Disability Rights Arkansas

Little Creek Behavioral Health

*Photos taken by DRA staff during onsite monitoring visits. Photos reflect the most recent conditions observed by DRA staff but may not reflect the current conditions at the facility. If you are associated with a facility and have updated information or photos you would like to share, please contact DRA at [email protected]

Location: Conway, AR                       Population Served: Non-Arkansas residents ages 6-21. Deaf and hard of hearing unit.

# of residents per unit: up to 8 Residents per room: 1-2 Capacity: 64

Contact with family (Calls and visit schedule): Weekly to Bi-weekly calls. Visits with families are scheduled (no additional details were provided).

Restraint utilized? Yes Chemical Restraint utilized? Yes Seclusion utilized? No

Treatment Components:

Clinical Director: LPC-S                    Therapists:4 full-time therapists (2 LMSW, 1 LCSW, 1 LAC)

Treatment modalities offered: “Trauma-informed Care, Cognitive Behavior Therapy (CBT), Eye movement desensitization and reprocessing (EMDR) and Reality Therapy, Person-Centered and Deaf Mental Health.”*

# of individual therapy sessions/week: 1-2

# of group therapy sessions led by a licensed mental health professional/week: 2-3

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PRLU or OLTC

Visit Compliance Report

  • “Video footage reviewed. Staff ratio was initially 1:6 Staff then 3:6 for fight that proceeded elopement.” As soon as two additional staff left, 2 clients exited the back door. The original staff member made no attempt to stop clients from exiting back door.
  • Regs not correctable –
    • R907.2 – Staff did not provide the level of supervision, care, and treatment necessary to ensure the safety and well-being of each child at the facility.

PRLU or OLTC

Visit Compliance Report

Walkthrough conducted; Census 49. Staff advised 2 clients were quarantined pending test results. Bathroom out of order in Angelfish; Maintenance had been called. MARs reviewed with no issues noted.

Police Report

Call Card, Runaway

Two residents eloped; Caller has little info about them. They have been gone 1 minute; Call then stated they had returned a minute later, but thinks they will do it again. Staff called again stating Juvenile1 was in restraints and Juvenile 2 left. Officer arrived on scene.

PRLU or OLTC

Notice of Incident

  • Elopement (1)
    • Client and peer kicked door, making it open, and got outside. FC Sheriff Department arrived at facility and left once everything was calmed. No injury to client. Client placed on Unit Restriction and Physical Hold. No follow-up details.

PRLU or OLTC

Notice of Incident

  • Elopement (2)
    • Client attempted to get over facility gate, but staff intervened. After returning to the back door, the client attempted to run through another gate but failed and was placed in restraint. FC Sheriff Department at facility for assistance. Client attempted to climb over the gate again but was stopped by staff and taken back to facility. No injury to client. Client placed on Unit Restriction and Physical Hold. No follow-up details.

PRLU or OLTC

Notice of Incident

  • Maltreatment
    • Client was dragged in a room by his peers and wanted to get out; Client was in the room for approximately 6 minutes before he was able to walk out by his peer. Staff stayed seated the entire time while client was being forced to play an inappropriate sexualized game. Facility investigation included interviewing residents on the unit, interviewing staff, and reviewing camera footage. The allegation of neglect towards client was substantiated. The incident location was in client’s room (camera footage not available in client’s rooms). Client stated he was forced to play a game called butt raped. Butt raped is where a peer or peers will sexually hump on the target client while clothed. Staff member was terminated due to the violation of Little Creek’s Zero Tolerance Policy.
    • Specialist reviewed video on 12/29/21 which shows peers dragging client into a room from 7:05pm – 7:12pm on 12/27/21. Client is clearly heard yelling “no”. Client attempted to stay close to staff member. No video footage was available for bedroom. At no time did staff member do anything to stop anything reported in this incident. The hotline was not called regarding this incident. Facility was cited for 110.9 and 907.2. Consultation had with Risk Mgmt. regarding making hotline calls in the future.

PRLU or OLTC

Visit Compliance Report

Walkthrough conducted; Census 48. No concerns noted.

PRLU or OLTC

Visit Compliance Report

Walkthrough conducted and classroom viewed on camera. No issues noted.

Police Report

Call Card, Sexual Offense

“One resident touched another”; Info restricted.

PRLU or OLTC

Notice of Incident

  • Sexual Contact
    • Client stated he would like to file a police report on his peer for accidentally touching him on his bottom while attempting to wake him up. Client stated there was no sexual intent behind this incident. Both clients acknowledged that peer stated, “I touched your bottom on accident, I thought I was touching your stomach”. Police report was made.

PRLU or OLTC

Visit Compliance Report

Walkthrough conducted and 6 MARs reviewed. No issues noted.

PRLU or OLTC

Visit Compliance Report

Walkthrough conducted and 5 MARs reviewed. No issues noted.

PRLU or OLTC

Visit Compliance Report

  • Conducted employee record reviews on-site.
  • Regs out of compliance –
    • R103.1 – Background checks were pulled, and 26 staff members did not have background checks present in packet. Due to absence of HR worker, Acadia employee stated she would follow up and send email no later than 11/15/21 whether individuals are employed and if background checks need conducted.

PRLU or OLTC

Visit Compliance Report

Walkthrough conducted and 3 MARs checked, no concerns noted. Watched video of classroom; Ratio was correct in videos. Overall facility in order and good repair.

PRLU or OLTC

Visit Compliance Report

  • Completed building and grounds walkthrough; Census is 52. MARs reviewed for 5 residents.
  • Regs out of compliance –
    • R914.6 – No fire escape diagram posted in “Bass” unit. Staff reports a plan to put diagrams in plexiglass and mount them to the walls.

PRLU or OLTC

Notice of Incident

  • Complaint
    • Specialist received complaint of facility being short staffed and poor management. Complaint stated that staff are forced to stay against their want. Staff has charges on background and talks down to kids and staff. A kid was recently choked by a staff member and staff all lied to save the staff member and sent the boy home. They want this staff member back on the floor. There is almost never an interpreter in the deaf classroom. Not enough direct care or case managers.
    • Follow up was done with background check unit and background check was completed for staff member. Ratios at random check at facility was within standards. No further follow-up details.

PRLU or OLTC

Corrective Action Agreement

  • Non-compliance areas cited since 07/01/21 –
    • 905.9 Behavior Management – Cited for staff failing to use the minimal time and force necessary after initiating a restraint hold for 3 incidents.
    • 907.2 Ratio and Supervision – Cited for staff not providing the level of supervision, care, and treatment necessary to ensure the safety and well-being of each child at the facility for 2 incidents.

PRLU or OLTC

Notice of Incident

  • Complaint
    • Specialist received complaint that 2 therapists resigned, leaving only the clinical director to provide therapy services to the residents. Residents are reportedly not receiving therapy services.
    • According to the individual who made the complaint, the therapists left due to unprofessional contact, mistreatment of staff, and mistreatment of residents. The reporter also mentioned that the staff who resigned were asked to “stay on paper” so that it would not appear as though the agency did not have any therapists on staff.

PRLU or OLTC

Notice of Incident

  • Assault
    • Client was upset and began to attack staff. Peer became upset client was attacking staff, so they charged at client and knocked them into a wall.
    • Client noted to have slight bleeding around gum line of left central incisor and left lateral incisor with both teeth noted to be loose. Client has appt on 8/31/21 for dental evaluation. The dentist notes that no further treatment is needed.

PRLU or OLTC

Notice of Incident

  • ER Visit – Possible Appendicitis
    • Client was complaining of severe stomach pain, so she was sent to the ER due to possible appendicitis. No follow-up details.

PRLU or OLTC

Technical Assistance, Visit Compliance Report

Specialist discussed with staff regarding a needed interim corrective action for staff involved in an incident; Discussed reporting incidents that violate Licensing Standards even if they are screened out from the Child Abuse Hotline. Management had several questions regarding what standards in the Minimum Licensing Standards apply to them; Further discussion will take place as soon as all needed parties are available.

PRLU or OLTC

Notice of Incident

  • Maltreatment
    • Therapist blocked resident in corner from trying to fight peer. Resident began to push the therapist back so the BHA staff took the resident to the ground. BHA staff then attempted to put his hand around the resident’s neck and therapist intervened and removed the BHA staff away from resident. When asked later, the resident denied the BHA staff squeezed his hand around his neck. Witnesses reported staff did squeeze his hands around his neck.
    • Staff placed on Administrative Leave as of 8/20/21 and returned to work on 8/24/21 to receive de-escalation training. After specialist reviewed camera footage, a new hotline call was placed and accepted so the staff was placed on office duties with no direct or unsupervised contact with residents until investigation is completed. Unsubstantiated.  

PRLU or OLTC

Technical Assistance, Visit Compliance Report

  • Specialist discussed a report sent to the specialist involving a previous resident and staff member. Specialist is not prepared to leave a Licensing finding at this time due to the ongoing CACD investigation. Specialist reviewed 5 children’s records.
  • TA –
    • R904.1.h – The charts of 3 residents were noted to be missing required legal documents.
    • R110.9 – Specialist discussed with staff what reasonable cause means in mandated reporting and educated staff on expectations of staff to report any suspected child maltreatment or neglect to the Child Abuse Hotline immediately.
    • R905.17 – A restraint documented in a resident’s chart was noted to not have the names of staff involved in the restraint listed.
  • Licensing Specialist was asked to sit in on a meeting occurring with Tracie Schnider with Behavioral Health and Aging, who was there to discuss options for a deaf Arkansas DCFS foster child to be place at the facility. Specialist explained that the child shall not be admitted prior to the approval of the CWARB.

PRLU or OLTC

Notice of Incident

  • Staff Sexual Abuse
    • Alleged offender (previous staff) has been accused of having sexual intercourse with a previous resident during his time at the facility from Jan. – Mar. 2021. It is reported that the facility once reprimanded the employee for giving candy to this resident then conducted their own investigation into the sexual abuse allegations, but never called this report into the hotline, and that 2 other employees were aware of this situation and failed to report it.
    • Staff is no longer employed at the facility as of 3/31/21. On 8/17/21, Specialist received response from facility staff confirming they had knowledge of the accusation but did not find substantial evidence during their own investigation. Staff was terminated from employment on 3/31/21 after a no call no show. On 8/18/21, Specialist discussed with facility representatives the incident and appropriate mandated reporting. No further details.