Disability Rights Arkansas

United Methodist Children's Home Little Rock

*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 rstanford@disabilityrightsar.org

Methodist Children’s Home operates multiple programs on a single campus. Police responses to this campus often do not identify the program they are responding to. All reports plausibly related to the PRTF or Qualified Residential Treatment Program/Group Home (QRTP) have been included here. Where we can be certain the response was to the QRTP it is noted.

Location: Little Rock, AR                   Population Served: Children and adolescents in need of out of home psychiatric care in a residential setting

# of residents per unit: 20 Residents per room: 1 Capacity: 40

Contact with family (Calls and visit schedule): Clients have regularly scheduled phone call opportunities. The number of actual calls depends on the clients wish to utilize these opportunities. In person visitation (assuming no quarantine precautions) is available every weekend and can be scheduled at other times as needed by the family or guardian.

Restraint utilized? Yes Chemical Restraint utilized? Yes Seclusion utilized? Yes

Treatment Components:

Clinical Director: LCSW                    Therapists: 1 full-time therapist (LCSW)

Treatment modalities offered: Facility declined to identify any specific treatment modalities available

# of individual therapy sessions/week: Minimum 1 per week scheduled. May vary upon the treatment plan of the client.

# of group therapy sessions led by a licensed mental health professional/week: Minimum of 1 with 2 preferred.

UMCH LR Report (combined)

Photo Appendix to report

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PRLU or OLTC

Notice of Incident

  • Injury – Assault
    • Client and peer got into argument and client walked up to peer and started punching him. Staff intervened and separated them both. Peer’s nose and mouth were bleeding, and he was transferred to ER. A non-emergency number was called, and the police came out; Client was charged with 3rd degree battery. Peer was diagnosed with Posttraumatic deformity of the nasal septum and was instructed to follow up with an Ear Nose and Throat Specialist within the next week.
    • Both residents were restricted to come within 10 feet of each other. Specialist visited facility on 8/19/21 to view video footage of incident; The staff to child ratio was 1 staff to 8 children according to the video. Agency was cited for 907.3 – Ensure staff to child ratios are in compliance with the minimum licensing standards for PRTF facilities. Specialist advised facility to call hotline due to inadequate supervision. Child Abuse Hotline was called, not accepted. Specialist instructed the administration to retrain involved staff and provide documentation.

Police Report

Battery Third Degree

Staff stated Juvenile1 punched Juvenile2 in nose after altercation, Juvenile2 sent to ACH for treatment. Juvenile1 stated Juvenile2 provoked him by “talking crap” to him; Juvenile2 stated Juvenile1 repeatedly bullies him and punched him out of nowhere; Juvenile 2s nose was broken.

PRLU or OLTC

Notice of Incident

  • Accidental Injury
    • Client tripped over the door stopper in the gym while playing kickball. Client injured her wrist when she fell, and X-ray was ordered after the nurse assessed. Client’s X-ray returned normal, and no broken/fractured bones were found.
    • Specialist reviewed video of incident and saw no issues with supervision (2:8 staff to kids ratio) or how staff responded to the injury.

Police Report

Disturbance

Officers responded in reference to a report by a refused complainant of an unknown male having assaulted her. Phone pinged at location, but officers could not locate complainant after circulating area and two callbacks. Officers also checked with staff, who stated they were unaware of situation.

Police Report

Information Report

Officers circulated the area and attempted multiple callbacks after a 911 hangup with negative results.

PRLU or OLTC

Complaint Survey with POC, Revisit Survey, Workload Report

  • Complaint #AR00026923 substantiated. Complaint #AR00026924 substantiated. Complaint #AR00026925 substantiated. Complaint #AR00026926 substantiated. Complaint #AR00026927 substantiated. Complaint #AR00026933 unsubstantiated. Complaint #AR00026934 substantiated. Complaint #AR00026935 substantiated. Complaint #AR00026937 substantiated. Complaint #AR00026939 unsubstantiated. Complaint #AR00026940 substantiated. Complaint #AR00026941 substantiated.
    • N 100 – Facility failed to ensure clients were free from restraint and or seclusion use for discipline purposed for 4 clients.
    • N126 – Facility failed to ensure clients were free from restraint and or seclusion use for discipline purposed for 4 clients who had documented restraint and/or seclusion.
    • N127 – Facility failed to ensure clients’ medication regimens were free of chemical restraints ordered on an as-needed (PRN) basis for 7 clients who had orders for as needed chemical restraints.
    • N128 – Facility failed to ensure no injury occurred during a physical restraint for 3 clients who had documented use of restraints and or seclusion.
    • N129 – Facility failed to ensure restraint and seclusion were only used in an emergency situation for 6 clients who had restraints and/or seclusion.
    • N130 – Facility failed to ensure an Emergency Safety Intervention was discontinued after the emergency situation had ceased for 4 clients who had documented restraint and/or seclusion.
    • N131 – Facility failed to ensure restraint and seclusion were not used simultaneously to assure the safety of the clients for 7 clients who received a chemical restraint and were placed in a physical restraint and seclusion.
    • N132 – Facility failed to ensure a restraint was conducted in a safe and appropriate manner to prevent potential injury for 1 client reviewed for restraint and/or seclusion.
    • N135 – Facility failed to ensure an Authorization / Consent / Release document was signed by the clients’ parents / legal guardian at the time of admission for 6 clients who were admitted to the facility.
    • N136 – Facility failed to ensure a copy of the facility’s Restraint and Seclusion policy was received by the client’s parents/legal guardian at the time of admission for 8 clients who were admitted to the facility.
    • N140 – Facility failed to ensure physician orders were obtained for all restraints and seclusion utilized for 12 clients who had restraints and/or seclusion implemented.
    • N142 – Facility failed to ensure the least restrictive Emergency Safety Intervention was ordered and that less restrictive measures were attempted prior to application of a restraint or seclusion for 5 clients.
    • N145 – Facility failed to ensure a face-to-face assessment was conducted within one hour after initiating a restraint to protect client rights for 3 clients who had been restrained.
    • N149 – Facility failed to ensure Emergency Safety Interventions were documented and in the clients’ record to assure an accurate and complete record of the events leading up to, during, and after the intervention for 11 clients who required an ESI.
    • N155 – Facility failed to ensure all Emergency Safety Interventions (ESIs) were documented on a cumulative log to enable tracking of the interventions used and the outcomes for 12 clients who had ESIs performed.
    • N170 – Facility failed to ensure staff provided continuous visual monitoring while clients were in the seclusion rooms to assure the physical and psychological well-being of the client for 3 clients who had been placed in seclusion.
    • N188 – Facility failed to ensure all staff who participated in ESIs were present during the client debriefing to provide the client and staff with an opportunity to analyze the events surrounding the ESI and determine if any changes in the clients’ treatment plans were needed for 7 clients who had ESIs performed.
    • N189 – Facility failed to ensure all staff who participated in ESIs were present during the staff debriefing to provide the staff with an opportunity to analyze the events surrounding the ESI and determine if any changes in the clients’ treatment plans were needed for 6 clients who had ESIs performed.
    • N202 – Facility failed to ensure staff involved in an Emergency Safety Intervention (ESI) that resulted in client injuries met with supervisory staff to evaluate the circumstances that caused the injuries and developed and implemented a plan to prevent further potential injuries for 1 client who received an injury during a personal restraint.
    • N207 – Facility failed to ensure a serious occurrence was reported to the State Agency as required, to enable the agency to provide any needed oversight of the facility’s investigation for 1 client whose records were reviewed for serious occurrences.
  • 09.30.21 Revisit Survey found facility still not in substantial compliance with participation requirements. Regs out of compliance:
    • N 135 – Facility failed to ensure an Authorization/Consent/Release document for use of Emergency Safety Interventions (ESIs) was signed by the client’s parents/legal guardian at the time of admission for 4 clients.
    • N 149 – Facility failed to ensure an Emergency Safety Intervention (ESI) was documented and in the client’s record to assure an accurate and complete record of the events leading up to, during, and after the intervention for 1 client who had an ESI.
    • N 207 – Facility failed to ensure a serious occurrence was reported to the State Agency as required, to enable the agency to provide any needed oversight of the facility’s investigation for 1 client.
  • 11.03.21 Revisit Survey (no POC provided from 09.30.21 Revisit) found facility in compliance with program requirements. No new noncompliance was found.
  • Survey Team Composition and Workload Report –
    • Surveyor 1 onsite 61.25 hours 8am – 6pm; 8 travel hours, 47 off-site report prep hours (08/02/21 – 08/13/21).
    • Surveyor 2 onsite 61.25 hours 8am – 6pm; 8 travel hours, 8.75 off-site report prep hours (08/02/21 – 08/13/21).
    • Surveyor 3 onsite 61.25 hours 8am – 6pm; 5 travel hours, 47 off-site report prep hours (08/02/21 – 08/13/21).
    • One surveyor onsite 19 hours 8am – 6pm; 4 travel hours, 7.5 off-site report prep hours (09/28/21 – 09/30/21).
    • Two surveyors onsite 6.25 hours each, 8am – 6pm; 0.5 travel hours each. Surveyor 2: 1 off-site report prep hours (11/03/21).

PRLU or OLTC

Notice of Incident

  • Maltreatment
    • Client attempted to self-harm and tie clothing around her neck, scratching staff when they tried to intervene. After staff took clothing away from client, client became more aggressive attempting to attack staff. Client was placed in a restraint and received a chemical due to her behavior. Child Abuse Hotline was called and initially not accepted.
    • Once video was reviewed by facility it was discovered that staff member appeared to strike the child and it was said that the staff member used a profanity and lost her cool during the situation. The staff member was put on leave pending the outcome of an internal investigation.  
    • Specialist received email about the incident on 8/6/21 and asked for incident report from facility administrator. Specialist received report on 8/19/21; Specialist visited facility on 8/19/21 and reviewed video of the incident. Specialist confirmed staff member striking the child, and cited the agency for 905.4.g – The following action shall not be used, including as discipline: Physical Injury or threat of bodily harm. Specialist advised staff to call incident back into hotline. Specialist followed up the next day and discovered the report was screened out; Specialist called the hotline, and it was accepted. Specialist received a call from the assigned investigator for an interview.

Police Report

Criminal Mischief Second Degree

Staff stated he took the kids to Dairy Queen and no one would buy Juvenile anything. When they returned to facility, Juvenile was upset and started to throw items around the room and at window. Juvenile also kicked Staff’s vehicle several times. Juvenile was transported to Children’s Hospital.

PRLU or OLTC

Visit Compliance Report

  • Specialist conducted inspection of the girl’s unit with no regs out of compliance; The boy’s unit is currently quarantined due to Covid-19.
  • Specialist reviewed med logs for 4 children with no regs out of compliance. Current census 25 with 10 boys and 15 girls.

PRLU or OLTC

Complaint Founded

A complaint was received regarding a chemical restraint used on June 21st, 2021.  After reviewing the still shots and video, it was noted that the child was seated and calm with the chemical restraint was used:

  • 905.11- Chemical restraints shall be used only if ordered by a Physician. A chemical restraint is an emergency behavioral intervention that uses pharmaceuticals by topical application, oral administration, injection, or other means to modify a child’s behavior. (Per this regulation, a chemical restraint should only be used if an emergency behavioral intervention is needed. Licensing recommends re-training staff on written policy governing the use of behavioral control measures with children to be completed by 10/09/21).

PRLU or OLTC

Complaint Founded

When investigating an incident involving the elopement of multiple kids on 4/28/21, pictures and video were reviewed. The finding for the complaint is founded as the agency violated the following standards:

  • 905.11- (See above for definition)- Chemical restraints were used on multiple children that appeared to be compliant and not agitated upon return to the facility
  • 905.4.h – The following actions shall not be used, including as discipline: Humiliating or degrading action. (One child was injected and forced to pull his pants down in the hallway in front of others. PRLU considered this to be humiliating or degrading action).

PRLU or OLTC

Complaint Founded

Visit to UMCH conducted to follow up on an incident report. More information was requested and has not been provided yet:

  • 907.2 – (See above for definition) Provider reported incident dated 6/27/21 regarding an incident that took placed on 5/11/21. Staff was off the hall for a minimum of one hour and children were left unattended.
    • 907.6- (See above for definitions) Staff failed to provide 30-minute checks during sleeping hours.

PRLU or OLTC

Visit Compliance Report

  • Specialist visited facility to review videos regarding an incident. Complaint found true. Cited for 907.2 and 907.6.
    • 907.2 – Provider reported incident dated 6/27/21 regarding an incident that took place on 5/11/21.  Staff was off hall for a minimum of 1 hour and children were left unattended.
    • 907.6—Staff failed to provide 30-minute checks during sleeping hours
  • Specialist reviewed records for 3 children with no regs out of compliance.

Police Report

Disturbance

Staff advised that Juvenile stated he wanted to hit everybody and himself, holding part of a broken chair. Juvenile stated he was mad after being accused of something he didn’t do. MEMS transported Juvenile to Children’s Hospital.

PRLU or OLTC

Visit Compliance Report

  • Specialist reviewed meds for 2 residents; Resident missed AM dosage on 7/5/21 and PM dose on 7/12/21. Facility staff could not explain why the med log showed the dosage was not given.
  • Regs out of compliance, not correctable –
    • R406.4.d – Ensure Med Logs are initialed by the staff giving the meds going forward.
  • TA –
    • R409.6 – Window in room 507 will not open. Ensure window will open before a child is placed in that room.

Medicaid Inspection of Care

On-Site Inspection

  • Included: IOC, Notice of Sanctions, CAP
  • Multiple deficiencies noted. Plan of Correction required to be completed within 30 days.

PRLU or OLTC

Visit Compliance Report

  • No regs noted out of compliance.
  • TA –
    • R911.6 – Windows in both Day Rooms are broken and awaiting repairs and the window in room 1238 in the boy’s unit is also broken. Staff stated parts have been ordered; The rooms are currently locked and not accessible to anybody but maintenance staff.

PRLU or OLTC

Notice of Incident

  • Other – Peer Altercation
    • Resident instigated a verbal altercation with peer and slapped peer. Staff intervened and resident went back to his seat.
    • Child Abuse Hotline was called, not accepted. Specialist requested video footage and conducted follow up visit at the facility.

Police Report

Missing Person

Staff reported that Juvenile 1&2 kicked open a door at facility and left. Both Juveniles were found and returned to facility.

Police Report

Rape

Officers received referral from Child Abuse Hotline. Juvenile 1 disclosed that Juvenile 2 entered his room and penetrated him. Investigation is ongoing.

Police Report

Sexual Assault Second Degree

Officers received referral from Child Abuse Hotline. Juvenile 1 disclosed that Juvenile 2 came into his room while he was sleeping and attempted to have sex with him. Juvenile 1 stated he pushed Juvenile 2 off him and Juvenile 2 exposed his penis and left.

PRLU or OLTC

Notice of Incident

  • Other – Swallowed Object
    • Client became non-compliant, refused to leave foyer area, and began to use a marker to color before breaking it in half. After client was instructed by staff to hand the marker over, client asked “what do you think would happen if I swallow this”. The client then placed it in her mouth, showed it to staff on her tongue and swallowed it. Staff then took the client to bathroom for a full body search to make sure she didn’t have other items. Nursing assessed the client and gave her Bisacodyl so she could use the bathroom to release the item. X-ray was ordered and item was not found during the x-ray.
    • Staff were informed that the involved client is to not be allowed access to the following: markers, pens, pencils, or sharp instruments. The client is also monitored during meals to ensure she does not bring back utensils with her.

Police Report

Information Report

Officers received 911 hang up call; Upon arrival, Staff stated no one in the building had called 911. Staff also stated everyone was fine.

PRLU or OLTC

Visit Compliance Report

  • Specialist viewed video footage from 5 incident reports. (Video footage from five incident reports involving IC including two reports from 2/28/21, 3/12/21, 3/18/21, and 3/20/21).
  • The 1st incident showed staff went into a hold without appropriate de-escalation attempts; Appropriateness of hold was questionable. One of the staff members involved in the hold has been terminated regarding a different matter. The 2nd incident showed a staff member pushing a client against a wall to separate from another client. The 3rd incident showed a staff member using an improper hold, client had injury
    to his shoulder; This incident was reported to the Child Abuse Hotline but was unfounded. However, this is a true Licensing Complaint for inappropriate behavior.
  • Regs out of compliance –
    • R905.9 – 3 staff members shall have training on behavior management including deescalation, appropriate restraints, and proper documentation of incidents.
    • R907.2 – 3 staff members shall have training on behavior management including deescalation, appropriate restraints, and proper documentation of incidents.
    • R905.4.g – 3 staff members shall have training on behavior management including deescalation, appropriate restraints, and proper documentation of incidents.