Client was sent to Dallas County Medical Center for an X-ray of his left foot. Patient is complaining of swelling and bruising after kicking a soccer ball. X-ray revealed no fracture or dislocation.
PRLU or OLTC
Accidental Injury, Notice of Incident
PRLU or OLTC
Complaint Survey
Complaint AR00035145 was in compliance.
Complaint AR00035775 was in compliance.
PRLU or OLTC
Maltreatment, Notice of Incident, Visit Compliance Report
A complaint was received stating that the complainant was concerned a resident was being over-medicated. The resident was observed as groggy, incoherent, and drooling.
Licensing Specialist: Arlene Horton
LS Horton visited the facility in response to the complaint. She observed and spoke with various residents, including the resident listed in the complaint. Licensing and OLTC nurse reviewed the resident’s MARs for 9/2024-10/2024, all physician orders since admission, vital stat records since admission, and the facility restraint log for 9/2024-10/2024.
No licensing violations were found. The complaint case was closed as UNFOUNDED.
PRLU or OLTC
Elopement, Notice of Incident
Client was outside playing football and when told it was time to come inside, he ran and went under the fence and took off running. Staff immediately called code orange. Police were notified. Code orange called at approximately 17:00. Client returned to Millcreek at 20:35.
Client is on elopement precautions. Per conversation with Ben Beasley of Millcreek, client did not go “under” the fence but “over”.
PRLU or OLTC
Complaint, Notice of Incident, Visit Compliance Report
A complaint was received that Millcreek clients are being overmedicated.
Licensing Specialist: Chelsea Vardell
Licensing visited the facility in regard to this case on 10/23/24, 10/24/24, and 12/13/24. Documentation for the following was reviewed: Pest control services, restraint packet and nursing notes, MARs record, Physician Orders and Physician progress reports, Health vital stat sheet, Facility restraint log.
No violations of the licensing standards were discovered during the course of the investigation. Licensing complaint was closed as Unfounded.
PRLU or OLTC
Maltreatment, Notice of Incident, Visit Compliance Report
A resident reported that roaches were observed in the cafeteria of the facility. He reported that one bug had been killed in the cafeteria and it remained there for several days. Resident also reported that a dead rat was found in front of one of her peer’s doors. Resident stated that staff yells and cusses at the residents.
Licensing Specialist: Kendra Slade
Census: 165
Licensing visited the facility in response to the complaint. LIcensing observed the following units: Tiger, Eagle, Kangaroo, Deerfield, Magnolia, Pebble Creek, and Success. The bathrooms, bedrooms, and dayroom areas were observed on each unit. A walkthrough of the cafeteria was also completed. The facility provided copies of invoices from the pest control company it uses. No evidence of pests were observed during the walkthrough.
This complaint was Unfounded by Licensing.
PRLU or OLTC
Notice of Incident, Peer Sexual Contact
Resident reported that his roommate touched his private area and tried to pull his pants down.
Licensing reviewed report. Facility reported that the residents had been separated and would no longer be roommates.
PRLU or OLTC
Elopement, Neglect, Notice of Incident, Visit Compliance Report
At approximately 17:00 unit supervisor received a call from Fordyce Police Department reporting that a patient had broken into a house and they needed to return him to Millcreek. Staff went to the residence and found patient sitting in a vehicle. Patient stated that the car battery was dead, so he was just sitting in it. Patient stated that he crawled under the fence while the unit was outside and staff wasn’t looking. Patient was returned to Millcreek and searched for contraband. Patient has been placed on suicide precautions due to patient stating that he wanted to kill himself. Staff that was assigned to patient will be terminated on 10/14.
Licensing Specialist: Clayton DeBoer
Facility visited in response to this incident. Staff/client ratio at the time of this incident was 1:6. Millcreek staff was not aware patient was awol until notified by Fordyce Police Department.
Facility cited 907.2 for staff not supervising patient for the amount of time it took for the patient to elope from facility, travel to and break into a residence.
PRLU or OLTC
Notice of Incident, Peer Altercation
While outside playing basketball, client went up to a peer and confronted him about a missing watch. They started talking and peer got angry and swung and hit client on the lip causing his lip to bleed. Staff intervened and separated patients. Client was sent to Dallas County ER where he received 5 sutures in his lip.
PRLU or OLTC
Visit Compliance Report
Licensing Specialist: Clayton DeBoer
Children’s Records Reviewed for multiple residents. All required items are present in a hard copy file.
PRLU or OLTC
Notice of Incident, Self-Harm
Client went to Dallas County Medical Center for an X-ray of his right hand due to pain after punching a wall. The X-ray showed no fracture or dislocation.
PRLU or OLTC
Notice of Incident, Self-Harm
Client kicked a door during a behavior injuring her left pinky toe. Dr. ordered an x-ray to check for fractures. X-ray came back normal
PRLU or OLTC
Medical, Notice of Incident
Client fell prior to coming to Millcreek. She has since been having knee pain. Dr. ordered an X-ray of her right knee to check it. The X-ray showed no fracture or dislocation.
PRLU or OLTC
Notice of Incident, Self-Harm
Resident was sent to Dallas County Medical Center for an x-ray on left hand due to complaint of hand pain after punching a concrete wall. X-ray found no abnormalities.
PRLU or OLTC
Medical, Notice of Incident
Medical Director ordered a CT for resident due to a history of rectal bleeding. CT Findings: 1. No acute inflammatory changes. No evidence for mechanical bowel obstruction. 2. Hepatic Steatosis 3. Nonspecific small lymph nodes in the right lower quadrant, root of mesentery, and retroperitomeum.
PRLU or OLTC
Accidental Injury, Notice of Incident
Resident was playing basketball and jammed his right third finger. He was taken to Dallas County Medical Center for an x-ray. Diagnosis: Nondisplaced volar plate fracture through the base of the middle phalanx of the right third finger.
PRLU or OLTC
Notice of Incident, Peer Altercation, Visit Compliance Report
Resident was involved in an altercation on her unit. She was targeted by several peers. Code green was called and staff separated the residents. Staff took the resident to Dallas County Medical Center to be checked out due to complaint of face pain. All scans and x-rays came back clear.
Licensing Specialist: Clayton DeBoer
9/25/24- Licensing visited facility and reviewed video: The resident received several kicks to the facial area. While this was happening, one of the staff members had already walked about to call a Code Green. The other staff was within arms’ length of the resident while they were being kicked and did little physically to intervene. Facility cited 907.2. Both staff will be retrained on TCI.
PRLU or OLTC
CAP, IOC Report
Multiple deficiencies were noted during the Inspection of Care (IOC) conducted on 9/16/24. A Corrective Action Plan (CAP) was submitted and approved.
PRLU or OLTC
Complaint Report, IOC
A Medicaid Inspection of Care review was triggered by a complaint against the facility. Deficiencies were cited.
PRLU or OLTC
Maltreatment, Notice of Incident, Redacted, Visit Compliance Report
Resident reported to her therapist that while trying to get in the storage closet, she had put her foot in the door. A peer moved her foot out of the door and as a staff member was shutting the door, the resident put her arm in the door and the staff member shut the door on her arm. A report was made to AR Child Abuse Hotline and accepted. Staff member was placed on administrative leave.
Licensing Specialist: Clayton DeBoer
Facility visited on 9/17/24. Video was reviewed of Deerfield for the entire morning of 9/14/24 which does not show the incident. Client indicated the incident was not in camera view. Client stated when this occurred, nothing was said by the staff member during or after the incident. Client visually had a bruise on her arm during visit, and nursing note on the day of the incident states the same. The peer that was present was interviewed, and reported that when she (peer) kicked the resident’s foot out of the doorway, the door shut on the resident’s arm. Peer stated from what she saw this was an accident.
11/21/24 – CACD case unfounded. This complaint has been unfounded by Licensing. Staff will be retrained on TCI.
Police Report
Police Report, Theft
Officer was dispatched to facility for a staff member wanting to report his stolen laptop. The staff member reported that he had locked the laptop in the back office and when he arrived for his shift, he saw that the laptop was gone.
He pinged it’s location from his phone and it pinged at a coworker’s residence. The staff member spoke with the coworker about returning the laptop, and the coworker stated he did not have it.
The staff member then contacted the police, and also checked the live ping again and the laptop had been turned off.
PRLU or OLTC
Accidental Injury, Notice of Incident
Resident was sent for an x-ray due to complaining of hand pain. Diagnosis: Nondisplaced fracture at the base of the left finger. It is undetermined how this occurred. Patient stated that he was running and bumped into another patient and fell down on his hand and that is how it occurred.
PRLU or OLTC
Notice of Incident, Redacted, Visit Compliance Report
Licensing received complaint that Millcreek failed to provide appropriate medical care to client.
Licensing Specialist: Clayton DeBoer
Licensing visited the facility on 9/9/24 in response to complaint stating that the reporter was concerned about a viral illness the resident had and that the facility physician had not provided the client with antibiotics. Physician and nursing notes were reviewed showing that the facility was providing care to the resident during her illness. The complaint has been closed as unfounded.
PRLU or OLTC
Maltreatment, Notice of Incident, Redacted, Visit Compliance Report
Resident reported that during a restraint, he bit staff and the staff member hit him in the face. A report was made to AR Child Abuse Hotline and accepted. Staff member was placed on administrative leave.
Licensing Specialist: Clayton DeBoer
Licensing visited facility and reviewed video footage on 9/9/24. Nursing note reviewed which does indicate a red cheek and abrasion to bottom lip. At no time during video review was any staff seen hitting the resident. Nothing can be definitively seen in restraint video that would result in resident getting marks on his face. At no time did any staff participating in the restraint react to the resident biting them.
The resident had reportedly been in a fight prior to the restraint. Video was backed up and 3 clients were seen attacking the resident, possibly resulting in the resident getting marks on his face. Staff separated the residents.
11/21/24 – CACD case unfounded. This complaint has been unfounded by Licensing. Staff will be retrained on TCI.
PRLU or OLTC
Accidental Injury, Notice of Incident
Resident was injured during recreation time when his foot collided with another patient’s toenail. He received a minor laceration on the 4th toe of his right foot. He was sent to Dallas County Medical Center ER and the laceration was closed with 4 sutures.