irritable, refused to comply with staff directives, and then attempted to attack a peer.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 030136
Date of Incident: 5/29/2025
Date Received: 5/30/2025
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
Incident report date/time: 05/29/25
5:25pm Location of Incident: Outdoors Incident Description: Aggressive to Peers,
Aggressive to Adults, Threat to Safety Staff Involved:
Events Leading: After dinner 4 staff and 5 clients were outside hanging out and
playing basketball. During this time a male peer was on the other end of the court ( alone )
separated from the other boys for other reasons , became irritable because he refused to
engage with her due to rules and them being on a peer limit. As the boys were lining up
purposely kicked the ball towards them to get closer to the boys. Once kicked the ball
towards the boys she was then redirected because she walked over and flipped a boy off. She
yelled at staff and staff instructed her to go inside, she refused "I'm not going in the fucking
house NO! " Staff then tried processing with her to get an understanding and during this
time she ran towards a female peer she had been accusing of flirting with he male peer
mentioned above and tried to attack her. 5:25pm-Personal Restraint: Staff attempted to
verbally intervene but continued to try and attack her peer. She was then placed in an
escort by two staff who continued to offer the client verbal redirection, refusing to calm
down she was escorted to where she fought and kicked staff the entire time.
Once in the house, the client continued to yell homicidal threats towards her peer, she was
still attempting to kick at staff's legs. Staff continued to offer verbal support but the client
remained escalated and tearful. 5:37pm-Personal Restraint End: After 12 long minutes of
trying to deescalate, she finally reached tension reduction and was able to sit down with
staff and then she was able to contract to safety and be released. Patient Debriefing
date/time: 05/29/25 5:38pm: Client was hyper focused on the male client who did not offer
her the attention she was craving, she was still making homicidal threats towards her female
peer that she attempted to attack. She remained very irrational and could not see her
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

responsibility in the situation. As this is the 5th client she has attacked in 4 weeks, an
bed has been found and the client will be . Nursing
Assessment date/time: 05/29/25 5:45pm: was sitting on couch in dayroom with a
staff member sitting on either side of her. She was angry, cursing and yelling. She was
yelling homicidal threats aimed at a peer, who was not in the room. She attempted to attack
this peer outside. She was yelling, "I'm going to fucking snap her neck. When she walks
through this door, I'm going to kill her." refused any interventions to help her calm
and refused assessment at this time. No physical distress noted or voiced. Guardian was
notified on 05/29/25 at 6:00pm was on 05/29/25
at 8:10pm.
Interim Action Narrative: Resident was placed in a restraint for safety and assessed for
care.
Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Facility provided documentation for this provider reported incident. Documentation
reviewed and uploaded. Licensing inquired if resident will return to the facility after
. Per facility, the plan is for the resident to return to the facility after acute care.


state: AR

facility_name: Youth Home

summary: Officers responded to the facility for an assault report.

raw_content:
send the footage to my work email address.

Riley was provided with the report number and instructed to contact the Sheriff's Office for further questions or
concerns.

CFS 2025-34286
Case P25-005111 Page 2 of 2

doc_type: Police Report


summary: A resident reported that her roommate was not respecting boundaries. The resident reported that her roommate kissed her on the lips, licked her arm, and “hunched” her.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 030052
Date of Incident: 5/23/2025
Date Received: 5/27/2025
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
Incident Report date/time:
05/23/25 6:40pm Location of Incident: Incident Description:
Events Leading: Client came to me and told me that her
roommate was not respecting her boundaries and after many times of telling her to stay on
her side of the room she finally got on her bed. client said she rested her eyes when she felt
her roommate kissing her on her lips and licking her arm. client said her roommate "
hunched " her two times and she got her roommate off of her. I talked to client to keep her
calm client was moved into another room away from her peer.
Interim Action Narrative: the residents were separated.
Narrative:
Licensing Narrative: Licensing reviewed complaint for licensing concerns. Facility
provided documentation for this complaint. 5/29/2025, licensing visited the facility and
interviewed the residents. Licensng will inquire about the contact information for a staff
member mentioned in the interview. 6/2/2025, licensing reached out to the staff member
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

mentioned by a resident. Staff member informed licensing that the resident informed her
that her roommate was not respecting her boundaries. Staff member informed licensing that
she spoke with the resident and peer about the situation. 6/3/2025, complaint unfounded by
licensing. Residents and staff member interviewed. 521 completed and returned. Case
complete.

doc_type: Notice of Incident


summary: A report was made against this resident for kissing, “hunching”, and licking her peer’s arm. The residents were separated from each other and moved to different rooms.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 030054
Date of Incident: 5/23/2025
Date Received: 5/27/2025
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
Incident Report date/time:
05/23/25 6:40pm Location of Incident: Incident Description:
Events Leading: A report was made against this client for her
kissing, " hunching " and licking her peer's arm. clients were separated from each other
and moved rooms. After the information was gathered staff would question the offending
client in question about respecting boundaries, and they would come off suspicious acting.
The client in question would question why their peer was removed and then would return to
their own room.
Interim Action Narrative: residents were separated.
Narrative:
Licensing Narrative: Licensing reviewed complaint for licensing concerns. Facility
provided documentation for this complaint. 5/29/2025, licensing visited the facility and
interviewed the residents. 6/2/2025, licensing reached out to the staff member mentioned
by a resident. Staff member informed licensing that the resident informed her that her
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

roommate was not respecting her boundaries. Staff member informed licensing that she
spoke with the resident and peer about the situation. 6/3/2025, complaint unfounded by
licensing. Residents and staff member interviewed. 521 completed and returned. Case
complete.


summary: A resident was left unattended while staff and peers left to go to school. The facility was cited 907.2 for the resident being left unsupervised.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 030007
Date of Incident: 5/23/2025
Date Received: 5/23/2025
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
Incident Report date/time:
05/23/25 8:35am Location of Incident: Incident Description: Threat to
Safety, Other-Client left unattended
Events Leading: Clients were
lining up to walk to school. Client was in her bedroom asleep. Staff and peers left to go to
school. School staff did a head count of their first period and inquired about the
whereabouts of the client. The school team immediately checked other classrooms and the
nursing station. Another team member dialed the house in attempts to locate client.
However, at this time a team member saw client approaching the front door of the school
with two staff. Client entered the school, appearing disheveled. Staff walked client to their
office and debriefed with client, allowing her to decompress. Client was apologetic to which
staff informed client she does not need to apologize. Time was spent validating client's
feelings. She was then taken to the decompression zone to allow more time for self
regulation before going to class. When house staff returned to the house, client was sitting
in the milieu alone, observed rocking in the floor. Staff asked client if she was okay and
offered a cool rag and water. Client was left unattended in the house for approximately 5
minutes. Nursing Assessment date/time: 05/23/25 10:05am: Patient presents in Siebert
school d-zone with two staff present. Patient reports she was left in the alone
with staff not present for 5 minutes. Patient denies having physical concerns but is reporting
anxious feelings. Patient request
Patient anxious and cooperative at this time. Will provide support as needed.
Guardian was contacted on 05/23/25 at 10:54am.
Interim Action Narrative: Resident was assessed and debriefed with staff.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Licensing inquired if incident was , the procedure for escorting
residents from the house, and if staff members involved will receive training and/or
warning. Per facility, staff are supposed to count the residents before leaving the house to go
anywhere on campus. Counts are done throughout the day from class to class and from one
buildng to the next for lunch etc to make sure staff keep all residents under supervision. The
staff involved will be retrained and were wrote up. 5/27/2025, licensing inquired if resident
was on any precautions when left unsupervised. Facility reported that resident was on
activity limit. Resident was limited from exercises and recreation. Facility will be cited for
907.2. Licensing requested training documentation. Facility reported training
documentation will be provided. 5/30/2025, facility provided training documentation for the
staff members involvded in this provider reported incident.


summary: A resident reported to staff that a peer would attempt to kiss them and slap their behind. The residents were moved to separate rooms.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 029861
Date of Incident: 5/17/2025
Date Received: 5/19/2025
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
Incident Report date/time:
05/17/25 7:20pm Location of Incident: Incident Description:
Events Leading: The client would talk
with staff and fold towels at the same time to keep their mind calm. The client is usually a
loud verbal speaker but would talk with hushed tones. The client would confide in staff and
tell them that another peer would attempt to kiss them and slap their behind. The client
would report this to their trusted staff and the next staff in line would be informed to
understand the situation to keep the clients separated. The client who made the report
would be moved to a different room and would appear satisfied with this decision.
Interim Action Narrative: Residents have een placed in separate rooms.
Narrative:
Licensing Narrative: Licensing reviewed complaint for licensing concerns. Facility
provided documentation for this complaint. 5/21/2025, licensing interviewed the residents
and inquired about camera footage. Licensing scheduled to review camera footage on
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

5/22/2025. 5/22/2025, licensing reviewed camera footage. Faciltiy informed Licensing that
on 5/14/2025 room searches were completed and an inappropriate item was found in the
resident's room. Per facility, the peer denied onwership and insisted that it was the
resident's. Pictures were provided and the item was removed from the bedroom. The
resident did not take ownership but was upset per facility. No licensing concerns observed
during camera footage review. Complaint unfounded by licensing. 5/27/2025,
documentation reviewed and residents interviewed. Complaint unfounded by licensing.
Approved by Program Coordinator. Case complete.


summary: Officers responded to the facility for a report that a staff member was assaulted by a juvenile.

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

Case P25-004570 Printed on May 20, 2025

Status Approved
Report Type Patrol
Primary Officer Wayne Camacho
Investigator None
Records Technician
Reported At 05/13/25 15:16
Incident Date 05/13/25 15:16
Incident Code BATT : BATTERY
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
2
Southwest

Disposition P- PENDING
Disposition Date/Time 05/13/25 16:09
Disposition Comments

APPROVED BY P. SIMMONS 4218
Review for Gang Activity Not Applicable

Primary Narrative By Wayne Camacho, 05/13/25 16:32
Battery 3rd

On 05/13/2025 at or around 1516 hours, |, Deputy W. Camacho, was dispatched to 20400 Colonel Glenn Road.
Youth Home in reference to a Disturbance with a Juvenile.

Upon arrival, | made contact with Shataria Davis, a Qualified Behavior Health Provider (QBHP). She stated she was
assaulted by a

She said struck her with a Stanley cup several times, once in the head. She was also punched several times on
her arms, kicked on her right leg, and bit on her left hand.

A Kami Miller, also a QBHP, said she witnessed the assault.

| approached and was able to get side of the story. said was upset because could not understand
how to score the task was asked to complete for Davis, which led to _ behavior.

| did not see any visible bruises on Davis's arms or a bite mark on her left hand.
Davis declined an ambulance but said she would drive herself to a hospital.
Davis was given this report number.

CFS2025-31132

Case P25-004570 Page 1 of 1


summary: A resident complained of pain after being attacked by a peer. The facility was cited 110.17 for late reporting.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 029695
Date of Incident: 5/8/2025
Date Received: 5/13/2025
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
. Incident Report date/time:
05/08/25 4:43pm Location of Incident: Incident Description: Aggressive to
Peers, Threat to Safety Staff Involved:
Patients
were in group where they were playing a game with the therapist, during the game a peer
said " oh you put the two fattest people on the same team". then became offended and
came out of group tearful and upset. Once group was over, was getting water and her
peer attacked her. 4:43pm-Personal Restraint: Client initially tried to fight back and protect
herself. Staff were using verbal de-escalation, the client stopped fighting against staff's hold.
Client began to process with staff. 4:51pm-Personal Restraint End: Staff continued to offer
verbal support. After patient calmed down she was then released from her personal restraint.
Patient Debriefing 05/08/25 at 6:10pm: Client was upset with her peer, she was angry that
she was attacked but focusing on what she could do to control the situation. Staff continued
to process the situation with the client. The client complained on having a hurt shoulder
from her peer attacking her. She was assessed by a nurse. Nursing Assessment date/time:
05/08/25 5:00pm: Pt visibly anxious and upset.
Pt c/o left shoulder pain. Noted redness on back in left
shoulder area. Full ROM in shoulder. Notified provider. Orders received. Guardian was
contacted on 05/08/25 at 5:30pm Injuries to staff or client: Client complained of Left
shoulder pain, Follow-up to injury: She was seen today 5/9 at , the
results state " Will send to sister clinic
to receive X-Rays. If negative, rotate every 6 hours.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Interim Action Narrative: Resident assessed by the nurse and sent to urgent care on
5/9/2025.
Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Licensing inquired about late reporting. Facility provided documentation for this provider
reported incident. Documentation uploaded to this case. Facility reported the incident was
overlooked. Facility will be cited 110.17 for late reporting.


summary: A resident disclosed significant suicidal ideations and reported that she is fearful of returning to the classroom, because she feels she will be beaten up.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 029414
Date of Incident: 4/30/2025
Date Received: 5/1/2025
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Incident Report date/time:
04/30/25 12:00pm Location of Incident: Incident Description: Suicidal, Threat to
Safety Staff Involved: Events Leading: disclosed significant Suicidal
Ideations and requested to go to She reported e would be
acceptable as well. She endorsed feeling lonely, hopeless, worthlessness, and sadness. She
reported she is tired of the bullying. Discussed the common theme of peer conflict and her
longing for feeling of understanding, acceptance, and sense of belonging from peers
discussed the day prior at time of face-to-face. She also admits she is fearful of returning to
the classroom setting as she feels she will be beaten up. She reported SI with plan to "slit
throat" or choke self out. Attempted to problem solve and offer solutions such as putting
forth effort to restore the relationships. She stated that she does not wish to restore with her
peers and feels they would later use this to their advantage. Client was admitted to
for stabilization. An email was sent to Kendra Rice on 05/01/25 about this incident.
Interim Action Narrative: Resident was admitted to .
Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Facility provided documentation for this incident. Licensing inquired if resident will return
after acute placement.


summary: Officers were dispatched to the facility to assist Emergency Medical Services.

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

Case P25-003705 Printed on May 20, 2025

Status Approved

Report Type Patrol

Primary Officer Karen Escamilla

Investigator None

Records Technician

Reported At 04/20/25 19:49

Incident Date 04/20/25 19:49

Incident Code ASTA : ASSIST AMBULANCE

Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
2
Southwest

Disposition P- PENDING
Disposition Date/Time 04/20/25 20:59
Disposition Comments

Approved JD
Review for Gang Activity Not Applicable

Case Comments
CFS202525800

Primary Narrative By Karen Escamilla, 04/21/25 00:30

Assist Ambulance

On April 20, 2025, at approximately 1949 hours, |, Deputy Escamilla, responded to 20400 Colonel Glenn Rd Little
Rock, AR 72210, in reference to a female being aggressive toward staff members at the Crestview House.

Upon arrival, | made contact with Amanda Fields, who advised that wanted to shower and requested a
razor. However, per Youth Home policy when there is a Tornado Warning or Tornado Watch they are not allowed to
shower in case they need to take cover in the showers. was upset that was not allowed to shower or use
arazor, so _.._ left Crestview House and Amanda followed .._. in the van. grabbed a long stick and tried to
poke Mrs. Z. but made no contact with her. They were able to calm _ _.._.__. and get .._. back in the house with small
restraints. started making threats toward Mrs. Z and did not wish to speak or see her. Amanda was able to
calm — _..-.-.. down. Prior to my arrival, Mrs. Z was no longer on scene.

| observed sitting down in a chair, no longer in restraints and calm. Amanda told hat M.E.M.S. would
be transporting to Children’s Hospital and they were concerned for safety. asked if would be able
to come back and Amanda told that she knew wants to get better, and would come back to the Youth
Home.

M.E.M.S. Unit 12 arrived on scene and transported without issues. | advised Amanda that | would be making a
report concerning the incident.

CFS2025-25800

Case P25-003705 Page 1 of 1


summary: Officers were dispatched to the facility in response to a battery between a juvenile and a staff member. While officers were present, the juvenile attempted to elope from the facility.

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

Case P25-003706 Printed on May 20, 2025

Approved
Report Type Patrol
Primary Officer Karen Escamilla
Investigator None
Records Technician
Reported At 04/20/25 20:46
Incident Date 04/20/25 20:46
Incident Code BATT : BATTERY
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
2
Southwest

Disposition CA- Cleared by Arrest
Disposition Date/Time 04/20/25 23:29
Disposition Comments

Approved JD
Review for Gang Activity Not Applicable

Asst Officers
2X71 - Bass, Steven; 2X72 - Knobloch, Matthew

Case Comments
CFS202525810

Primary Narrative By Karen Escamilla, 04/21/25 01:38

Battery 2nd / Fleeing on Foot

On April 20, 2025, at approximately 2046 hours, |, Deputy Escamilla, responded to 20400 Colonel Glenn Rd Little
Rock, AR 72210, in reference to a battery that occurred between a juvenile and a staff member at Sturgis House.

Upon arrival, | made contact with Matthew Chrysler, who advised that around 2003 hours, intentionally

threw a hard boiled egg at him from across the room and struck him in the hand. Matthew is a Licensed Practical

Nurse (LPN) with the Youth Home. Matthew advised the impact left a red mark on his left hand below his index finger

however, upon my contact there was no longer a visible redness. Matthew stated that was involved in an

altercation earlier during the day with a few of the residents. Matthew advised he wanted to press charges against
and that he would try to get video footage of the incident.

| made contact with Juvenile Intake, Lori Carrigan, and advised her of the incident. | provided Lori with the information
requested and she advised me of a court date. | completed the A.D.R. and had one of the staff members sign the
A.D.R. Matthew completed a witness statement form.

| advised Matthew and staff members that was being charged with Battery 2 nd Degree (5-13-202) with a court
date of May 12" at 0900 hours. They were provided with the copy of the A.D.R., court date, and report number.

While still on scene the staff members advised that was riling up the residents and kept making remarks toward
staff members and myself. A loud banging noise could be heard and the staff members advised that ..__.. was
pushing against the back door trying to get out. ran straight into} room,onto _ bed, and under the covers. |

made contact with along with one of the members however, did not acknowledge us in the room.

Case P25-003706 Page 1 of 2

| observed get up from the bed and make __ way into the open living room quarters. Once makes way
into the open area __ takes off running in a full sprint past staff members and pops open the front door. Staff members
along with myself take off after

| advised Dispatch that took off from Sturgis House heading towards the area of Crestview house and provide
clothing description. | advised Dispatch that isa wearing black shorts and black jacket.

Deputy Bass and Deputy Knobloch are at Crestview House due to another incident that was happening and step out
once | give out my transmission of fleeing. | continue running towards the back end of one of the houses and
located Deputy Knobloch with Deputy Knobloch was able to get handcuffed with no complications. Deputy
Knobloch and | assisted on standing up and ___-was placed into Deputy Bass’s patrol unit.

| made contact with Lori from Juvenile Intake at 2140 hours and advised her of the updated charges for . She
advised that the new charges would be added to _—case and the court date would remain the same. | advised the
staff members of this information.

Deputy Bass and | stood by while Matthew made arrangements to get sent to an acute treatment facility due to
behavior escalating. Matthew confirmed arrangements have been made for Deputy Bass and | transported
to Arkansas Children’s Hospital and a staff member followed us. was then transferred to the staff member

and Arkansas Children’s Hospital Security with no complications.
was charged with Battery 2nd Degree (5-13-202) and Fleeing on Foot (5-54-125(c)).

Matthew's witness statement form and photos were entered into property.

CFS2025-25810

Case P25-003706 Page 2 of 2


summary: Officers took a phone report from a parent stating his son was assaulted by a peer at the facility.

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

Case P25-003901 Printed on May 20, 2025

Status Approved
Report Type Patrol
Primary Officer Justin Paradise
Investigator None
Records Technician
Reported At 04/25/25 05:03
Incident Date 04/20/25 05:03 - 04/25/25 00:00
Incident Code BATT : BATTERY
20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
2
Southwest

Disposition P- PENDING
Disposition Date/Time 04/26/25 05:04
Disposition Comments

GD 4303.

Darr 4376
Review for Gang Activity Not Applicable

Primary Narrative By Justin Paradise, 04/26/25 05:14
Battery

On April 25, 2025, at about 1456 hours, Deputy Paradise, took a phone report about an incident that took place at
20400 Colonel Glenn on April 20, 2025, regarding a Battery.

Deputy Paradise made contact with Cecil Keeling. Cecil stated, his son Mwas assaulted on April 20,
2025, by between the ages of . Cecil stated, that was being bullied by subjects,
when IEE defended himself the became agitated. Cecil stated, that later on that day the attacked
HEEB in retaliation for the earlier incident beating him in the head for at least 30 seconds while a _.... around the
same age joined in the attack before Youth Home staff intervened. Cecil stated, that [—Jwas evaluated by the
facilities nurse who took pictures of his injuries and did the medical report. Cecil stated, that on April 21, 2025
comonlained that his head was hurting and he became dizzy. Cecil stated, he wanted to press charges against the

Deputy Paradise made contact via phone with Youth Home's Records Compliance Coordinator Robbie Lagrone. Ms.
Lagrone e-mailed Deputy Paradise the pictures of f——njuries as well as the nurses notes. Ms. Lagrone stated,
she had to get in with contact [J Youth Home's house leader who would give Deputy Paradise the

information.

Deputy Paradise uploaded pictures and the nurse's notes from the incident into evidence/property under items #: 1-6

Cecil was given a report number and advised on how he could obtain a copy.

CFS2025-26917

Case P25-003901 Page 1 of 1


summary: A resident jumped on a peer and hit a nurse with an egg before attempting to elope from the facility.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 029178
Date of Incident: 4/20/2025
Date Received: 4/22/2025
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Incident Report date/time:
04/20/25 9:30pm Location of Incident: Incident Description: Attempted
Runaway,
Events Leading: Client jumped on one of his peers and hit a nurse with an egg.
Client thought he was being taken to jail by the Sheriff's department and decided to bust
out of the door at . Client continued to run but was caught by law
enforcement. Client was taken to for further observations. UM on call,
CT on call and nurse were notified. Client spent the night at and
was transferred to for an on 04/21/25. Nursing
Assessment date/time: 04/20/25 9:40pm: Patient observed being walked to sheriff vehicle
under his own strength by two deputies. Guardian was notified on 04/20/25 at 9:07pm,
9:58pm, 10:17pm. paperwork and report was emailed to Kendra Slade on
04/22/25.
Interim Action Narrative: The police were called. Resident was transported to to be
evaluated and then to acute care.
Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: 4/21/2025, facility informed licensing of this provider reported
incident via email. 4/22/2025, Licensing reviewed provider reported incident for licensing
concerns. The facility provided documentation for this provider reported incident.
Documentation reviewed and uploaded. Licensing inquired about door damage. 4/24/2024,
facility provided licensing with a picture of the door damage. Licensing requsted a picture
once door was replaced. Per facility, "The magnetic lock held but door was bent at bottom.
Could lock with key if someone pushed on it from outside. The back door was damaged but
held. The front door was not damaged but did not hold. Do not believe that the resident
received a citation from the police. Supposedly will have a new door installed tomorrow."
4/30/2025, followed up with facility on the replacing the door. Facility reported it will 3 to 4
weeks due to the door being custom made.


summary: A resident hit his head during an altercation with a peer. The resident was sent to the Emergency Room for evaluation and treatment.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 029145
Date of Incident: 4/18/2025
Date Received: 4/21/2025
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Reports for
client in our PRTF program and resides in Incident Report 1
date/time: 04/18/25 6:07pm Location of Incident: Outdoors on Youth Home campus
Incident Description: Aggressive to Peers Staff Involved:
Events Leading: Client and peer were playing basketball when he pushed
his peer to the ground and peer then charged client aggressively. Client began to swing at
peer striking him but was wrestled to the ground hit his head on the court. The nurse was
notified. Client was placed on freeze for physical aggression and he accepted this
information expressing remorse for his behavior. Nursing Assessment date/time: 04/18/25
7:05pm: Nurse notified by staff at about 1850 that pt had gotten into altercation w/ peer.
Nurse arrived to house at 1905 for assessment. Upon assessment, pt is calm, cooperative.
Gait steady. Speech clear. Pt is alert and oriented to self/situation. Pt states that peer was
'racist' and 'trash talking' while playing basketball, which lead pt to push peer. Pt punched
peer in the nose before peer 'body slammed' pt. Pt hit head against concrete, states that
afterward 'the world was blurry', his ears were ringing, and he was 'unable to move'. States
that he 'felt like he was going to be paralyzed'. Per pt, staff sat with client for 10-15 minutes
before he was able to be brought up to the house. Nurse was not notified during this time.
During assessment, pt denies dizziness, light sensitivity. Full ROM present in all
extremities, hand grasp strong and equal bilat. Denies n/v.
Pt endorses h/an and jaw pain at 7/10. Abrasion
noted to back of head, scant blood present. Abrasion approx. 2-3mm in depth. Pt told to
clean area of debris, keep area clean and dry. Pt verbalized understanding. Pt sent to for
further evaluation d/t injury to head. Guardian was notified on 04/18/25 at 7:57pm. Incident
Report 2 date/time: 04/18/25 8:05pm Location of Incident: Outdoors on Youth Home
campus Incident Description: Staff Involved:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Events Leading: Client transported to d/t hit to head during
altercation w/ peer. See previous IR and nurses note for detailed assessment information.
Interim Action Narrative: Resident and peer were separated, resident placed on freeze, he
was assessed by the nurse, and transported to the
Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Facility provided documentation for this provider reported incident that has been uploaded.


summary: A resident began cursing and threatening staff. The same resident attempted to damage property and to hit staff members.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 029148
Date of Incident: 4/17/2025
Date Received: 4/21/2025
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Incident Report date/time:
04/17/25 2:29pm Location of Incident: Incident Description: Aggressive to
Adults, Threat to Safety Staff Involved:
Events
Leading: PT became upset after staff redirected him to stop calling staff slurs. Client began
to curse at staff and proceeded to fart on his peers. PT farted on staff and laughed about it.
Client has been on freeze for over a week and has not fully restored with staff. Staff informed
client that his freeze will be extended due to behaviors and refusal to restore in genuine
matter. Client was told that he could do anything that is safe in his area that was not in
direct vision of the television. PT has colored pencils and paper and refused to engage in
those activities. PT began to threaten to hit staff due him being upset he will not be
removed from freeze. Client continued to curse at staff and grabbed staff computer. 2:29pm-
Personal Restraint: Pt grabbed and attempted to throw staff computer. Staff removed the
computer from client reach. Pt ran behind staff desk and attempted to hit staff. Client was
placed in a personal restraint. PT was in a personal restraint and hit a staff member while
fighting against the hold. Client was in a personal restraint in a chair behind staff desk in
the beginning of the hold. Staff tried to ask the client to calm down and told him that we
want to let him go when he could calm down. Pt was refusing to listen to staff and
screamed. Client told staff he wanted to attack a staff member and was still angry. PT was
escorted away from staff desk while in a personal restraint. Client was restrained in hallway
area behind staff desk area away from other client's view. 2:40pm-Personal Restraint End:
Pt began struggling again, attempting to walk away from staff and thrash arms while in
hold. Additional staff helped support pt and staff and tagged out a team member. Pt was
offered more water and a cool cloth. He accepted staff wiping his forehead with the cloth. Pt
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

ceased in struggling as verbal support continued. Staff encouraged pt to take deep breaths.
Pt was able to contract for safety. Staff asked pt if he needed anything or wanted space and
pt stated he was ok and he continued to decompress. After a few minutes he asked to return
to his room and this was allowed as he was not in seclusion. Patient Debriefing date/time:
04/17/25 2:45pm: Following intervention pt was asked if he was injured to which he pointed
at a superficial mark on his right arm consistent with resisting restraint. Staff asked pt if he
was willing to be assessed by the nurse and he agreed. Staff talked with pt about making
positive choices following mistakes. Pt appeared sad but shook his head in understanding.
Pt was transported via . Nursing Assessment
date/time: 04/17/25 2:42pm: was observed standing in the time out room, continuing
to calm and de-escalate while processing with staff and pacing. He was observed holding a
wet wash cloth. His arms appeared erythemic and a small superficial scratch noted to (R)
antecubital fossa area. Minimal bleeding with scant amount of blood. Erythema also noted
to clavicle area. boasted proudly about being combative and resistant against the
restraint while stating, "He is weak. He can't do anything to me. He isn't a man". This
nurse attempted to explore with the relationship with the team member that
continues to target and threaten. During debriefing the previous day, told the unit
manager that he would continue to go after throughout the shift. began shifting
blame and minimizing his behaviors reporting his freeze was extended for no particular
reason. When recalling the behaviors reported, snidely grinned endorsing and
admitting to: farting on peers and staff, cursing and threatening, intimidating, attempting to
destroy property, becoming physically aggressive to staff, walking into restricted area with
intent to harm staff, testing limits, and refusing to follow instructions. He continued to
arrogantly boast about team members running away from him when he is becoming hostile
and aggressive. He admits that the team member that he seems to target the past few days,
sets clear limits, behavioral expectations, and holds him accountable thus endorsed
deliberately targeting, intimidating, and assaulting this team member in hopes of getting
the team member fired. He appeared to lack any remorse and discussed plan to continue to
attempt to go after this team member with intent to harm. AAOx4. No signs of physical or
mental distress. Appears calm although unpredictable as he continues to voice threats and
display a tense hostile glare. Active ROM to all extremities. Reports is only injury is the
scratch noted to his (R) AC while boasting about how strong he is and endorsing he was
combative and resistant against restraint. No further physical markings, erythema, bruising,
abrasions, deformities, protrusions, lacerations, or edema noted. Gait is steady. was
encouraged to make acceptable choices and reminded of clear behavioral guidelines.
Denies need or desire for wound care for his scratch. Encouraged to explore coping skills to
help defuse tension and while still getting his needs met. Denies concerns. Feels
interventions were appropriate. Attending notified. Freeze for physical aggression
continued. Residential services director working on . Guardian was notified
on 04/17/25 at 3:05pm. 3:11pm. on 04/17/25
at 4:45pm for an .

Interim Action Narrative: Resident was placed in restraints for safety and transported to
.
Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Facility provided documentatoin for this provider reported incident. Documentation
reviewed and uploaded. Resident was discharged.


summary: A resident reported that his nose was injured when he was thrown to the floor by a staff member during a restraint. 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
R
Notice of Serious Incident
Case Number: 028907
Date of Incident: 4/10/2025
Date Received: 4/10/2025
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Incident Report
date/time: 04/10/25 8:45am Location of Incident: Incident Description:
Patient Injury,
Events Leading: Upon entering the classroom where is located
at the school, Staff approached to inquire about his behavior last night. told
staff that he had been thrown to the floor by a Team Member hitting his nose on the floor
and that the Team Member had twisted his arm behind his back.
The team member is suspended until the
results of the investigation have been completed. fell during this restraint and we
think that his nose is broken. He has been sent out to for an evaluation and I
will send the paperwork as soon as we receive it.
Interim Action Narrative: Staff member was suspended pending investigation. Resident was
evaluated at urgent care.
Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing reviewed complaint for licensing concerns. Facility
provided documentation for this incident. 4/11/2025, Licensing requested for camera
footage to be saved for review. Licensing spoke with another entity who reported no
concerns. Facility provided licensing with more documentation. 4/15/2025. licensing
reviewed camera footage and requested witness statements from the staff members involved
in the restraint. 4/17/2025, facility provided witness statements from staff members. Witness
statements reviewed and uploaded. Program Coordinator informed the facility that licensing
need to speak with the staff members observed on the camera footage. 4/21/2025, spoke
with staff members via telephone. 4/23/2025, licensing requested the name and
phone for the other staff member to be interviewed. 4/24/2025, facility provided licensing
with the name of the other staff member. 4/25/2025, licensing spoke with staff member
via telephone. 4/28/2025, case unfonded by licensing. 521 completed and sent to facility for
signature. Documentation and interviews reviewed. Case complete. 5/16/2025, licensing
inquired if staff member named in this complaint returned to work. Facility reported that
staff member has not returned but will be retrained unpon return and documentation will be
provided. 5/21/2025, followed up with facility to see if staff member has returned.
5/30/2025, licensing inquired if staff member has returned to work. 6/2/2025, facility
informed licensing that staff member has not rturned to work.


summary: A resident began cursing staff and slamming doors, then barricaded herself in her room while self-harming.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 028835
Date of Incident: 4/4/2025
Date Received: 4/7/2025
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resided in Incident Report date/time:
04/04/25 7:15pm Location of Incident: Incident Description: Threat to
Safety, Patient Injury Staff Involved:
Events Leading: Client was told that she is not
allowed any sugar and became escalated to the point of cursing staff and slamming her
room door. She barricaded herself in her room and refused to open the door. While the door
was closed, Client began to scream and stated she will be screaming as long as she is in
and stated she "needs to to go to ". Staff went into the room and client was
sitting in the corner at which point she began banging her head against the wall. Staff
attempted to talk with her to help deescalate client but this was not an effective approach at
this time. A personal restraint was initiated when client would not stop banging her head
and it was deemed necessary for her safety. 7:15pm-Personal Restraint: Staff had to push
open door because patient refused to remove herself from entrance of room. Once access
was granted to room patient began banging head against wall which resulted in personal
restraint. At this time, staff were calming talking with patient attempting to deescalate her
and help her regulate. She kept banging her head with a staff member having to place their
hand between the wall and her head. She continued to curse, talk loudly and demand to go
to acute. 7:22pm-Personal Restraint End: Staff was able to talk with client for her to calm
down. Client was able to comply to directives, including deep breaths and releasing one arm
at a time. Client was able to listen to directions and contract to chair in milieu where she
was offered water, cold towel, and assessment from nurse. Patient Debriefing date/time:
04/04/25 7:30pm: Staff and patient debriefed about the incident and what led to her
barricading herself in her room. Patient does not want to be discharged and go home and is
fearful that she is close to being discharged. She was able to talk with staff calmly and
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

discussed some strategies of how to handle her strong emotions in a more constructive way.
Nursing Assessment date/time: 04/04/25 7:45pm: was placed in hold following
barricading herself in her room and banging back of head against the wall. This nurse
assessed the pt following incident. No noted knots or bruising to back of head. Pt c/o of
9/10 pain to head. Administered for pain.
Steady gait. Speech
clear. No petechiae noted. Notified provider on call. Orders received. Guardian was notified
on 04/04/25 at 8:55pm, 8:56pm, and 9:00pm. was transported to on
04/04/25 at 10:05pm for an . She will not return to Youth Home and was
discharged from our program on 04/07/25.
Interim Action Narrative: Resident was assessed and transported to acute care.
Narrative:
Licensing Narrative: Licensing reviwed provider reported incident for licensing concerns.
Facility provided documentation for this provider reported incident. Documentation
reviewed and uploaded. Resident will not return after acute care. Resident was discharged
from the facility on 4/4/2025.


summary: Mold was identified under old flooring during a routine flooring replacement. Residents were moved temporarily to a classroom in the school during renovations.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 028671
Date of Incident: 3/31/2025
Date Received: 3/31/2025
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: During routine replacement of flooring in , contractor
discovered that there is mold under the old flooring necessitating moving the patients out of
the house during cleaning and replacement of flooring. There are currently 8 male patients
in that house. They will be moved to a classroom in the school that was set up for this
purpose during COVID. They will have cots for sleeping and a bathroom that includes a
shower. Of course, staffing will remain within ratio and all communication with
parents/families will continue without interruption.
Interim Action Narrative: The residents will be moved to the school until issue is resolved.
Narrative:
Licensing Narrative: Licensing was informed of provider reported incident via email and
encouraged facility to enter the incident into ELS. The facility reported there are 8 residents
currently residing at the . 4/1/2025, Licensing observed and took pictures
where the residents were relocated while renovations are taking place. Licensing
spoke with Ms. Beverly and Ms. Susan about submitting a request for temporary approval.
Facility submitted a request for temporary approval for the accommodations at .
4/2/2025, temporary approval request sent to management for approval and request
approved. 4/3/2025, facility informed that request for temporary approval was approved.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

4/14/2025, faciltiy provided licensing with an update on . Per facility,
renovations would be completed this afternoon and requested to schedule a walkthrough on
4/15/2025. 4/15/2025, licensing completed a buildings and grounds for the
. 4/16/2025, licensing informed facility that they do not have to attend the board
meeting on 4/23/2025.


summary: The Licensing Unit visited the facility to conduct a random regulatory checks review. No deficiencies cited.

raw_content:
521 Visit Compliance Report

Licensee: Youth Home, Inc.

Facility Number: 128

Licensee Address: 20400 COLONEL GLENN ROAD
LITTLE ROCK AR 72210

Licensing Specialist: Kendra Slade
Person In Charge: Mary Kelly
Record Visit Date: 3/25/2025
Home Visit Date: 3/25/2025

Purpose of Visit: Monitor Visit

Regulations Out of Compliance:

Regulations Needing Technical Assistance:

Regulation Not Applicable:

Regulations Not Correctable:

Narrative:

Time of Visit: 10:30 am to 11:45 am

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

ARRAN SBA SE
DEPARTMENT OF

S77 HUMAN
=a SERVICES
Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot $140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550

EF
3/
rf

Page 1 of 3

Census: 43

Program Coordinator reviewed random regulatory checks for the PRTF program at Youth Home.

Program Coordinator was greeted by the receptionist who stated he would inform Ms. Diana Simon of
licensing’s arrival. Ms. Simon escorted Program Coordinator to the administrative area. Ms. Beverly Foti
provided Program Coordinator with the census. Ms. Simon and Program Coordinator picked staff members

from a provided list for the PRTF (Napier, Sturgis, Chestnut, Rose, Mabee) houses and other areas.

Napier House

B. Alexaner — Qualified Behavioral Health Provider (Part Time)

A. Paige - Qualified Behavioral Health Provider

Sturgis House
R. Horton - Qualified Behavioral Health Provider III

Y. Johnson - Qualified Behavioral Health Provider I
L. Jenkins - Qualified Behavioral Health Provider III
D. Miles - Qualified Behavioral Health Provider II]

Chestnut House

B. Julian - Qualified Behavioral Health Provider III
L. Ford - Qualified Behavioral Health Provider II
D. Wade - Qualified Behavioral Health Provider II]

Rose House

B. Pettigrew - Qualified Behavioral Health Provider Shift Lead
Z. Foreman — Qualified Behavioral Health Provider III
F. Armstrong — Qualified Behavioral Health Provider Shift Lead

Mabee House’

T. Crockett — Qualified Behavioral Health Provider III

J. Sprinkle — Qualified Behavioral Health Provider IT]

K. Goldman — Qualified Behavioral Health Provider Shift Lead

Other Staff Members

M. Griffin — Clinical Therapist

M. Egger — Clinical Therapist

G. Blair — Recreation Specialist IT

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

Page 2 of 3

T. McDaniel — Recreation Specialist

F. Egwim — Qualified Behavioral Health Provider (Sub-pool)
J. Tate — Qualified Behavioral Health Provider (Sub-pool)

B. Malone - Qualified Behavioral Health Provider Shift Lead
C. Hoof — Qualified Behavioral Health Provider J]

K. Otey - Qualified Behavioral Health Provider |

J. Davis — Registered Nurse

M.. Howell — Registered Nurse

All regulatory checks (Child Maltreatment and Arkansas State Police) reviewed complied with the minimum
license standards 103.2 and 103.5.

*#*#* Pursuant to A.C.A. § 9-24-406(e) (3-4): If you believe that the Department’s notice of noncompliance
is in error, you may ask for reconsideration. The request for reconsideration must be in writing and delivered
to the Department by certified mail within twenty (20) business days of receipt of the notice of
noncompliance. The request must specify the parts of the notice that are alleged to be in error, explain why
you believe those parts are in error, and include documentation to support the allegation of error. Once
received the Department shall issue a decision on your request within twenty (20) days after receipt of the
request.

Provider Comments:

CCL Staff Signature : Date: 3/25/2025
if

i
Analy
Provider Signature Date: 3/25/2025

ral
fever, bate
(/

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

doc_type: Visit Compliance Report


summary: A resident exposed himself to his peers while sitting in the milieu. The resident was put on a peer limit with all residents present.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 028139
Date of Incident: 3/8/2025
Date Received: 3/10/2025
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Incident Report date/time:
03/08/25 8:06pm Location of Incident: incident Description:
Events Leading: Client was sitting in the milieu during med
monitoring. Client raised up his leg and pulled his shorts up exposing his penis to his peers.
Incident Report was emailed to Kendra Slade on 03/10/25.
Interim Action Narrative: Resident was placed
on peer restriction and will not have a roommate.
Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Facility provided documentation for this provider reported incident. Documentation
reviewed and uploaded. Licensing inquired about safety plan and ratio at the time of this
incident. Facility reported: The ratio was 4 staff to 8 patients at the time of the incident. The
resident was placed on peer limits with all of those that were exposed. The resident did not,
and will continue to not, have a roommate.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A staff member visited the police station to file a report. The staff member reported that a resident kicked, headbutted, and spit at him.

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

Case P25-002123 - UNAPPROVED DRAFT Printed on October 15, 2025

Status Pending
Report Type Patrol
Primary Officer Adrianne Chambers
Investigator None
Records Technician
Reported At 03/06/25 16:18
Incident Date 03/06/25 16:18
Incident Code BATT : BATTERY
Location 20240 COLONEL GLENN RD, LITTLE ROCK, AR 72210
2
Southwest

Disposition P- PENDING
Disposition Date/Time 03/06/25 16:18
Review for Gang Activity Not Applicable

Primary Narrative By Adrianne Chambers, 03/06/25 16:38

Battery

On March 6, 2025 at approximately 1638 hours, Clytrell Daniel arrived at 2900 S woodrow to file an incident report.

Daniel stated that he works for the Youth Home located at 20400 Colonel Glenn Rd. Daniel stated that yesterday he
was involved in an incident with a patient by the name of . Daniel stated that was currently on lock
down and a took a water jug to his room which is considered contraband. Daniel stated that he and other staff members
were informed by the cites therapist, that if refused to listen or follow directions then to take — puzzles ad Lego's.
Daniel's stated that thats what he and other staff members did. Daniel stated that acted calm at first then started
to attack him and other staff members. Daniel's stated that started to kick him, spit at him, as well as head butting
him. Daniel's stated that the fight lasted from approximately 1224 hours to 1233 hours before it was broken up. Daniel's
stated that his supervisor, Anthony White witness the end of the fight. Daniel's stated that the facility had written an
incident report as well as notified . Daniel stated that he went to the doctor yesterday and
was Cleared by his doctor. Daniel stated that he had minor bruising to his knees, which photos will be attached to this
incident report. Daniel was provided with this incident number.

Case P25-002123 Page 1 of 1


summary: Resident was observed in her room with another resident lying on top of her, kissing her.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 027962
Date of Incident: 3/2/2025
Date Received: 3/3/2025
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Incident Report date/time:
03/02/25 6:15pm Location of Incident: Incident Description:
Events Leading: client was in her room at this time.
all the clients were in there room due to shower/phone call time. staff was walking the halls
to check on clients room at this time. client was seen laying down while another client was
on top of her kissing her. client expressed after she was caught that the other client forced
her to kiss her. she also stated that this has happened before. a was made. staff
told what reported to staff. Nursing Assessment
date/time: 03/02/25 6:40pm: pt sitting in a family room and deescalating with staff. tearful.
reports that peer tried to choke her. no s/sx of acute physical distress. resp even/unlabored.
cooperative. reports that neck hurts. no markings noted on the neck at this time.
. full ROM to all joints noted.
. offered prn pain med - refused at this time. expressed concerns about the school
tomorrow. reassured that it will be looked into in am. notified, pt placed on
FOH for safety. Guardian was notified on 03/02/25 at 7:01pm.
Interim Action Narrative: , resident was assessed by the nurse,
and placed on FOH.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Facility provided documentation for this provider reported incident. Licensing inquired
about safety plan. Facility reported: "Resident was put on a peer limit wherein she is not
allowed to communicate or be without 6 feet of peer. Her classes in school were also
switched so she is not in the same class as her peer." Resident was also placed on front of
house precaution last night to avoid them being in the same bedroom until room changes
can be made. The facility has a doctor?s order for the resident to always be in the milieu,
and sleep in the milieu as well, so she?s not in a dorm room. Licensing inquired about
witness statements and camera footage. 3/5/2025, facility reported that resident's bedroom
has changed. 3/6/2025, Program Coordinator reviewed camera footage and the facility
provided witness statement from the resident. No supervision concerns observed during
camera review.


summary: Resident was observed lying on top of another resident, kissing her.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 027960
Date of Incident: 3/2/2025
Date Received: 3/3/2025
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for
client in our PRTF program and resides in Incident Report date/time:
03/02/25 6:15pm Location of Incident: Incident Description:
Staff Involved:
Leading: client was in her room. Client was
caught by staff laying on top of her peer kissing her. Client processed with staff about her
action. She told staff that she didn't do anything. Client told staff that she was just playing
around. a . staff reported to the what the victim stated that this
client forced her onto the bed. Nursing Assessment date/time: 03/02/25 6:34pm: pt is in her
room laying in bed with eyes closed. arouses to verbal stimuli. no s/sx of acute physical
distress. resp even/unlabored. cooperative. denies any
needs/complaints/concerns/pain/injuries at this time. full ROM to all joints noted.
notified, pt placed on Freeze PA. Guardian was notified on 03/02/25 at 7:04pm
Interim Action Narrative: resident was assessed by the nurse,
and placed on freeze.
Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing reviwed provider reported incident for licensing concerns.
Facility provided documentation for this provider reported incident. Licensing inquried
about safety plan. Licensing inquried about safety plan. Facility reported: "Resident was
put on a peer limit wherein she is not allowed to communicate or be without 6 feet of peer.
Her classes in school were also switched so she is not in the same class as her peer.
Licensing requested witness statements and camera footage. 3/6/2025, Program
Coordinator reviewed camera footage and the facility provided witness statement from the
resident. No supervision issues observed during camera review. 3/11/2025, witness
statement reviewed and uploaded.


summary: A resident was sent to the emergency room for evaluation after injuring her hand by punching a mirror.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 027879
Date of Incident: 2/26/2025
Date Received: 2/27/2025
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for Private placement
client in our PRTF program and resides in House Incident Report date/time:
02/26/25 7:15pm Location of Incident: House Incident Description: Self Injury(Not
Suicidal), Threat to Safety, Medical Emergency ( Staff Involved:
Tyreesha McCollum, Kantris Oliver, Lauryn Gilmore, Amiya Walker, Joseph Davis, Ashley
Sims Events Leading: The client had a phone call with her mother, in which her mother
tried to encourage her to move past her frustration with a fellow peer. The client expressed
that she has not been loved and been mistreated. The client expressed how her peers were
ridiculing her and bring up past situation with a fellow peer. The client did not finish the
phone call with her mother, the client began to escalate and punch walks and pace. Client
went to the rec room and began to pace and punch walls. Client then exited the rec room
and flipped over the table where another staff's computer was. Staff's computer was
damaged in the process. Client then returned to the rec room and continued pace, cry,
breathe heavy, and punch walls. Client punched the mirror in the rec room, causing it to
chip and caused her hand to bleed. Her other hand was swollen and discolored. Nursing
Assessment 1 date/time: 02/26/25 7:40pm: It was reported that pt was hitting walls and
plastic mirror. Pt was pacing the day room, clenched fists, angry. Pt would not allow staff
close to her. She did allow this nurse to assess her hands. Right hand was bruised, red, and
swollen. Left hand was swollen and had about a half inch open wound on the top of the
hand. Pt refused Ibuprofen, ice pack, and having VS taken. Notified on call provider of
incidents and wounds. Pt eventually allowed assessment of vitals - ,
Pt being sent out to to have hands evaluated. Mom notified and reported
she was in route to to meet patient. Nursing Assessment 2 date/time: 02/27/25
1:02am: Returned from @ around 1:00am. Both hands bruised and scarred from
punching walls. Said she was fine. No complaints of any kind. Said she didn't get night time
meds , but that she was okay. Was ready for bed. Per staff and patient no fractures were
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

found. Returned with no discharge instructions/paperwork.
Guardian was notified
on 02/26/25 at 7:16pm. paperwork was emailed to Kendra Slade on 02/27/25.
Interim Action Narrative: Resident was assessed by the nursed and evaluated at the .
Narrative:
Licensing Narrative: Licenisng reviewed provider reported incident for licensing concerns.
Facility provided documentation for this provider reported incident. Documentation
reviewed and uploaded. Licensing inquired if the mirror was removed.Facility reported that
the mirror (plastic/shatterproof) was removed from the wall.


summary: A resident was found in her bedroom with pants tied around her neck. The resident was placed on Eyeball, Front of House, and Supportive Status.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 027831
Date of Incident: 2/24/2025
Date Received: 2/25/2025
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for Private placement
client in our PRTF program and resides in House Incident Report date/time:
02/24/25 6:30pm Location of Incident: House Incident Description: Suicidal Staff
Involved: Jasmine Griffin, Joseph Davis Events Leading: i was doing phone calls and i
called clients mom clients mom stated that was disrespectful and hung up in her face
yesterday because she told her no to bringing makeup for her. client got upset about that
and went to her room about a hour later clients roommate came to me and told me to come
here i walked in her room and client was tearful and had her sweatpants around her neck,
client let me remove her pants from her neck and didn't really talk much i asked her why
was she upset she stated it was because she wanted to talk to her mom and she feels her
mom is being mean to her. Client wrote a last letter to mom stating she loves her but she
doesn't want to be here anymore. I asked client can she come to the mileu with me and the
client complied and came up to the mileu to sit with me. i called clients mom a little after
the incident and mom stated she still doesn't want to talk to her and that she has to protect
her peace and can't allow to be disrespectful as that is the whole reason she's at
youthhome. client appeared to calm down after meds and asked me to take a shower client
was placed on eyeball and complied with keeping the door cracked to be monitored.
Nursing Assessment date/time: 02/24/25 7:00pm: Client reportedly was in her room after a
bad phone call with guardian. Client reportedly tied pants around her neck. Staff was able to
remove ligature without restraint or injury. Client is nonverbal, looking downwards. Denies
pain/injury, shrugs shoulders. Neck appears wnl, full active ROM to neck, no signs of
injury noted. The tissue appears intact, there is no bruising noted. Client tearful, and agrees
that she had a bad phone call. Encouraged client to be strong and confident, as this
situation is temporary and suicide is a permanent solution to a temporary problem.
Encouraged client to use healthy coping skills like exercising, reading, writing, walking
and/or talking. Client did not contract for safety and was placed on eyeball, front of house,
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

and supportive status. A packet was printed out for her and placed near her bed. Client is
resting quietly with eyes closed at this time. Guardian was notified on 02/24/25 at 10:15pm.
Interim Action Narrative: Staff intervened and resident was assessed by the nurse.
Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Facility provided documentation for this provider reported incident. 2/26/2025,
documentation reviewed and uploaded. Resident was placed on eyeball and front of house.


summary: A resident was found with a stick and poke tattoo on her hand.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 027813
Date of Incident: 2/20/2025
Date Received: 2/25/2025
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for Private
placement client in our PRTF program and resides in House Incident Report
date/time: 02/20/25 4:31pm Location of Incident: House Incident Description: Self
Injury (Not Suicidal) Staff Involved: Jasmine Griffin, Amiya Walker, Charles Murphy,
Ebony Galmore Events Leading: The client would be in their room during quiet time and
would inflict this wound out of "boredom" Client appears to have tattooed themselves using
the "stick and poke" method, with the word "love" on her right hand. They would seem to
be mimicking behaviors of other clients in the house and would even tell their mother they
did it out of boredom. The client would then afterwards process with a staff member saying
they would do this out of boredom. They would call it a "Stick and poke" and appear
emotionally stable. Client assessed by nurse; room searches were conducted. Nursing
Assessment date/time: 02/20/25 5:10pm: Nurse received a call from staff regarding patient
engaging in self-tattooing behavior using the stick-and-poke method to tattoo the word
"love" on her left thumb. Nurse conducted a face-to-face assessment, during which the
patient stated she used a piece of wood obtained from the closet in her room to perform the
tattoo. Patient reported no pain or irritation at the site; however, nurse observed redness and
mild edema. Patient stated she engaged in this behavior out of boredom. Nurse educated
patient on the risks of infection from using unsterilized items for tattooing. Patient verbally
acknowledged understanding with no further questions or concerns. No signs of distress
were noted at this time. On-call MD was notified, and the following orders were given:
Freeze, FOH, Eyeball, and SS. On-call CT and on-call UM were also notified. Nurse spoke
with patient's mother, who expressed frustration with patient's actions and behaviors but
reported no additional concerns. Guardian was notified on 02/20/25 at 5:20pm
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Interim Action Narrative: Resident was assessed by the nurse and placed on safety
precuations.
Narrative:
Licensing Narrative: Facility informed licensing of this provider reported incident.
2/25/2025, licensing reviewed provider reported incident for licensing concerns. Facility
provided documentation for this provider reported incident. Documentation reviewed and
uploaded.


summary: A resident was transported for acute care after becoming aggressive with staff and exhibiting unsafe behaviors.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 027681
Date of Incident: 2/18/2025
Date Received: 2/20/2025
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for Private
placement client in our PRTF program and resides in House Incident Report
date/time: 02/18/25 8:26pm Location of Incident: House Incident Description:
Threat to Safety Staff Involved: Ebony Galmore, Jasmine Griffin, Kelton Johnson, Ben
Malone, Ashley Pankey, Meredith Reddin Events Leading: client was placed on front of the
house due to her unsafe behaviors, including peers attempting to attack her for being
aggressive with staff members. client was given this information then she started to be
aggressive with staff. client pushed a staff member during this time because she was upset .
As staff was trying to remove the client's mattress from her room client started to pull/tug
bed away from staff to keep her bed from coming to the front. Client had to be restrained at
this time to keep everyone safe. 8:26pm-Personal Restraint: client was being aggressive with
staff after being asked to leave room. client had to be removed from her room due to unsafe
reasons. client was hitting, and kicking staff while being removed from her room. Client was
walked to the milieu, and restrained in a seated position on the couches in the milieu
8:28pm-Personal Restraint End: client was release from the restraint. client was tearful at
this time. client was asking for support from a staff member at this time. 8:30pm-Personal
Restraint: client was being no compliant with staff. client asked for a phone call. staff told
her that she could not make a call until she calmed down. client started yelling at staff' i
need a call now'. client was told again that if she calmed down that she will get a phone call.
client started walking toward the phone, and started dialing her moms phone number. client
was asked to step away from the phone at this time. client refuse to step away from the
phone. staff reached in to take the phone then she started to assault a staff member with a
phone. client had to be restrained at this time. 8:39pm-Personal Restraint: client was still
being non complaint with staff at this time. a chemical restraint was requested at this time.
8:45pm-Chemical Restraint: client was aware that she will be getting a chemical shot. client
did not want a chemical shot she was scared of the needle. client was giving the option to
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

take a chemical pill, client agreed to the chemical pill by mouth. client took the pill at this
time. 8:47pm-Personal Restraint End: client just finishing taking a chemical pill. client
contracted to safety, and was released at this time. Patient Debriefing date/time: 02/18/25
8:46pm: after taking the chemical pill client finally calmed down. client did not apologize to
staff about her actions. client did state that she was ready to lay down. she went to sleep
shortly after at this time. Nursing Assessment date/time: 02/18/25 9:15pm: The nurse
received orders for the client to be placed at the front of the house due to unsafe behaviors,
including threats from peers attempting to attack her in response to her aggression toward
staff. The client was informed of this decision, at which point she became aggressive with
staff. During this escalation, the client pushed a staff member in frustration. As staff
attempted to remove the client's mattress from her room, she began pulling and tugging at
the bed to prevent its relocation. Due to continued aggression and safety concerns, the
client was placed in a personal restraint. Upon release from the restraint, the client
attempted to attack staff, ran into unauthorized areas, and attempted to use the phone
inappropriately. The client was subsequently placed in another personal restraint to ensure
safety. Following this incident, the on-call MD was notified of the client's unsafe and
disruptive behaviors, and the following orders were approved: personal restraint, freeze PA,
and chemical restraint. The nurse completed a face-to-face assessment at 9:15 PM, during
which the client denied any physical injuries or concerns. The client was observed lying on
a mattress at the front of the house and requested earplugs, which were provided. The on-
call UM was notified at 9:28 PM, and the on-call therapist was informed at 9:34 PM.
Guardian was notified on 02/18/25 at 9:05pm.
on 02/19/25 at 12:33pm for an .
Interim Action Narrative: Resident was restrained for safety and assessed by the nurse.
Narrative:
Licensing Narrative: Facility emailed Program Coordinator regarding this provider
reported incident. 2/20/2025, provider reported incident was reviewed for licensing
concerns. Facility provided documentation for this provider reported incident.
Documentation reviewed and uploaded. Resident will return to the facility after .


summary: Staff conducted a room check and found a homemade tattoo gun hidden in a resident’s bedroom. The resident admitted that it was hers and that she gave herself and other peers tattoos with the item.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 027613
Date of Incident: 2/15/2025
Date Received: 2/17/2025
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for Private placement
client in our PRTF program and resides in House Incident Report date/time:
02/15/25 3:31pm Location of Incident: House Incident Description: Self Injury(Not
Suicidal), Threat to Safety Staff Involved: Aloria McKoy, Montez Peterson, Gregory Nesdahl
Events Leading: Staff conducted a room check and found a homemade tattoo gun hidden
on top of the mirror inside the bedroom. Client admitted to staff that it was hers and that
she was the one who made the contraband. Client also admitted to giving herself and other
peers tattoos with the item as well. Nursing Assessment date/time: 02/15/25 5:15pm:
Patient presents at nurse station reporting that she administered a puncture through the
skin tattoo onto her left hand that reads "I quit'. No redness or swelling noted. Patient
denies having pain at this time. Patient educated on the dangers of puncture to the skin
with infection. Patient hands were cleaned by patient with soap and water and nurse
administered triple antibiotic ointment. Provider notified and no new orders at this time.
Will monitor for infection. Guardian was notified on 02/15/25 at 5:05pm
Interim Action Narrative: Resident was assessed by the nurse and educated on the dangers
on punctures to the skin.
Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Facility provided documentation for this provider reported incident. Licensing reviewed and
uploaded documentation for this provider reported incident. Facility reported resident was
put on front of house, supportive status, eyeball, and freeze.


summary: A resident was seen with a stick and poke tattoo on her hand. The resident reported that she let a peer administer the tattoo on her hand.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 027616
Date of Incident: 2/15/2025
Date Received: 2/17/2025
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for Private placement
client in our PRTF program and resides in House Incident Report date/time:
02/15/25 4:38pm Location of Incident: House Incident Description: Self Injury(Not
Suicidal), Threat to Safety Staff Involved: Fredricka Armstrong, Aloria McKoy, Montez
Peterson, Gregory Nesdahl Events Leading: While walking to the café staff noticed a stick
and poke tattoo on the clients hand. Nursing Assessment date/time: 02/15/25 5:15pm:
Patient present at nurse station window. Patient reports she allowed a female peer to
administer a puncture through skin tattoo on her righthand in black ink. Not pain noted.
No redness present or edema. Patient washed hand with soap and water. triple antibiotic
ointment administered. On call provider notified and no new orders received. Guardian was
notified on 02/15/25 at 5:43pm.
Interim Action Narrative: Resident was assessed by the nurse.
Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Facility provided documentation for this provider reported incident. Licensing reviewed and
uploaded documentation. Licensing will inquire if resident was placed on any precautions
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

and/or peer. Facility reported resident was put on front of house, supportive status, eyeball,
and freeze.


summary: A resident was seen with a stick and poke tattoo on her hand. The resident admitted to staff that she asked her peer to give her a tattoo.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 027614
Date of Incident: 2/15/2025
Date Received: 2/17/2025
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for Private
placement client in our PRTF program and resides in House Incident Report
date/time: 02/15/25 3:31pm Location of Incident: House Incident Description: Self
Injury(Not Suicidal), Threat to Safety Staff Involved: Aloria McKoy, Montez Peterson,
Gregory Nesdahl Events Leading: While talking to the peer that made the tattoo gun, said
peer mentioned she'd given and a tattoo as well. admitted to staff that she
asked her peer to give her a tattoo knowing it was against YH policy. was pulled to the
side after dinner to confirm that she had a stick and poke tattoo of a smiley face on her
hand. Nursing Assessment date/time: 02/15/25 4:57pm: Patient present at nurse station
window. Patient reports she allowed a female peer to administer a puncture through skin
tattoo on her righthand in black ink. Not pain noted. No redness present or edema. Patient
washed hand with soap and water. triple antibiotic ointment administered. On call provider
notified and no new orders received. Guardian was notified on 02/15/25 at 5:38pm
Interim Action Narrative: Resident was assessed by the nurse.
Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Facility reported resident was put on Front of House, Supportive Status, Eyeball, and
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Freeze. Facility provided documentation for this provider reported incident. Documentation
reviewed and uploaded.


summary: A resident was transported to the emergency room after exhibiting seizure-like behavior.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 027558
Date of Incident: 2/12/2025
Date Received: 2/13/2025
Facility Name: Youth Home, Inc.
Facility Number: 128
Incident Type: Licensing
Report Description: Incident Report for Private
placement client in our PRTF program and resides in House Incident Report
date/time: 02/12/25 7:53pm Location of Incident: House Incident Description:
Staff Involved: Mya Medley, Micah Craig,
Ebony Galmore, Joseph Davis Events Leading: The client was upset about a conversation
with her therapist regarding being placed on TRS. The client processed with staff and
seemed receptive to the information. As the client began walking to her room, she fainted in
the hallway and exhibited seizure-like behavior. paperwork was emailed to Kendra Slade
on 02/13/25.
Interim Action Narrative: Resident was assessed by the nurse and evaluated at the .
Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Facility provided documentation for this provider reported incident. Documentation
reviewed and uploaded.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: An Inspection of Care review was conducted. No deficiencies were cited.

raw_content:
February 14, 2025
Youth Home, Incorporated
20400 Colonel Glenn Rd
Little Rock, AR 72210-5323
The Division of Provider Services and Quality Assurance (DPSQA) of the Arkansas Department of Human
Services has contracted with Arkansas Foundation for Medical Care (AFMC) to perform Inspections of Care
(IOC) for Inpatient Psychiatric Services for Under 21. The Medicaid Manual for Inpatient Psychiatric Services
for Under Age 21 was used in the completion of this report.
Observations and any deficiencies noted are listed below for the inspection conducted at the following service
site on the following date:
Youth Home, Incorporated
Provider Medicaid ID:
Onsite Inspection Date: February 11, 2025
Onsite Inspection Time: 9:00 AM
A summary of the inspection and any deficiencies noted are outlined below.
Inspection of Care Summary
Facility Tour:
Upon arrival at the facility, AFMC staff were promptly greeted at the entrance by a Youth Home, Incorporated
receptionist in the main lobby. AFMC staff signed the visitor log and were given visitor badges. AFMC was
immediately taken to a conference room where they were met by the Regulatory Director, Utilization Review
Director, Records Compliance Director, and the Training Officer. AFMC staff were given the completed and
signed consent form listing approval for access to the AFMC portal. Facility staff were given the Document
Request Form and AFMC staff discussed the requirements for the Inspection of Care.
A tour of the facility was completed with a Unit Manager. The facility environment was extremely clean, well-
organized, and appeared to be in good repair. In two of the dormitories there were clients on unit restrictions
with staff members in attendance. All other clients were in classes in the educational school building. There
were no immediate issues noted during the facility tour. Staff were able to answer questions regarding the
facility.
Facility Review – Policies and Procedures:
Upon review of the site’s policies, procedures, and certification requirements, no deficiencies were noted.
Personnel Records – Licenses, Certifications, Training:
There were thirty-nine personnel records reviewed, eight (28%) professional staff and thirty-one (26%)
paraprofessional staff. Upon review of the personnel records, no deficiencies were noted.
Observations:
At the conclusion of the onsite inspection, AFMC staff reviewed the final document request form with the
Regulatory Director, Utilization Review Director, Records Compliance Director, and the Training Officer at the
completion of the on-site Inspection of Care. The provider signed the acknowledgement of manual requirements

that were made available in the provider’s policy and procedures. AFMC staff explained that these findings were
preliminary and there was still an off-site portion to be completed.
Clinical Summary
As a part of the Quality-of-Care survey of the IOC, an active Fee for Service (FFS) Medicaid client list was
requested, client and/or guardian interviews were conducted, and a clinical record review was completed. The
following is a summary of findings and noted deficiencies.
Client/Guardian Interviews:
There was no active FFS Medicaid clients currently admitted at the time of IOC. Therefore, no client interviews
were conducted.
Program Activity/Service Milieu Observation:
In two of the dormitories there were clients on unit restrictions with staff members in attendance. All other clients
were in classes in the educational school building. Clients were engaged in schoolwork and organized activities.
Staff were calmly interacting with clients and providing a therapeutic environment that was conducive for learning
and treatment therapies. All areas with clients were noted to be staffed adequately and according to the facility’s
staffing ratio policy.
Medication Pass:
No active FFS Medicaid clients received medications during medication pass. Due to the observation of non-
Medicaid clients not being complaint with the HIPAA minimal necessary rule, no medication pass was
observed. The tour of medication room was completed with facility staff and a review of facility policies and
procedures regarding medication administration, count/reconciliation/handling of controlled substances, and
medication errors/discrepancies was completed. There were no discrepancies noted regarding medication
storage, cleanliness of the medication room, and policy review.
Clinical Record Review Deficiencies:
There was no active FFS Medicaid clients currently admitted at the time of IOC. Therefore, no clinical records
reviews were conducted.
Respectfully,
Inspection of Care Team
InspectionTeam@afmc.org
1020 W. 4TH ST., SUITE 300
LITTLE ROCK, AR 72201 • afmc.org
Youth Home, Incorporated – Little Rock, AR – IOC Report 2 | P ag e

doc_type: IOC Report


summary: A resident was transported to the emergency room after blacking out and being found on the floor of the bathroom.

raw_content:
house, upon return from , around 5:30am per staff. Pt was walking and talking,
alert and oriented X 3. Speech Clear. Eyes PERRLA. Pt understood instructions from
to and . No reports of pain from pt. Pt
states is sleepy from being up all night. No bleeding or bruises noted. Vitals as follows:
. Notified provider. No further needs at this time.
Guardian was notified on 01/31/25 at 7:33pm and on 02/01/25 at 7:10am.
Interim Action Narrative: Resident was assessed by the nurse and evaluated at the
Narrative:
Licensing Narrative: Facility sent an email to licensing regarding this provider reported
incident and provided documentation. Licensing reviewed provider reported incident for
licensing concerns, reviewed and uploaded documentation.


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

raw_content:
521 Visit Compliance Report

Licensee: Youth Home, Inc.

Facility Number: 128

Licensee Address: 20400 COLONEL GLENN ROAD
LITTLE ROCK AR 72210

Licensing Specialist: Kendra Slade
Person In Charge: Mary Keily
Record Visit Date: 1/29/2025
Home Visit Date: 1/29/2025

Purpose of Visit: Subsequent Building and Grounds

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

Regulations Not Correctable:

Narrative:

Time of visit: 12:00 pm to 12:45 pm

www.arkansas.gov/dhs. : Se
Serving more than one million Arkansans each eal :

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

“Page 1 of 3

Census: 46
Program Coordinator Slade was escorted throughout the PRTFs by two Youth Home staff members.

The following areas were observed in each house: milieu/dayroom, kitchen/dining area, laundry room,
game/quiet room, bedrooms, and bathrooms.

Walking to the different houses, Program Coordinator observed the grounds were maintained, There were
leaves on the grounds, parked cars and/or a van parked near each house, and some houses had outdoor
greeting signs. Most of the residents were at school during the walkthrough of the houses.

Mabee House: Ratio 1:1, there was a resident on shut down. The resident and staff member were sitting in the
milieu/dayroom area. She appeared to be working on schoolwork. Bedrooms were organized and maintained.
Bathrooms were clean. Program Coordinator noticed the bathroom doors had a slide like device (color
changes) for residents to indicate if the bathroom is occupied.

Chestnut House: There were no residents present during the walkthrough. There were two staff members
present. One staff member appeared to be completing paperwork and the other staff member communicated
with Program Coordinating while walking through the house. Some bedrooms were cleaner than others. The
bathrooms were clean, and no odor was detected.

Sturgis House: Ratio 2:3, the residents and staff members were eating lunch. Per staff, the residents were at
the house for one of the following: shut down, physical aggression, or house restriction. The bathrooms were
clean, and some bedrooms were cleaner than others.

Rose House: Ratio 1:3, two residents were on house restriction and the other resident was on medical. The
resident on medical was in a room off to the side of the milieu. The staff member was sitting at a table facing
the bedroom hall. There was a resident in her bedroom due to licensing being in the building and the other
resident was down the hall in the bathroom.

Program Coordinator observed the bathrooms that were unlocked. These bedrooms belonged to the residents
that were in the house. The residents’ bedrooms were clean and organized and the bathrooms were clean also.

Napier House: No residents were present during the walkthrough. Each bedroom and bathroom were clean.
There were two staff members present during the walkthrough. One staff member was in the staff's office and
the other staff member was eating lunch at the workstation facing the resident’s bedrooms. Ms. Betty (staff
member) reported that the residents cook a meal once a week with staff for life skills.

All areas observed were safe and in good repair. The grounds were clean and free of safety hazards.

Provider Comments:

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CCL Staff Signature : Date: 1/29/2025

Provider Signature : Date: 1/29/2025

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summary: An officer was dispatched to the facility in response to a disturbance. A staff member stated that a resident struck him in the back of the head with a closed fist, grabbed his hair, and refused to let go.

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

Case P25-000858 Printed on February 20, 2025

Status Approved
Report Type Patrol
Primary Officer Lance Parker
Investigator None
Records Technician
Reported At 01/28/25 23:00
Incident Date 01/28/25 23:00
Incident Code BATT : BATTERY
Location 20400 COLONEL GLENN RD, LITTLE ROCK, AR 72210
2
Southwest

Disposition CA- Cleared by Arrest
Disposition Date/Time 01/29/25 01:11
Disposition Comments

bs#2495
Review for Gang Activity Not Applicable

Primary Narrative By Lance Parker, 01/29/25 01:16
Battery

On 1/28/25 at approximately 2305 hours |, Deputy L. Parker, responded to the Chestnut House at the youth services
home located at 20400 Colonel Glenn Road in reference to a disturbance. Upon arrival | made contact with the
complainant, Dejuan Williams, who is a Qualified Behavioral Health Provider (QBHP) for the youth home. Williams
advised that just prior to our arrival he was involved in an altercation with a resident minor,

Williams advised that got very angry with him this evening when he came into _— room. He advised that he
was attempting to take two water bottles away from after grabbed them and took a fighting stance
against Williams. Williams advised that when he attempted to take the bottles struck him in the back of his
head with a closed fist and then grabbed a handful of his hair and refused to let go; Williams believed that he may have
had some hair pulled out but was unable to locate his hair on the floor at this time. There was a light spot on his head
in the area he pointed to where the hair was grabbed. Williams advised that he and several other workers at the youth
home had to pry __.. . fingers/hand open in order to get him to release his hair. Williams refused medical
attention at this time but advised he wishes to pursue charges against

| then made contact with who advised a similar story. | stated that _ was angry at Williams for trying to
take things from _roomand — grabbedhishair. _ advisedthat _ left hand was sore from where staff had to force

hand open to get to release William's hair. There was visible redness on left hand. | spoke with
another QBHP that was present during the incident and witnessed the altercation, Diana Coleman. Coleman advised a
similar recount as Williams in that she saw take an aggressive stance holding two hard plastic water bottles
filled with water like | was about to use them against Williams. Coleman then observed as Williams took the water
bottles away from and then .._ struck Williams in the back of the head and grabbed his hair. She advised
that it took several staff members prying hand open before _finally released William's hair.

| was informed by the staff that MEMS was already on the way to the scene to transport to Rivendell. |
contacted the Juvenile Intake Officer, Elizabeth Mahan, and apprised her of the situation; | advised her that | am
looking to charge with Battery 2nd due to _— causing injury to a professional worker for Youth Services.
Mrs. Mahan advised to issue a court date to February 27, 2025 at 1000 hours. | completed an ADR for

Case P25-000858 Page 1 of 2

Battery 2nd and provided with — copy containing said court date. A copy of the ADR and photographs
were attached to this report to be used as evidence. The original ADR was submitted to records for dissemination to
the proper channels.

MEMS 625 arrived on scene. | apprised them of the situation and requested they conduct an assessment on __. mental
well-being due to the caller advising to dispatch that was feeling "homicidal" toward staff. | also requested
they check for injuries following the altercation. was cleared by MEMS to be transported to Rivendell;
was loaded onto the ambulance and transported without further incident. | provided the staff at the Chestnut House

with — report number and advised them to contact the Sheriff's Office if they have any further questions. Staff advised
there are cameras in the building, however, the one nearest to room would likely be unable to see much
of the incident. They advised me that they could not access cameras at this time, but may be able to provide camera
footage at a later date.

| was advised by staff that with Nevada County DHS. Her
information and phone number are attached to this report as requested by Mrs. Mahan so that she can be made aware
of this situation.

CFS: 2025-06184

Case P25-000858 Page 2 of 2