summary: Two residents eloped from the facility by climbing a fence while outside.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 024460
Date of Incident: 10/1/2024
Date Received: 10/2/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 10/1/24 at approx. 1700
) and were outside on the main court when
staff noticed the resident and peer isolating by the fence. Staff members attempted to
process with both the resident and the peer. While processing, the peer climbed the fence
and then the resident appeared to follow. Both residents proceeded to elope off the facility
property despite numerous staff attempts to de-escalate and process. Administrator on call
was on the scene of the incident. Fayetteville PD were contacted at approx 1702. At
approximately 0530 on 10/2/24 both residents knocked on the back door to north and were
allowed back in the facility. Both residents were searched and the police were contacted that
the residents were back. Both residents were placed on elopement precautions and
restricted to the unit x24 hr's to be reassessed. Both residents will process with primary
therapists and JPO of was notified.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 10/3/2024 - Licensing specialist reviewed the provider reported
incident. Licensing will follow up with facility for nursing notes and incident report.
10/9/2024 - Incident report information received, reviewed and uploaded to ELS.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


state: AR

facility_name: Yellow Rock Behavioral Health (formerly Piney Ridge)

summary: Officers were dispatched to the facility for two runaway juveniles.

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

Incident Report
Print Date/Time: 10/21/2024 07:50 Fayetteville Police Department
Login ID: aarcher ORI Number: AR0720100
Date Code Type Make Model Description Tag No. Item No.
Page: 2 of 3

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

doc_type: Police Report


summary: A resident was transported to Arkansas Children’s Hospital after reporting he was having auditory and visual hallucinations.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 024410
Date of Incident: 9/30/2024
Date Received: 10/1/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description:
) reported he was having auditory and visual hallucinations after he
had gotten in Referral was made for acute care, he was transferred to Arkansas Childrens
Hospital via EMS under the direction of Melissa Chambers from DCFS. Our staff stayed at
the hospital with him until a DCFS worker was able to meet them. was
then admitted to Bridgeway in Little Rock for acute care.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 10/2/2024 - The provider reported incident was reviewed by the
licensing specialist. Licensing specialist will follow up with the facility if the resident will be
returning after acute.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

doc_type: Notice of Incident


summary: A resident was sent to Physicians Hospital for treatment of a laceration after a peer hit him in the head with a chair.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 024408
Date of Incident: 9/30/2024
Date Received: 10/1/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: Resident
09/30/24 @1138 Peer
asked teacher for staff?s name. Staff turned
around and said their name to peer. Peer kept pronouncing it wrong. Resident
told peer it wasn?t a hard name to pronounce and peer told resident to shut up. Resident
antagonized peer verbally and peer got up, got a chair and hit resident on the top of the
head. Resident went out of the room immediately and was taken to the nurses. Resident was
assessed by nurses with a laceration noted on the top of the right side of his head and
another laceration on the top of the left side of his head. First aid applied. APRN on call
notified and gave orders for resident to go out to Physicians Hospital. Resident also noted
swelling to left hand from punching the wall while resident was frustrated from the
altercation. Upon return, resident with two staples to left side laceration, 5 staples to right
side laceration. Left hand placed in splint. Follow up according to orders. Will remove
Staples in 10-14 days as directed. will follow-up with APRN at facility as needed.
was placed on assault precautions will be on no sports
until healed
Interim Action Narrative:
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: 10/2/2024 - The provider reported incident was reviewed by the
licensing specialist. Licensing specialist will follow up with the facility for nursing notes and
hospital discharge paperwork. 10/14/2024 - Nursing notes and aftercare documentation
received, reviewed and uploaded to ELS.


summary: Officers were dispatched to the facility to assist EMS with a patient.

raw_content:
Incident Report
Print Date/Time: 10/21/2024 07:45 Fayetteville Police Department
Login ID: aarcher ORI Number: AR0720100
Incident: 2024-00068499
Incident Date/Time: 9/30/2024 1:11:25 PM Incident Type: ASSAULT BATTERY
Location: 4253 N CROSSOVER RD Venue: FAYETTEVILLE
FAYETTEVILLE AR 72703
Phone Number: (479)521-5800 Source: Phone
Report Required: No Priority: 3-Low
Prior Hazards: No Status: Report
LE Case Number: Nature of Call:
Unit/Personnel
Unit Personnel
351 351-JEHL
509 509-GRAY
Person(s)
No. Role Name Address Phone Race Sex DOB
1 Caller MOORE, ANNA
2 Caller CEMS (479)521-5800
Vehicle(s)
Role Type Year Make Model Color License State
Disposition(s)
Disposition Count Date/Time
Unit:351
Disposition Count Date/Time
03NORPT 1 09/30/2024 13:50
Unit:509
Disposition Count Date/Time
03NORPT 1 09/30/2024 13:38
Property
Date Code Type Make Model Description Tag No. Item No.
Page: 1 of 1
Page: 1 of 2

CAD Narrative
09/30/2024:13:37:35jgrayNarrative:STANDBYWHILECEMSPICKEDUPPATIENT.NOISSUES.D3
09/30/2024:13:18:20bwhiteNarrative:STAFFISGOINGWITHTHEAMBULANCE
09/30/2024:13:17:56bwhiteNarrative:CALLERREQANAMBULANCEDUETOSUBJSEEING&HEARINGTHINGS
09/30/2024:13:17:37bwhiteNarrative:NOTCOMBATIVERIGHTNOW
09/30/2024:13:17:28bwhiteNarrative:ASSAULTOCC'DTHISMORNING
09/30/2024:13:17:22bwhiteNarrative:INDHSCUSTODY,REQHEBEENSENTBYAMBULANCETOTHECHILDRENS
HOSPITAL
09/30/2024:13:16:58bwhiteNarrative:
09/30/2024:13:16:49bwhiteNarrative:CEMSCALLED&ADVCALLWASTRANSFERREDTOTHEM,REQPDRESPOND
FORSUBJTHATASSAULTED2SUBJSATTHISLOC
09/30/2024:13:13:05bwhiteNarrative:CALLINGBUSNTOGETFURTHERINFO
09/30/2024:13:12:09bwhiteNarrative:UNKFURTHER
09/30/2024:13:11:55bwhiteNarrative:INTHEINTAKEAREA
09/30/2024:13:11:48bwhiteNarrative: MALEASSAULTED2SUBJSATTHISLOC
Page: 2 of 2

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


summary: A resident was sent to Arkansas Children’s Hospital after twisting his ankle while playing football.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 024355
Date of Incident: 9/29/2024
Date Received: 9/30/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 9/29/24 at approximately 1520
) was playing football in the gym when he jumped to catch a football and landed
on his right ankle, twisting it. He expressed pain and an inability to walk on it, and was sent
to Arkansas Children's Hospital for evaluation. ACH diagnosed
He returned to PRTC on 09/29/2024
Follow-up orthopedic appointment to be scheduled.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 10/1/2024- Licensing specialist reviewed the provider reported
incident and will follow up with the facility if the resident was placed on any restrictions.
10/1/2024 - Facility response received: "He was placed on no sports. "
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Physicians Specialty Hospital for evaluation of his jaw after an altercation with a peer.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 024360
Date of Incident: 9/28/2024
Date Received: 9/30/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 09/25/2024, was in a
verbal altercation with a peer that resulted
in punching in his mouth. No injuries were reported or observed by/of
either resident at that time. On 09/28/2024, reported to nursing an inability to
swallow easily and pain to his jaw. He was sent on 09/28/2024 to Physicians Specialty
Hospital ER. He was diagnosed and returned to
PRTC on 09/28/2024. Follow-up orthopedic appointment to be scheduled. At the time of
the incident - was placed on assault precautions, his JPO has been in contact from
the facililty and continues to process behaviors with therapist.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 10/1/2024 - The provider reported incident and facility implement was
reviewed by the licensing specialist. Licensing specialist will follow up with the facility in
regards to camera footage of the incident. 10/1/2024 - Response received from the facility
stating "The incident was outside where there is not video and too far back time wise."
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident eloped from the facility while outside. The resident was returned later by the Springdale Police Department. 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
Notice of Serious Incident
Case Number: 024303
Date of Incident: 9/24/2024
Date Received: 9/27/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 9/24/24 at
approximately 1120 was refusing outside, took his shoes and socks off and while staff was
processing with him, resident went over the fence and ran towards the apartments next to
the facility. Staff attempted to follow but he could not be located. Fayetteville police
department was called at 1128. Resident was brought back by Springdale Police at 1604, skin
assessment was completed and Resident had a small abrasion on top of right foot, no
bleeding noted. He was placed on elopement precautions and restricted to unit to be re-
assessed at 24 hours. He will also process with primary therapist. saw the APRN
the next day, an xray for left foot was ordered after he reported that he jumped down a
bridge while out of facility unauthorized. On 9/25/24 the in house xray occured
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 9/27/2024 - Licensing specialist reviewed the provider reported
incident and will follow up with the facility in regards to the late report. Facility staff state
they forgot to report the incident. Licensing specialist will inquire about the safety plan for
the incident. 10/1/2024 - Facility response received "He was placed on precaution for
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

elopement and was restricted to the unit to be assessed every 24 hours. " 10/14/2024 -
Facility issued citation for standard 110.17 for reporting an incident on 9/27/2024 which
occurred on 9/24/2024. 521 sent for signature.


summary: Caller reported a resident ran away from the facility. Officers checked multiple locations but did not locate the resident.

raw_content:
Incident Report
Print Date/Time: 10/21/2024 07:42 Fayetteville Police Department
Login ID: aarcher ORI Number: AR0720100
Incident: 2024-00066978
Incident Date/Time: 9/24/2024 11:29:09 AM Incident Type: MISSING PERSON
Location: 2805 E ZION RD Venue: FAYETTEVILLE
FAYETTEVILLE AR 72703
Phone Number: (479)430-8440 Source: Phone
Report Required: Yes Priority: 1-High
Prior Hazards: No Status: In Progress
LE Case Number: 2024-00066978 Nature of Call:
Unit/Personnel
Unit Personnel
310 310-MCKINNEY
389 389-HARWOOD
478 478-VEGA
480 480-PERALEZ
Person(s)
No. Role Name Address Phone Race Sex DOB
1 Caller CHERUIYOT, RICHARD
Vehicle(s)
Role Type Year Make Model Color License State
Disposition(s)
Disposition Count Date/Time
Unit:310
Disposition Count Date/Time
01RPT 1 09/24/2024 13:39
Unit:389
Disposition Count Date/Time
02GONEONARRIVAL 1 09/24/2024 12:18
Unit:478
Disposition Count Date/Time
02GONEONARRIVAL 1 09/24/2024 12:43
Unit:480
Disposition Count Date/Time
02GONEONARRIVAL 1 09/24/2024 12:36
Page: 1 of 3

Incident Report
Print Date/Time: 10/21/2024 07:42 Fayetteville Police Department
Login ID: aarcher ORI Number: AR0720100
Property
Date Code Type Make Model Description Tag No. Item No.
Page: 2 of 3

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


summary: A resident was sent to Physicians Specialty Hospital for eye pain.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 024178
Date of Incident: 9/21/2024
Date Received: 9/23/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: Description of the report: When this resident was admitted she was
missing her left eye, on 09/21/2024 she started complaining of pain in that eye socket. She
was assessed by nurse, redness and swelling was noted. APRN was notified, order was given
to send her to the ER at PSH for care. They referred her to NW Specialty to see the eye
specialist. She returned to the facility the same day with 2 different eye drops to be given to
her. She was given dx . She also has an eye patch to wear to help prevent
any further infections. Date of occurrence: 09/21/2024 Corrective Action taken by the
agency or follow up done: We will give antibiotic drops as ordered and follow-up with her
primary eye Dr. per her previous appointment on October 23rd in Little Rock.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 9/23/2024 - Licensing specialist reviewed the provider reported
incident. Licensing specialist will follow up with the facility for name, dob. and
guardianship of the resident. -
Nursing notes received, reviewed, and uploaded to ELS.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was sent to Arkansas Children’s Hospital after experiencing abdominal pain and fever.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 024122
Date of Incident: 9/19/2024
Date Received: 9/20/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: Description of the
report: Resident woke up complaining of abdominal pain and had a fever of 101.4. He was
assessed by nursing and APRN was called. She instructed us to take him to Arkansas
Childrens Hospital for evaluation. He left here at 0745 and returned at 1035 with diagnosis
. He did not return with any new orders or any follow-up unless
symptoms worsen. Date of occurrance: 09/19/2024 Corrective Action taken by the agency or
follow up done: We will monitor and he can return to ER if symptoms worses. We will treat
his fever with PRN medication as ordered.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 9/23/2024 - Licensing specialist reviewed the report and will request
nursing notes documentation from ACH. 10/1/2024 - Nursing notes received, reviewed, and
uploaded to ELS.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


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

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 024069
Date of Incident: 9/16/2024
Date Received: 9/18/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 9/16/2024 at approx 0908
appeared to swallow a lego. He saw the aprn, was placed on clear liquid
diet x 72 hours and an x-ray was ordered. He had xray on 9/17/24 and it stated
No further treatment ordered at this time.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 9/19/2024 - Licensing specialist reviewed the report and will follow up
with facility to inquire if this was intentional and if the facility has implemented a safety
plan. 10/1/2024- Facility response received: "Yes ? he was placed on self-harm precautions
to be assessed every 24 hours."
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Officers were dispatched in response to a juvenile who ran away from the facility. Officers located the juvenile and returned him to the facility.

raw_content:
Incident Report
Print Date/Time: 10/21/2024 07:43 Fayetteville Police Department
Login ID: aarcher ORI Number: AR0720100
Incident: 2024-00064986
Incident Date/Time: 9/16/2024 7:33:32 PM Incident Type: MISSING PERSON
Location: 2805 E ZION RD Venue: FAYETTEVILLE
FAYETTEVILLE AR 72703
Phone Number: (870)329-6232 Source: 911
Report Required: No Priority: 1-High
Prior Hazards: No Status: In Progress
LE Case Number: Nature of Call:
Unit/Personnel
Unit Personnel
439 439-SINIAWA
493 493-ESPINAL
Person(s)
No. Role Name Address Phone Race Sex DOB
1 Caller ROPER, NICHOLAS VON White Male
SPRINGDALE AR 72764
Vehicle(s)
Role Type Year Make Model Color License State
Disposition(s)
Disposition Count Date/Time
Unit:439
Disposition Count Date/Time
03NORPT 1 09/16/2024 20:19
Unit:493
Disposition Count Date/Time
03NORPT 1 09/16/2024 20:18
Property
Date Code Type Make Model Description Tag No. Item No.
Page: 1 of 2

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


summary: A resident was sent to Children’s Hospital after landing on his left hand while playing basketball.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 023992
Date of Incident: 9/15/2024
Date Received: 9/16/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 9/15/24, per staff report
was playing basketball and dunked the ball. When he came back to the ground resident lost
his footing and landed on his left hand. Resident immediately complained of pain. Left
hand was swollen, call placed to on-call doctor which ordered resident to go be evaluated.
Resident returned from the Arkansas Children's Hospital Springdale - Emergency
Department approximately around 2035. Resident diagnosis
Resident will follow up with Orthopedics.
Interim Action Narrative: Resident's hand was x-rayed and will follow up with Ortho.
Maltreatment Narrative:
Licensing Narrative: Licensing reviewed provider reported incident for licensing concerns.
Program Coordinator will follow up with facility on outcome of Ortho appointment and year
resident was born. Facility reported that they have to wait for Ozark Orthopedics to set up
an appointment. 9/18/2024 - Licensing specialist reviewed provider reported incident.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Multiple deficiencies were noted during the Inspection of Care (IOC) conducted on 09/09/24. A Corrective Action Plan (CAP) was submitted and approved.

raw_content:
Medicaid IP Sec. 2: State Criminal SR017961 No file received.
241.110B Background Check - SR017063
IP Acute Para-
professional
Observations:
AFMC staff reviewed the final document request form with the Director of Performance Improvement at the
completion of the on-site Inspection of Care and the provider signed the acknowledgement of manual requirements
that were not made available in the provider’s policy and procedures.
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:
Staff and clients were observed throughout the facility in the classroom setting on the school unit and in organized
group activity in the gymnasium. Clients were engaged in schoolwork and activities. Staff were calmly interacting
with clients and providing a therapeutic environment that was conducive for learning and treatment therapies.
Medication Pass:
No active FFS Medicaid clients received medications during a medication pass while AFMC staff was onsite.
Due to the observation of non-Medicaid clients not being complaint with the HIPAA minimal necessary rule, no
medication pass was observed. AFMC RN visited with the facility medication nurse who was able to show
AFMC RN the facility policies and procedures regarding medication administration, narcotic
count/reconciliation/handling, and medication discrepancies.
Facility nurse was able to verbalize the step-by-step process of medication delivery including the demonstration
of the five rights of medication administration, documentation of medication delivery, verification of client
taking medication including mouth/cheek checks, and how clients are educated about each medication. The
facility nurse also verbalized the process utilized when a client refuses medication. Tour of medication room
completed no discrepancies with medication storage, cleanliness of medication room, and knowledge of
medication dispensing found.
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.
Corrective Action Plan:
The CAP must be completed within 30 calendar days of the date of the email notice of the IOC reports.
Additionally, any findings that were noted in any Health and Safety Inspection(s), which are governed by
certification rules and requirements, are shared with DPSQA and may result in other remedial actions, by
DPSQA, if warranted.
*For more details on the individual related deficiencies, please log into the portal.
Piney Ridge Treatment Center, LLC – Fayetteville, AR – IOC Report 3 | P ag e

Respectfully,
Inspection of Care Team
InspectionTeam@afmc.org
1020 W. 4TH ST., SUITE 300
LITTLE ROCK, AR 72201 • afmc.org
Piney Ridge Treatment Center, LLC – Fayetteville, AR – IOC Report 4 | P ag e

doc_type: IOC Report


summary: Officers were dispatched regarding a missing juvenile. The juvenile left the facility by going over the fence. Staff followed the juvenile, who was still on facility grounds.

raw_content:
Incident Report
Print Date/Time: 09/18/2024 14:23 Fayetteville Police Department
Login ID: aarcher ORI Number: AR0720100
Incident: 2024-00060676
Incident Date/Time: 8/30/2024 6:56:01 PM Incident Type: MISSING PERSON
Location: 4253 N CROSSOVER RD Venue: FAYETTEVILLE
FAYETTEVILLE AR 72703
Phone Number: (757)362-8343 Source: 911
Report Required: No Priority: 1-High
Prior Hazards: No Status: In Progress
LE Case Number: Nature of Call:
Unit/Personnel
Unit Personnel
462 462-TOLE
473 473-ALGEO
499 499-HINTON
Person(s)
No. Role Name Address Phone Race Sex DOB
1 Caller HOOVER, JUSTIN
MICHAEL
Vehicle(s)
Role Type Year Make Model Color License State
Disposition(s)
Disposition Count Date/Time
Unit:462
Disposition Count Date/Time
03NORPT 1 08/30/2024 19:39
Unit:473
Disposition Count Date/Time
03NORPT 1 08/30/2024 19:54
Property
Date Code Type Make Model Description Tag No. Item No.
Page: 1 of 2

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


summary: Police were called by a facility employee who stated that a patient punched her in the face.

raw_content:
Incident Report
Print Date/Time: 09/18/2024 14:26 Fayetteville Police Department
Login ID: aarcher ORI Number: AR0720100
Incident: 2024-00060026
Incident Date/Time: 8/28/2024 6:48:48 PM Incident Type: ASSAULT BATTERY
Location: 4253 N CROSSOVER RD Venue: FAYETTEVILLE
FAYETTEVILLE AR 72703
Phone Number: (479)287-0402 Source: Phone
Report Required: Yes Priority: 3-Low
Prior Hazards: No Status: Report
LE Case Number: Nature of Call:
Unit/Personnel
Unit Personnel
504 504-STONE
Person(s)
No. Role Name Address Phone Race Sex DOB
1 Caller RAWLINGS, GARRY White Male
JAMES
BENTONVILLE AR 72713
1 Unknown
Vehicle(s)
Role Type Year Make Model Color License State
Disposition(s)
Disposition Count Date/Time
Unit:504
Disposition Count Date/Time
03NORPT 1 08/28/2024 20:14
Property
Date Code Type Make Model Description Tag No. Item No.
Page: 1 of 2

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


summary: A resident reported pain and bruising after kicking doors and walls while upset. An x-ray was ordered.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 023671
Date of Incident: 8/28/2024
Date Received: 9/3/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 8/27/24 Resident was
upset and tore down posters from facility that were posted on the wall. Resident repeatedly
kicked the doors and walls while being redirected by staff. Resident complained about their
toe hurting. Upon nurse assessment, Resident was able to move all toes. No lacerations,
bruising, or deformity noted. OTC medication was given or pain. Resident will be on
Assault Precautions for property destruction. Next day there was bruising and he reported
pain. A consult was written up to see APRN which he saw on 8/30/24 whom ordered an x-
ray. Xray on 9/1/24
. He will go to Ozark Ortho urgent care
today.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 9/4/2024 - The provider reported incident was reviewed by the
licensing specialist. Follow up with the facility regarding the ortho appointment will be
inquired of the facility. 9/4/2024 - Facility response received: " ,
weight bearing as tolerated. He goes back on the 13th for a follow up. "
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident reported right hand pain and swelling after a physical altercation with a peer. An x-ray was ordered.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 023571
Date of Incident: 8/27/2024
Date Received: 8/28/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 8/27/24 at approximately 1303
and started arguing and
entered into a physical altercation and were separated by staff. After staff separated the
residents, began aggressively punching the wall with a closed right fist. He was
redirected by staff. The resident then came back to the unit to decompress and was
punching a chair, walls and doors with his hand. Both staff and nurse redirected him. Nurse
assessed amd resident?s right hand was red and swollen, resident reported 10/10 pain and
was given ice and PRN PO Ibuprofen for pain. APRN on call notified and ordered x-ray to
right hand. .
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: Reviewed for licensing concerns.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was transported to Children’s Hospital after being hit in the face by a peer while horseplaying.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 023512
Date of Incident: 8/25/2024
Date Received: 8/26/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 8/25/24 at approx 1515
was outside with his unit when he and resident
began to horseplay by pretending to hit one another. The residents
were directed several times to stop by staff but continued. The resident pretended to hit the
peer and accidentally did hit the peer in the chin. The peer then hit the resident causing an
approximately 1 inch laceration on the eyebrow above left eye. A large hematoma, with
swelling developed. The wound was cleaned with Hibaclense and sterile water and non
stick dressing applied. APRN notified and orders received to transport resident to
Children's Hospital for evaluation and treatment. Resident denied any pain after incident
and ice was provided for swelling. Resident returned to PRTC from the hospital at 1944.
. MD at Arkansas Children's Hospital noted
Both
residents will be processed with.
Interim Action Narrative:
Maltreatment Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: 8/27/2024 - The provider reported incident was reviewed by the
licensing specialist, will follow up for restrictions and request a copy of the nursing notes.


summary: A resident eloped from the facility while outside.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 023504
Date of Incident: 8/25/2024
Date Received: 8/26/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 8/25/24 at approximately 2115
had been outside in the courtyard refusing to go inside for awhile. He
climbed on the awning and was threateing to hurt himself or others. Supervisors and Nurses
continued to attempt to process with him and he walked across the awning, crawled on the
fence and jumped down from the fence on the other side of faciity grounds. Fayetteville PD
was contacted approx 2117 and the resident returned to the facility on his own at 2122. Risk
assessment was completed and resident denied suicidal thoughts at the time of the
assessment. Resident denied wanting to injury himself at the time of the assessment. He
was place on elopement precautions and restricted on the unit to be reassessed in 24 hours.
will process with primary therapist.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 8/27/2024 - The provider reported incident and facility implement
was reviewed by the licensing specialist.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident reported to nursing that his finger was jammed while catching a football.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 023485
Date of Incident: 8/24/2024
Date Received: 8/26/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 08/24/2024, reported
to nursing that his finger was jammed due to catching a football. met with the APRN
who ordered an XRAY of his hand.
APRN ordered resident to go to Ozark Orthopaedics on Monday, 8/26/24.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 8/26/2024 - The provider reported incident and facility implement
was reviewed by the licensing specialist.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident wrote a grievance stating a staff member called him and a peer a name, shoved them on their beds, and ripped up their papers. The facility was cited 110.9.a for late reporting. 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: 023679
Date of Incident: 8/24/2024
Date Received: 9/3/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Dual
Report Description: On 08/25/2024, wrote a
grievance against BHA saying that called him,
and another resident a name. He said shoved them on their beds
and ripped up their papers. Upon speaking with the RC, it was reported that and
had been antagonizing all night, calling him names and commenting on
his deceased child. After internal review, this was reported to the and
was accepted for investigation on 8/30/24. The incident was assigned to the
. It is believed by PRTC that the was only accepted for
The staff has been suspended pending investigation. came
to interview the resident on 9/1/24
Interim Action Narrative:
Maltreatment Narrative:
Over the
weekend, on 8/24, wrote a grievance saying entered his and ?s
bedroom and shoved them both. 2 other roommates were asleep and didn?t see it. When
they were shoved, fell backwards into his bed and hit his head on the top bunk.
was shoved into the bookshelf. It is unknown if hit his head. No reported
injuries. Another staff reported hearing the 2 kids yelling that shoved them and
responded with ?yeah because you kicked me first?. then started ripping up
the children?s things. was suspended from the facility.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: 9/3/2024 - The complaint was reviewed by the licensing specialist.
Permission was obtained from investigator to follow up with the facility for the
following information: ? If the resident wrote a grievance on 8/24/2024, why was it not
called into the until 8/30/2024?[Ronissa Adams] complaint was completed on
8/25/24, the patient advocate was out for emergency family leave, obtained on 8/27/24 late
in the afternoon by admin. The complaint was confusing at first and was reviewed
internally. ? Confirm the staff is on suspension[Ronissa Adams] - yes ? Request any witness
statements - In most instances these are not released. We will further consult with corporate.
? Is any video footage of these children?s hallway to show if the staff went into the
bedroom[Ronissa Adams] - We tried to download the video ? but it kept erroring out and
would not save. But it is not uncommon for staff to go into bedrooms to unlock bathroom
doors, etc. ? The names of all the staff that were working on this until at the time of the
alleged incident. [Ronissa Adams] , and was
assigned to East. I do believe that various supervisors were working at the facility that night,
to include the COO and CEO. Various different timeframes where reported. ? Names of all
the roommates in this bedroom[Ronissa Adams] - and
Has this A/O ever had any complaints made about him before[Ronissa
Adams] HR Director will not be back in the office until Wednesday ? 9/4/24. 9/4/2024 -
Licensing specialist followed up with the facility. Requested a copy of the resident grievance
form and facility policy for mandated reporting. Notified the facility that it is common
practice to request witness statements from the facility and would need them no later than
9/6/2024. 9/5/2024 - The following response was received from facility staff: "It was
confusing because the times that the residents listed on complaints was earlier in the night.
In addition, the complaint alluded to this occurring in the bedroom hallway according to at
least one of the residents. The time frame was confusing as Trish Marshall and Justin
Hoover was at the facility that evening for multiple hours including one or the other of the
two spending a lot of time on the east unit hallway. Trish Marshall ? COO, Ronissa Adams ?
DPI/RM and Kathy Vickers ? DHR reviewed multiple hours of video from that night and
from what we saw in the hallway ? could not see what we understood of the incident.
However both Trish and I attempted to save video from the evening/night in question and
it kept erroring out and would not save. Because of the different time frames being said and
a couple of different places where the incident could have occurred we believed it was
important to review thoroughly. If you plan to come here ? I can show you the statements
and continue to consult on your request. FYI will be here tomorrow to speak to
individuals. Jarred ? I hope that this clears up any confusion as we continue our
collaboration. In addition I have attached the policies to this email." Resident grievance
and facility policy attachments have ben reviewed and uploaded to ELS. 9/6/2024 - A visit
was conducted at the facility to address concerns for the complaint, obtain witness
statements for the following staff: , , and . Obtain
witness statements for the following residents: and
obtain a copy for the grievance report made on 8/25/2024 from resident

and address the report not being made immediately after the it was
reported to staff. Staff was interviewed at the facility in regards to mandated
reporting and the reported complaint. 9/26/2024, facility inquired about ICA being lifted.
9/30/2024 - Findings 521 inspection sent to facility. Licensing findings are UNFOUNDED.
Training for the incident has been reviewed and uploaded to ELS. 10/22/2024 Approved by
Progream Coordinator. Case complete.


summary: A resident reported to nursing that he injured his toe while playing in the gym. An x-ray was ordered.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 023484
Date of Incident: 8/24/2024
Date Received: 8/26/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 08/24/2024, ) reported to
nursing that he injured his toe while playing in the gym. He stated that he accidentally
kicked the basketball goal pole and has pain in his 3rd toe. saw the APRN and an
XRAY was ordered. .
APRN will order further treatment.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 8/26/2024- The provider reported incident and facility implement was
reviewed by the licensing specialist.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Two residents eloped from the facility while outside. The residents returned to the facility approximately 1.5 hours later.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 023435
Date of Incident: 8/22/2024
Date Received: 8/23/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 8/22/24
approximately were outside refusing to go inside and
remained outside refusing for a while. The two residents climbed the fence and left the
facility grounds, two nurses followed but were not able to keep up. The Fayetteville PD was
called at approx 1929. The residents returned on their own accord on foot at approximately
2112. They were gown searched and assessed by nurses with no injuries. They were placed
on restricted to unit with elopement precautions to be reassessed in 24 hours. They will
process with primary therapist.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 8/26/2024 - The provider reported incident and facility implement has
been reviewed by the licensing specialist.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Officers were dispatched to the facility in response to two missing juveniles.

raw_content:
Fayetteville Police Department
Summary
Print Date/Time: 09/18/2024 14:31 Fayetteville Police Department
Login ID: aarcher ORI Number: AR0720100
Case Number: 2024-00058460
Case
Case Number: 2024-00058460 Incident Type: Missing Person
Location: 4253 N CROSSOVER RD Occurred From: 08/22/2024 19:25
FAYETTEVILLE, AR 72703 Occurred Thru: 08/22/2024 19:25
Reporting Officer ID: 520 - WYATT Disposition: Investigation Complete
Disposition Date: 08/22/2024
Reported Date: 08/22/2024 19:29 Thursday
Offenses
No. Group/ORI Crime Code Statute Description Counts
Subjects
Type No.Name Address Phone Race Sex DOB/Age
Missing Person 1
FAYETTEVILLE, AR 72703 14
Missing Person 2
16
Reporting Person 1 ROPER, NICHOLAS VON
SPRINGDALE, AR 72764 24
Arrests
Arrest No. Name Address Date/Time Type Age
Property
Date Code Type Make Model Description Tag No.Item No.
Vehicles
No. Role Vehicle Type Year Make Model Color License Plate State
Routing:
Page: 1 of 2

OfficerID: AWYATT, A Wyatt / Case Narrative #2024-58460
Officer A. Wyatt #520
Missing Person (Recovery)
Case #2024-58460
Case Narrative
On August 22, 2024 at approximately 1930 hours I, Officer Alex Wyatt, was
dispatched to Piney Ridge 4253 N Crossover rd for a missing person call. Upon
arrival I met with Nicholas Roper ( He stated that two
juveniles, ) and
, had escaped their facility.
Mr. Roper informed me of the physical description of each juvenile and gave a
history to his knowledge of them. and approximately 150 pounds. He
was last seen wearing a black shirt, black shorts, and black shoes. He has brown hair
and brown eyes. and approximately 160 pounds. He was last seen with
blue and black puma branded shirt and shorts with red and black Jordan shoes. He
has brown hair and brown eyes. Mr. Roper stated that had been at their
facility for a few months and they have not had any trouble with him during his time
there. had only been there a month. Neither of them have ran away before and
have no known contacts in Fayetteville. Mr. Roper informed me that earlier in the day
the two had gotten into trouble for harassing another kid there. They did not like that
they were in trouble and got angry with the staff. The two juveniles then jumped the
fence that borders vantage point and took off on foot in an unknown direction. That
is when he contacted 911 to report them. Mr. Roper had only recently got on shift and
had this limited information.
While speaking with Mr. Roper Cpl. McAbee #411 was patrolling the area looking for
the missing juveniles. I gave Mr. Roper a contact card with my information and case
number for their records. He validated his phone number and gave me the phone
number for the charge nurse in case we needed to contact the facility after his shift
was over at 0700 the next day. I then put the two juvenile’s information into a report
and notified dispatch to mark them as missing persons and to put a BOLO out for
them.
On August 22, 2024 at approximately 2120 hours, I was dispatched to Piney Ridge for
a recovery report. Upon arrival I made contact with Mr. Roper who stated that the
juveniles had returned just prior to him calling 911 for a new report. He told me that
the juveniles had just walked up and down the road before coming back. I put eyes
on but was in the shower. Both juveniles were safe and in custody of
the facility.
Processed by A. Diaz / A. Remick
Page: 2 of 2

Incident Report
Print Date/Time: 09/18/2024 14:30 Fayetteville Police Department
Login ID: aarcher ORI Number: AR0720100
Incident: 2024-00058460
Incident Date/Time: 8/22/2024 7:29:52 PM Incident Type: MISSING PERSON
Location: 4253 N CROSSOVER RD Venue: FAYETTEVILLE
FAYETTEVILLE AR 72703
Phone Number: (870)329-6232 Source: Phone
Report Required: Yes Priority: 1-High
Prior Hazards: No Status: In Progress
LE Case Number: 2024-00058460 Nature of Call:
Unit/Personnel
Unit Personnel
411 411-MCABEE
520 520-WYATT
438-CONWELL
Person(s)
No. Role Name Address Phone Race Sex DOB
1 Missing Person Black Male
2 Missing Person Black Male 0
FAYETTEVILLE AR 72703
3 Caller ROPER, NICHOLAS VON
Vehicle(s)
Role Type Year Make Model Color License State
Disposition(s)
Disposition Count Date/Time
Unit:411
Disposition Count Date/Time
02GONEONARRIVAL 1 08/22/2024 20:14
Unit:520
Disposition Count Date/Time
01RPT 1 08/22/2024 20:25
Property
Date Code Type Make Model Description Tag No. Item No.
Page: 1 of 2

Incident Report
Print Date/Time: 09/18/2024 14:29 Fayetteville Police Department
Login ID: aarcher ORI Number: AR0720100
Incident: 2024-00058483
Incident Date/Time: 8/22/2024 9:21:33 PM Incident Type: FOLLOW UP
Location: 4253 N CROSSOVER RD Venue: FAYETTEVILLE
FAYETTEVILLE AR 72703
Phone Number: (870)754-8409 Source: Phone
Report Required: No Priority: 3-Low
Prior Hazards: No Status: Not In Progress
LE Case Number: Nature of Call:
Unit/Personnel
Unit Personnel
441 441-IBARRA
520 520-WYATT
438-CONWELL
Person(s)
No. Role Name Address Phone Race Sex DOB
1 Caller RAYLEIGH, NURSE (870)754-8409
Vehicle(s)
Role Type Year Make Model Color License State
Disposition(s)
Disposition Count Date/Time
Unit:441
Disposition Count Date/Time
03NORPT 1 08/22/2024 21:24
Unit:520
Disposition Count Date/Time
03NORPT 1 08/22/2024 21:48
Property
Date Code Type Make Model Description Tag No. Item No.
Page: 1 of 2

CAD Narrative
08/22/2024:21:48:29awyattNarrative:INREFERENCETO2024-58460.D3
08/22/2024:21:39:36tkelleyNarrative:5201012WITHSUBJ
08/22/2024:21:23:56tkelleyNarrative:33410-4
08/22/2024:21:23:12tkelleyNarrative:24-58460
08/22/2024:21:22:06tkelleyNarrative:SUBJSARE10-4,JUMPEDTHEFENCEANDCAMEBACK
08/22/2024:21:21:47tkelleyNarrative:ADVSUBJSAREBACK
Page: 2 of 2


summary: A resident reported that he accidently swallowed a marble while he and a peer were playing a game.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 023372
Date of Incident: 8/20/2024
Date Received: 8/21/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 8/20/24 ) it was reported by
the resident at 0737 that he and a peer were playing a game that consisted of blowing and
sucking a small marble in a tube between their mouths and the resident accidentally
swallowed the marble. Resident denied shortness of breath. He saw the APRN later that am
who ordered an x-ray. He had the x-ray in house on same day. The x-ray indicated
.
APRN was notified and he will have miralax, MOM
and colace. Nurses will process safety concern with residents.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 8/22/2024 - Licensing specialist reviewed the report and will request
nursing notes and a safety plan for the incident. 9/11/2024 - LIcensing specialist followed
up with facility inquire how the resident is doing now.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident complained of pain and swelling to the left side of his face after being hit by a peer with a hard plastic item.

raw_content:
AR KANS A S&S
DEPARTMENT OF

4 HUMAN
<a¥ SERVICES

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

Notice of Serious Incident
Case Number: 023251
Date of Incident: 8/16/2024

Date Received: 8/16/2024

Facility Name: Piney Ridge Treatment Center
Facility Number: 203

Incident Type: Licensing

Report Description: Child?s name:
Description of the report: This resident was hit in the face by

with a hard plastic item. | reports pain and swelling
to the left side of this face. He was assessed Mw OUtti‘s‘C*@Y APRN with orders to take to
Arkansas Childrens Hospital for assessment. Date of occurrence: 08/16/2024 Corrective
Action taken by the agency or follow up done: Resident was seen at Childrens Hospital , an
assessment was completed he returned with J with order for tylenol or
ibuprofen for pain.

Interim Action Narrative:

Maltreatment Narrative:

Licensing Narrative: 8/19/2024 - Licensing specialist reviewed the provider reported
incident and will follow up with the facility regarding nursing notes and how the resident
obtained the plastic object. 8/27/2024 - Licensing specialist received hospital paperwork
from the facility. It was reviewed and uploaded to ELS. The facility states the plastic object
was a building block for children and he was placed on assault precautions.

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


summary: A resident reported that a staff member let her and a peer use a nicotine vape on more than one occasion. 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: 023259
Date of Incident: 8/15/2024
Date Received: 8/16/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Dual
Report Description: On 08/14/2024,
reported to a staff member that had let her, and peer
use her nicotine vape on more than one occasion. was
suspended pending internal investigation, and a call was placed and accepted
spoke to the two residents on 8/16/24.
Interim Action Narrative: Staff placed on leave pending investigation.
Maltreatment Narrative:
and another Piney Ridge patient said they went
with to an area of the facility that does not have cameras so they could use her
nicotine vape. She let them use her nicotine vape. Then they went to another area in the
facility with no cameras. They vaped there again, and they vaped in one of the girls?
bedrooms. will likely be in Piney Ridge for another six months, probably.
Licensing Narrative: 8/19/2024 - The provider reported incident was reviewed by the
Licensing Specialist. Licensing specialist spoke with the facility concerning the residents
having access to employee's personal belongings. The facility has implemented new
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

policies concerning the personal belongings and cell phones being placed in a secure
location while on the floor. 9/11/2024 - finding requested from supervisor.
9/16/2024, facility inquired if ICA could be lifted due to unsubstituted finding per
documentation from 9/17/2024, Program Coordinator inquired if staff member
would receive training. Facility reported staff member would receive additional training of
boundaries and zero tolerance of any type of abuse. Program Coordinator requested
documentation once training is completed. 10/9/2024 - Licensing specialist followed up
with the facility for confirmation of retraining dates and documentation. Facility response
was that the employee was not retrained as they are no longer working at the facility.


summary: Licensing received complaint that a resident at the facility did not receive appropriate medical care on numerous occasions and was not provide his special diet. The complaint also stated that the resident was able to escape the facility numerous times. 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: 023154
Date of Incident: 6/12/2023
Date Received: 8/12/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: did not recieve appropriate and ordered medical care on
numerous occasions such as taking his bloodpressure as directed by his nephrologist at Ar
Childrens hospital , didn?t provide his special diet, when he was discharged from facility I
could have been anyone picking him up as they never asked for ID or had me sign anything
, they just let him go. This is supposed to be a lock down facility but he escaped numerous
times by climbing on a picnic table and scaling the fence.MORE
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 8/16/2024 - The complaint was reviewed by the Licensing Specialist.
Licensing specialist attempted phone call to reporter to obtain additional information but
was not answered. 8/19/2024 -
. Licensing specialist contacted the report to obtain additional information
regarding the report. The reporter states she was concerned with how the facility discharged
the resident. The reporter states the facility staff did not check I.D. upon arrival nor confirm
who she was before letting the resident go with her. The reporter states the facility did not
accommodate the resident's special diet of low salt. The reporter stated the resident was
able to elope twice, once he was picked up by police and managed to get in the trunk of the
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

police car and obtain ammunition. The reporter states the resident once discharged from
the facility was being transported to Fostering Change to start reintegration and he told the
reporter and Fostering Change staff the facility transporter allowed him to use his vape and
play games on his phone and he saw he had pornography on his phone and that he was a
pedophile. Licensing specialist requested the reporter obtain the specific dates for the
elopement to ensure the facility reported the incidents. Licensing specialist staffed the
phone call information obtained from the reporter with Program Coordinator C. Vardell.
was checked to review information regarding the resident seeing porn on the Piney
Staff transporter phone and ensure staff were made aware of the allegation. Ronissa Adams
was made aware of allegations involving the staff giving the resident his vape and seeing
pornography on his phone. A visit will be conducted to address the concerns discussed with
the reporter. 8/20/2024 - Licensing specialist received a response from the facility: "If I
recall correctly, this was never documented and given to Risk. The resident never completed
a grievance and/or documented anything pertaining to a vape or anything else. It was
shared by his therapist supposedly to another therapist that he stated something pertaining
to a vape and\or phone access. This was brought up verbally days after the fact, but was still
not documented by the person who received it which questioned the validity of reported
topic. Information was later brought up by the that the then discharged resident
reported information to her. Then apparently accepted, and when
the facility could confirm who the staff was in question by the , the staff
was suspended, , and it was closed. 11/15/2024 - Findings 521 sent to
facility. 11/22/2024 - Followed up with facility for signed findings 521 inspection report.


summary: Resident reported to staff that a staff member took pictures and videos of him, showed him nude pictures of herself, has been bringing him food and candy, asked him if he was a virgin, and made an inappropriate comment about oral sex. Complaint was founded by Licensing. The facility was cited 109.1.g.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 023151
Date of Incident: 8/8/2024
Date Received: 8/12/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Dual
Report Description: On 8/10/24 around 2209 T to a
staff member that BHA took pictures and videos of him. The resident
reported that the staff member showed him nude pictures of herself. The resident reported
that the staff member allowed the resident to speak with her sister on the phone. The
resident reported that this staff member has been bringing him food and candy. The
resident reported that the staff asked if he was a virgin and made an inappropriate comment
about oral sex. The resident reported that this incident occurred on 08/08/2024 in front of
his bedroom door in the crossover hallway. on 08.11.2024 at 1040.
reported that the
. The staff member is currently suspended.
Interim Action Narrative:
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Licensing Narrative: 8/12/2024 - The complaint was reviewed by the licensing specialist.
Permission requested from to contact the facility to inquire about
footage and initiate the complaint. Licensing specialist contacted the facility to retain video
footage for timeframes mentioned in the report. 8/13/2024 - A visit was conducted to
initiate the complaint and review camera footage for the allegations. 3 video recording were
observed during the visit recording 1 - 8/8/2024 - 23:00 - 23:18 - and
resident can be seen sitting the hallway. The staff person can be seen on her phone
regularly. The staff person can be seen showing the resident things on her phone at the 4:00
minute mark of the recording. It is not known what the staff is showing the resident. This
continues for approximately 18 minutes with the staff person showing the resident her
phone screen periodically. Recording 2 -8/8/2024 - 23:37 - 23:56 - The staff person
can be seen sitting in the hallway with the resident The staff person and the
resident exchange a sticky note. It is not known what is on the sticky note. The staff person
can be seen putting her hand in her pocket for what appears to be an earbud that the
resident had given to her. The staff person can be seen giving the resident objects which
appear to be bags of snacks. It is not clear what the staff was giving to the resident. Later
the resident can be seen eating McDonalds in the hallway which was ordered by staff.
recording 3- 8/8/2024 - 13:06 - 13:09 - The video view shows the staff person and
resident in the laundry room. The resident and staff both enter the laundry room which
is not in the camera view. It is unknown what takes place in the laundry during this time.
Licensing specialist discussed concerns observed in the video footage and requested a
safety plan for the staff member, facility will do retraining for cell phone usage and personal
belongings on the units. Statements were requested from staff on the floor at the same time
the resident was interacting with Licensing specialist requested training for staff
and resident boundaries on regards to showing favoritism and retraining for sleeping hours
policies and what time residents need to be in their personal areas for bedtime. 9/18/2024 -
Licensing specialist requested a witness statement for a staff person who was on duty
8/8/2024 23:00 for the timeframe of reviewed footage. This staff person was stationed just
up the hallway from and 9/19/2024 - Facility response received for the
request of the witness statement: " interviewed and stated the
other staff member had no involvement and because the other staff member was a sister-in-
law to we chose not to interview because we did not want to affect the case with the
police in any way. However, I have attached two other witness statements." The statements
have been reviewed and uploaded to ELS. 9/20/2024 - Licensing issued the facility a
citation 109.1g 1. Unprofessional conduct in the practice of child welfare activities shall
include without limitation: g. Engaging in behavior that could be viewed as sexual,
dangerous, exploitative, or physically harmful to children.

Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 023318
Date of Incident: 8/15/2024
Date Received: 8/19/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 8-15-24 BHA was arrested for Sexual Indecency with
a Child. This is related to the incident that was reported to Licensing on 8- 12-
is no longer employed with the facility.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: Licensing Specialist will request termination documentation.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Piney Ridge Treatment Center
Facility Number: 203
Licensee Address: 2805 E ZION RD
FAYETTEVILLE AR 72703
Licensing Specialist: Jarred Parnell
Person In Charge:
Record Visit Date: 8/13/2024
Home Visit Date: 8/13/2024
Purpose of Visit: Complaint Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
August 13, 2024 – licensing specialist conducted a visit at the facility for complaint case 023151 to review
video footage and initiate the report. The following video footage records were reviewed while at the facility:
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Time Stamp: August 8, 2024 – 23:00–23:18. Video footage shows staff person and resident
sitting in the hallway. . can be seen on her phone regularly. can be seen showing the
resident things on her phone at the four minute mark of recording and it is not known what the staff is
showing the resident. This continues for approximately 18 minutes with the staff person showing the resident
her phone screen periodically.
Time stamp August 8, 2024 at 23:37–23:56. The staff person can be seen sitting in the hallway
with the resident. and the resident exchange a sticky note. It is not known what is on the sticky note.
can be seeing putting her hand in her pocket for what appears to be an earbud that the resident had
given to her. The staff person can be seen giving the resident objects which appeared to be bags of snacks. It
is not clear what the staff was giving the resident.
Timestamp: 8/8/2024 - 13:06 - 13:09 - The video view shows the staff person and resident in
the laundry room. The resident and staff both enter the laundry room which is not in the camera view. It is
unknown what takes place in the laundry during this time.
Licensing specialist inquired from the facility why the resident was allowed to stay up out of his room during
the sleeping hours. Facility administration, stated staff are not supposed to be on their phones for extended
periods of time or have personal belongings while working nor was the resident supposed to be out of his
room during sleeping hours.
has been suspended and the facility plans to take disciplinary actions for the employee.
Licensing Requested all staff members be retrained, on cell phones, personal belongings while supervising
residents, as well as staff and resident boundaries to address favoritism or special favor between staff and
residents.
Licensing specialist requested documentation for a statement from the other staff on the unit with in
regards to the nature of the conversations between her and the resident and whether or not inappropriate
conversations took place.
Licensing is not prepared to the leave a finding at this time.
Provider Comments:
CCL Staff Signature : Date: 8/15/2024
Provider Signature : Date: 8/15/2024
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident complained of pain in his groin after falling on the steps of the playground area.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 022892
Date of Incident: 7/29/2024
Date Received: 7/30/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 7/29/24 around 1910
Resident came to nurse?s office at Crossover unit complaining of pain in his groin
area. Resident stated that he fell on the steps of the playground area and injured his groin
area. PRN medication was given, and Ice was given to the Resident to apply in the groin
area. r, APRN was notified of the situation and ordered the Resident to be sent out to
Specialty hospital for further evaluation. Resident?s mother was notified of the situation and
spoke to Resident. PRTC transported the Resident with 2 staff members. The Specialty
Hospital was unable to evaluate him due to them not being able to obtain images of the
groin area. He was then sent to NW Springdale Hospital. Resident was given pain
medication at hospital and his discharge diagnosis is: The
Emergency Department provider ordered the following: rest, ice, Tylenol, and ibuprofen.
Karen R, APRN was notified of the discharge diagnosis and instructions.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 7/31/2024 - The provider reported incident and facility implement
was reviewed by the licensing specialist.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Facility received a complaint that alleged that staff would give vapes, dab pens with cannabis, cigarettes, lighters and cell phones to the residents. The complaint was UNFOUNDED by Licensing.

raw_content:
Licensing Narrative: 7/30/2024 - The provider reported incident and facility implement
was reviewed by the licensing specialist. 7/30/2024 - Licensing specialist requested
permission to visit the facility and discuss the incident with facility staff. 8/8/2024 - A visit
was conducted and a full walkthrough was completed of the all outdoor areas and fence
rows the residents have access to for the complaint case.

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Piney Ridge Treatment Center
Facility Number: 203
Licensee Address: 2805 E ZION RD
FAYETTEVILLE AR 72703
Licensing Specialist: Jarred Parnell
Person In Charge:
Record Visit Date: 8/30/2024
Home Visit Date: 8/30/2024
Purpose of Visit: Complaint Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
No in-person licensing visit completed on 8/30/2024.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Licensing Specialist received a complaint on 7/30/2024 for ELS Case #022873.
This complaint has beenUNFOUNDEDby licensing.
Provider Comments:
CCL Staff Signature : Date: 8/30/2024
Provider Signature : Date: 8/30/2024
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident walked away from staff and the facility while outside with her unit.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 022869
Date of Incident: 7/26/2024
Date Received: 7/29/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 7/26/2024 at approximately 1253
was outside with her unit. She began to walk away from staff and was redirected
several times to come back. The resident ignored staff directs to come back and somehow
squeezed between the gate by the cafeteria into the parking lot and with staff and nurse
following to the main road. Staff member and nurse continued to process with her but out of
an abundance of caution the Fayetteville Police Department was called, however the staff
was able to talk the resident into returning to the facility within 28 minutes from leaving.
She was placed on elopement precautions to be re-assessed within 24 hours. The resident
did not verbalize pain and had no observed injury.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 7/31/2024 - The provider reported incident and facility implement
was reviewed by the licensing specialist.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident reported that his roommate told him their other roommate performed a sexual act on him while he was sleeping. The complaint was UNFOUNDED by Licensing.

raw_content:
facility to speak with staff and review concerns for the provider reported complaint. Facility
staff states the resident who saw the alleged incident stated this happened when they were
last at the facility around January 2024. The alleged victim does not know if the
incident occurred because he was told by the witness he saw the incident happen while
he was asleep.

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Piney Ridge Treatment Center
Facility Number: 203
Licensee Address: 2805 E ZION RD
FAYETTEVILLE AR 72703
Licensing Specialist: Jarred Parnell
Person In Charge:
Record Visit Date: 7/30/2024
Home Visit Date: 7/30/2024
Purpose of Visit: Complaint Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
7/30/2024 - A visit was conducted to initiate complaint 022866. Licensing specialist spoke with facility staff
to discuss the provider reported complaint and safety plan implemented by the facility. Facility staff state it is
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

not known when the alleged incident took place. The alleged victim for the report was interviewed and was
not aware of the incident. was told by and later
reported it.
The residents have been separated already prior to the incident being reported and the facility will implement
increased supervision for the residents.
Licensing is not prepared to leave a finding at this time.
Provider Comments:
CCL Staff Signature : Date: 7/31/2024
Provider Signature : Date: 7/31/2024
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Piney Ridge Treatment Center
Facility Number: 203
Licensee Address: 2805 E ZION RD
FAYETTEVILLE AR 72703
Licensing Specialist: Jarred Parnell
Person In Charge:
Record Visit Date: 8/30/2024
Home Visit Date: 8/30/2024
Purpose of Visit: Complaint Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
No in-person licensing visit completed on 8/30/2024.
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Licensing Specialist received a complaint on 7/29/2024 for ELS Case #022866.
This complaint has beenUNFOUNDEDby licensing.
Provider Comments:
CCL Staff Signature : Date: 8/30/2024
Provider Signature : Date: 8/30/2024
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident rolled off the top bunk while sleeping, resulting in a laceration to his left eyelid.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 022725
Date of Incident: 7/20/2024
Date Received: 7/22/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: Resident -
Description of report: On 07/20/2024 this resident was awaken quickly, possibly from a
dream and rolled off his top bunk. He landed face down on the floor and has a laceration to
his left eyelid. He was taken to WRMC due to him reporting dizziness after the fall.
Corrective action taken by the agency or follow up? He returned from WRMC,
No outside follow-up ordered. He will follow-up with APRN here as
needed. We will keep dressing to eye dry and clean until it is healed.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 7/23/2024 - The provider reported incident and facility implement
was reviewed by the licensing specialist.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was taken to the Physician Specialty Hospital emergency room after he was injured while playing football.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 022693
Date of Incident: 7/18/2024
Date Received: 7/19/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 07/18/2024, was at football practice when he was trying to
catch a ball being thrown to him. and were trying to both catch the ball when
was tripped up on accident and hit his face on a nearby pole. This caused an
approximately 1-inch laceration above his left eyebrow and a chipped tooth. was
taken to the Physician Specialty Hospital ER for the wound to be evaluated.
and returned to PRTC. He is being set up with a
dentist.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 7/22/2024- The provider reported incident and facility implement was
reviewed by the licensing specialist.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was injured during an altercation with a peer.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
R
Notice of Serious Incident
Case Number: 022696
Date of Incident: 7/17/2024
Date Received: 7/19/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On 07/17/2024,
were in the classroom when
approached and started taking some of his things. asked to stop
several times, staff was redirecting, then hit in the face. was taken out of
the classroom and was assessed by nursing. was placed on assault precautions
to be reassessed in 24 hours. It was confirmed on 7/19/24 that his tooth was chipped. An
appointment with dentist will be set up.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 7/22/2024- The provider reported incident and facility implement was
reviewed by the Licensing Specialist. A safety plan was requested from the facility for the
residents. 7/31/2024 - Licensing specialist followed up again in regards to the incident
inquiring about the safety plan for the residents. 8/19/2024 - The safety plan for the
residents was separation and placed on assault precautions.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident being admitted to the facility eloped from the facility before admission was completed.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 022420
Date of Incident: 7/3/2024
Date Received: 7/5/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Licensing
Report Description: On July 3rd at approx 1549 resident
resident was being admitted. Before the admission was completed the
resident ran out the front door. Police were immediately notified. At approx 8pm one of the
nurses was driving home and saw resident on the side of the highway, she contacted the
police who were able to get him. He was returned to facility at 2125 by Fayetteville police
department. He had no injuries upon return and was cooperative with being brought back
to facility.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 7/8/2024- The provider reported incident and facility implement was
reviewed by the Licensing Specialist. Police information was reviewed by the licensing
specialist. 7/8/2024, Program Coordinator requested police documentation. Police
documentation received and Licensing Specialist informed. 7/8/2024 - Resident was placed
on elopement precautions.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Officers responded to a report of a missing juvenile who eloped when arriving at the facility.

raw_content:
Incident Report
Print Date/Time: 07/17/2024 15:09 Fayetteville Police Department
Login ID: bjenkins ORI Number: AR0720100
Incident: 2024-00045969
Incident Date/Time: 7/3/2024 3:10:18 PM Incident Type: MISSING PERSON
Location: 4253 N CROSSOVER RD Venue: FAYETTEVILLE
FAYETTEVILLE AR 72703
Phone Number: (479)587-1408 Source: Phone
Report Required: Yes Priority: 1-High
Prior Hazards: No Status: In Progress
LE Case Number: 2024-00045969 Nature of Call:
Unit/Personnel
Unit Personnel
347 347-SAMUELS
351 351-JEHL
470 470-WHITLEY
477 477-MURRIN
Person(s)
No. Role Name Address Phone Race Sex DOB
1 Caller WOODS, SAMANTHE JO 21320 KIRKSY RD (479)670-8305 White Female 06/21/1977
ELKINS AR 72727
Vehicle(s)
Role Type Year Make Model Color License State
Disposition(s)
Disposition Count Date/Time
Unit:347
Disposition Count Date/Time
03NORPT 1 07/03/2024 15:51
Unit:351
Disposition Count Date/Time
03NORPT 1 07/03/2024 15:53
Unit:470
Disposition Count Date/Time
01RPT 1 07/03/2024 15:55
Property
Date Code Type Make Model Description Tag No. Item No.
Page: 1 of 1
Page: 1 of 2

CAD Narrative
07/03/2024:16:32:14jcurryNarrative:RECORDSENTERINGSUBJASMISSING
07/03/2024:16:32:00jcurryNarrative:BOLOFOR
07/03/2024:15:28:20cadlerNarrative:
07/03/2024:15:25:26cadlerNarrative:CALLERWANTSTOCAUTIONPOLICETOBE"ONGUARD"WITH //
07/03/2024:15:24:46cadlerNarrative:NOPETWITH
07/03/2024:15:23:41cadlerNarrative:
07/03/2024:15:23:14cadlerNarrative:PRIMARYLANGUAGEISENGLISH
07/03/2024:15:23:07cadlerNarrative:NOPERSONALBELONGINGSON
07/03/2024:15:22:58cadlerNarrative:NOWEAPONSKNOWN
07/03/2024:15:22:44cadlerNarrative:UNKMEDICALORPHYSCIALDISABILITIES
07/03/2024:15:20:55cadlerNarrative:
07/03/2024:15:19:53cadlerNarrative: DIDNOTHAVEABAG//NOCELLPHONEEITHER
07/03/2024:15:19:10cadlerNarrative:NOENVIRONMENTALCONCERNSBESIDESHEAT
07/03/2024:15:18:47mtheriaultNarrative:36510-4
07/03/2024:15:18:44cadlerNarrative: JUSTARRIVEDATTHEFACILITYFROM //NOKNOWNFRIENDSOR
FAMILYHERE
07/03/2024:15:17:58cadlerNarrative:CORR**HADANATTITUDEPERCALLER,NOTVIOLENT
07/03/2024:15:17:31cadlerNarrative:
07/03/2024:15:17:01cadlerNarrative:NOSTAFFFOLLOWING
07/03/2024:15:14:14cadlerNarrative:UNKNOWNDESTINATION
07/03/2024:15:14:03cadlerNarrative:
07/03/2024:15:13:39cadlerNarrative:
07/03/2024:15:13:27cadlerNarrative:LASTSEENNBTOWARDSATHLETICCENTER
07/03/2024:15:12:56cadlerNarrative:NODELAYINCALL
07/03/2024:15:12:52cadlerNarrative:
07/03/2024:15:12:08cadlerNarrative:
Page: 2 of 2

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


summary: Facility received a complaint that a staff member gave his vape to a resident to use while on a transport to a medical appointment. The complaint was UNFOUNDED by Licensing.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 022371
Date of Incident: 7/2/2024
Date Received: 7/2/2024
Facility Name: Piney Ridge Treatment Center
Facility Number: 203
Incident Type: Maltreatment
Report Description: On 7/2/24 at 1155, came to
PRTC. She stated that she received related to ex resident
Allegedly direct care staff member
had gone on a transport with and another staff member on 6-5-
24 to Little Rock for a medical appointment. Apparently, reported that
gave his vape to use during the appointment. stated that it was
". She did speak with as he
was working at the time. After this, PRTC spoke to him and suspended him pending
completion of internal investigation.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 7/3/2024 - The provider reported complaint was initiated with a visit
to the facility. 7/3/2024 - Permission requested from to
initiate and review the safety implement with the facility. 7/3/2024- A visit was conducted at
the facility to initiate the complaint and discuss the allegations with facility staff. A witness
statement from facility staff who was present but not the alleged offender witness statement
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

was requested from the facility. Licensing specialist received a CAP from the facility.
7/5/2024 - CAP request documentation has been uploaded to ELS. CAP was approved.
7/9/2024, Program Coordinator checked case is still pending. 7/10/2024 -
Licensing specialist contacted facility to staff to inquire if the staff member received training
in regards to this incident. The staff member received one hour of coaching and direction
from the Risk Department at Piney in regards to this specific incident. 8/13/2024 -
Licensing sent 521 for case findings for signature.

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Piney Ridge Treatment Center
Facility Number: 203
Licensee Address: 2805 E ZION RD
FAYETTEVILLE AR 72703
Licensing Specialist: Jarred Parnell
Person In Charge: Ronissa Adams
Record Visit Date: 8/13/2024
Home Visit Date: 8/13/2024
Purpose of Visit: Complaint Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
An in person visit was conducted for 8/13/2024
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

Licensing received a complaint on 7/2/2024 for ELS Case #022371
This complaint has been UNFOUNDED by licensing.
Provider Comments:
CCL Staff Signature : Date: 8/13/2024
Provider Signature : Date: 8/13/2024
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: Resident reported that he injured his hand by hitting a wall during poor sportsmanship.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 022294
Date of Incident: 6/27/2024
Date Received:6/28/2024
Facility Name: Piney Ridge Treatment Center
Facility Number:203
Incident Type: Licensing
Report Description: Resident reported to
APRN on 6/28/24 that he had hurt his hand playing outside and hit the wall during poor
sportsmanship. X-ray was completed on his right hand
. He will be seen on 06/28 by Ozark orthopedics
and we will follow their orders from there. Resident is currently on no sports due to injury.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 6/28/2024- The provider reported incident and facility implement was
reviewed by the licensing specialist.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: Officers responded to a report of a missing juvenile. Before officers arrive at the facility, facility staff report that the juvenile has been recovered.

raw_content:
Incident Report
Print Date/Time: 07/17/2024 15:28 Fayetteville Police Department
Login ID: bjenkins ORI Number: AR0720100
Incident: 2024-00043719
Incident Date/Time: 6/24/2024 3:30:14 PM Incident Type: MISSING PERSON
Location: 4253 N CROSSOVER RD Venue: FAYETTEVILLE
FAYETTEVILLE AR 72703
Phone Number: (479)957-5660 Source: 911
Report Required: No Priority: 1-High
Prior Hazards: No Status: In Progress
LE Case Number: Nature of Call:
Unit/Personnel
Unit Personnel
321 321-PEACE
472 472-GONZALEZ
Person(s)
No. Role Name Address Phone Race Sex DOB
1 Caller CALDERON, EMMY (479)957-5660 Female 08/18/1986
Vehicle(s)
Role Type Year Make Model Color License State
Disposition(s)
Disposition Count Date/Time
Unit:321
Disposition Count Date/Time
03NORPT 1 06/24/2024 15:47
Unit:472
Disposition Count Date/Time
03NORPT 1 06/24/2024 15:47
Property
Date Code Type Make Model Description Tag No. Item No.
Page: 1 of 1
Page: 1 of 2

CAD Narrative
06/24/2024:15:46:46agonzalezNarrative:STAFFWASWALKINGNORTHBOUNDONN.OLDMISSOURIWITHTHE
NOTHINGELSENOTED.D3
06/24/2024:15:45:38mtheriaultNarrative:472ADVSTAFFTOLDUSTOCANCEL
06/24/2024:15:43:38mtheriaultNarrative:365ADV WITHSTAFFMEMBERSWBJOYCE@OLDMISSOURI
06/24/2024:15:43:23mtheriaultNarrative:321D2ATWHITEOAK
06/24/2024:15:38:59mtheriaultNarrative:321ADVSTAFFATCIRCLEKADVSUBJISATWHITEOAKNOW
06/24/2024:15:35:29jcurryNarrative:STAFFISONFOOTNEARTHECIRCLEK
06/24/2024:15:35:06jcurryNarrative: //ITWASUNPROMPTED//THISISTHEFIRSTTIME
RANAWAY
06/24/2024:15:34:27jcurryNarrative:
06/24/2024:15:33:37jcurryNarrative:NOFRIENDSORFAMILYINTHEAREA//NOCELLPHONE
06/24/2024:15:33:20jcurryNarrative:NOSMT//NOPIERCINGS
06/24/2024:15:33:07jcurryNarrative:NODIAGNOSISNOMEDICATIONS
06/24/2024:15:32:43jcurryNarrative:NOTAGGRESSIVE
06/24/2024:15:32:36jcurryNarrative:NOC1NOC2
06/24/2024:15:32:31jcurryNarrative:STAFFDOESHAVEVISUALON ATTHECIRCLEKBUTISNEEDING
ASSISTANCEINGETTING TORETURN
06/24/2024:15:32:03jcurryNarrative:
06/24/2024:15:31:41mtheriaultNarrative:34710-4
06/24/2024:15:31:04jcurryNarrative: WASLASTSEENINTHEAREAOF
CROSSOVER/ZIONATTHECIRCLEK
Page: 2 of 2

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


summary: A resident was sent to the emergency room after being hit in the face by a peer during an altercation.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 022199
Date of Incident: 6/22/2024
Date Received:6/24/2024
Facility Name: Piney Ridge Treatment Center
Facility Number:203
Incident Type: Licensing
Report Description: Child?s Name:
Description of report: On 06/22/2024 this resident was hit in the face by
. He reported that he
lost consciousness after being hit on the right side of the face. He was sent to PSH ER for
evaluation.
He will be on no sports for
3 days, ice 20-30 min every 2 to 3 hrs as needed and ibuprofen as needed for pain. He was
also given Augmentin He was not scheduled a follow-up so he will
follow-up as needed with our APRN at the facility. was placed on AP precautions
and was placed on reverse 6 foot with staff to help ensure other residents safety.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 6/24/2024 - The provider reported incident was reviewed by the
Licensing specialist. Licensing specialist will follow up with the facility for video review.
7/3/2024- A visit was conducted to review video footage for the incident. Time stamp
6/22/2024 18:17:36 - 18:18:25 Supervision was reviewed for the incident as well as safety
plans and medical follow up. Both residents have been separated and processed with their
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

therapist. The aggressor was placed on assault precautions and to be assessed every 24
hours. The victim was taken for medical treatment and returned to the facility the same day.

Division of Child Care & Early Childhood Education
P.O. Box 1437, Slot S140, Little Rock, AR 72203-1437
P: 501.508.8910 F: 501.683.6060 TDD: 501.682.1550
521 Visit Compliance Report
Licensee: Piney Ridge Treatment Center
Facility Number: 203
Licensee Address: 2805 E ZION RD
FAYETTEVILLE AR 72703
Licensing Specialist: Jarred Parnell
Person In Charge: Ronissa Adams
Record Visit Date: 7/3/2024
Home Visit Date: 7/3/2024
Purpose of Visit: Self Report Visit
Regulations Out of Compliance:
Regulations Needing Technical Assistance:
Regulation Not Applicable:
Regulations Not Correctable:
Narrative:
7/3/2024- A visit was conducted to review video footage for the incident case # 022199. Time stamp 6/22/2024 18:17:36 -
18:18:25 In the video you can see residents moving into the unit. A staff member can be seen standing at the door with three
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 1 of 2

other residents. The victim can be seen walking in and is approached by the aggressor and punched in the face. Staff
immediately separate the residents and the victim was attended by a nurse who walked in behind the residents. The victim
was taken to for medical care and was released the same day. The safety plan for the incident was each resident to process
with their therapists, separation, and assault precautions. Also the aggressor reassessed every 24 hours.
Provider Comments:
CCL Staff Signature : Date: 7/3/2024
Provider Signature : Date: 7/3/2024
www.arkansas.gov/dhs
Serving more than one million Arkansans each year Page 2 of 2


summary: A resident was taken to Ozark Orthopedics after complaining of leg pain from slipping while playing kickball.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 022198
Date of Incident: 6/21/2024
Date Received:6/24/2024
Facility Name: Piney Ridge Treatment Center
Facility Number:203
Incident Type: Licensing
Report Description: Child?s Name:
Description of report: On 06/21/2024 resident was playing kickball for
Recreational Therapy, he slipped out of his shoe and initial complained of knee pain. Upon
initial assessment he was able to move knee without pain but did complain of his lower
right leg hurting. APRN was notified and we received an order to take him to Ozark Ortho
for.
He currently is in a cast and will do a follow-up on 07/01/2024 at 1430. He is
currently on no sports until further orders are received.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 6/24/2024 - The provider reported incident and facility implement
was reviewed by the Licensing Specialist.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov


summary: A resident was taken to urgent care after injuring his ankle by jumping down from an awning he had climbed to retrieve a football.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 022084
Date of Incident: 6/17/2024
Date Received:6/18/2024
Facility Name: Piney Ridge Treatment Center
Facility Number:203
Incident Type: Licensing
Report Description: On 6/17/2024 ) in
the evening around 1800, while outside the resident climbed on the awning to retrieve
football. He had been redirected by staff to not do this. The resident got the football and
jumped down hearing a ?pop? in his ankle. He was immediately assessed and the APRN
was called. His left ankle was noted to be extremely swollen, and he was taken to urgent
care of x-ray. Resident was taken to urgent care
He was placed in a cast and will follow-up with Dr. Patterson at Ozark
Orthopedics on June 24th. Resident will be treated for pain according to physician orders.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 6/20/2024 - The provider reported incident was reviewed by the
Licensing Specialist, Licensing specialist will follow up with the facility if any changes will
be made to the outdoor awning as a preventative measure. 6/20/2024- Licensing specialist
received correspondence from the facility "Please note that the resident would not follow
staff direction to stop. We have reviewed modifications multiple times throughout the years.
Because of a patient rights issue of not having to walk exposed to weather elements during
We Care. We Act. We Change Lives.
humanservices.arkansas.gov

inclement weather, we have kept the awning up. Staff will continue to redirect residents of
the safety issue related to climbing. "


summary: Officers responded to a complaint that two employees were having intercourse outside along the fence between Piney Ridge and Vantage Point.

raw_content:
Incident Report
Print Date/Time: 07/17/2024 15:35 Fayetteville Police Department
Login ID: bjenkins ORI Number: AR0720100
Incident: 2024-00041559
Incident Date/Time: 6/15/2024 9:31:15 PM Incident Type: INDECENT EXPOSURE
Location: 4253 N CROSSOVER RD Venue: FAYETTEVILLE
FAYETTEVILLE AR 72703
Phone Number: Source: Phone
Report Required: No Priority: 2-Medium
Prior Hazards: No Status: In Progress
LE Case Number: Nature of Call:
Unit/Personnel
Unit Personnel
465 465-DONALDSON
501 501-WARREN
Person(s)
No. Role Name Address Phone Race Sex DOB
1 Caller ANONYMOUS
Vehicle(s)
Role Type Year Make Model Color License State
Disposition(s)
Disposition Count Date/Time
Unit:465
Disposition Count Date/Time
02GONEONARRIVAL 1 06/15/2024 21:44
Unit:501
Disposition Count Date/Time
02GONEONARRIVAL 1 06/15/2024 21:44
Property
Date Code Type Make Model Description Tag No. Item No.
Page: 1 of 1
Page: 1 of 2

CAD Narrative
06/15/2024:21:34:51mkurtzNarrative:DESPITESAYINGSHEISAPASSERBY,CALLERSEEMEDTOHAVEKNOWLEDGE
OFFACILITYOPERATIONSANDSAIDADMINWOULDNOTBETHEREAND AREASLEEP.
06/15/2024:21:33:25mkurtzNarrative:MAYBE2-3MINDELAY.
06/15/2024:21:33:11mkurtzNarrative:CALLERISAPASSERBY.
06/15/2024:21:33:04mkurtzNarrative:UNKFURTHERDESC.
06/15/2024:21:32:59mkurtzNarrative:BOTHSUBJSINSCRUBS.
06/15/2024:21:32:40mkurtzNarrative:ALONGTHEFENCEBETWEENPINEYRIDGEANDVANTAGEPOINT.
06/15/2024:21:32:23mkurtzNarrative:CALLERREPORTINGTWOEMPLOYEESHAVINGINTERCOURSEOUTSIDE.
Page: 2 of 2

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


summary: A resident was taken to Ozark Orthopedics after complaining of pain in his left foot.

raw_content:
Placement and Residential Licensing Unit
P.O. Box 1437, Slot S140, Little Rock, AR 72203‐1437
P: 501.682.8590 F: 501.683.6060 TDD: 501.682.1550
Notice of Serious Incident
Case Number: 021894
Date of Incident: 6/10/2024
Date Received:6/11/2024
Facility Name: Piney Ridge Treatment Center
Facility Number:203
Incident Type: Licensing
Report Description: On 06/07/2024,
reported to staff that approximately a week ago, he almost fell outside. He is now having
pain in his left foot. APRN ordered x-ray to be done in house,
On 6/10/2024 he was taken to Ozark Orthopedics where they did
another x-ray and
He will be in a walking boot anytime he is walking or standing and will follow-up
in 4 weeks. He will follow up with aprn.
Interim Action Narrative:
Maltreatment Narrative:
Licensing Narrative: 6/12/2024 - The provider reported incident and facility implement
was reviewed by the Licensing Specialist.
We Care. We Act. We Change Lives.
humanservices.arkansas.gov