Disability Rights Arkansas

Perimeter Behavioral of the Ozarks / Woodridge of the Ozarks

*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

Location: Springdale, AR                   Population Served: Adolescent girls ages 7-17

# of residents per unit: Up to 12 Residents per room: 2 Capacity: 32

Contact with family (Calls and visit schedule): Weekly calls up to 3x/week for 10 minutes, intervention call available 1x/week for 10 minutes. Visitation available 2x/week for 30 minutes if previously scheduled. Zoom available if in person is not possible.

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

Treatment Components:

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

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

# of individual therapy sessions/week: Varies by client, most clients receive one individual therapy session per month

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

 

DRA Monitoring/Investigations

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PRLU or OLTC

Notice of Incident, Self-Harm

On 05/23/23 at approximately 23:30, it was reported that a resident placed a screw into her vagina. While doing so, she scratched the inside of her vagina, resulting in minor bleeding. RN arrived and assisted to the nurses’ station where area was assessed by 2 RNs. Minimal bleeding was noted at the time of assessment. The nursing staff was unable to visualize the entirety of the scratch that went up further in the vaginal canal. EMS was called for transport to the hospital for a more thorough assessment. Provider notified. Client was assisted out of the facility at 00:15 by EMS and floor staff. Client verbalized that the insertion of the screw was an attempt to hide/conceal the contraband. No significant injury requiring follow-up was noted in the discharge paperwork. Upon arrival back to the facility, client was placed on a 1:1 level of observation with hourly body searches, given paper scrubs to don, and placed in the comfort room.

Licensing narrative:

  • 5/24/2023 – Licensing visited the facility and discussed this incident. It was still unknown where the resident got the screw from. The resident was seen in paper scrubs standing in the “Comfort room”. The resident had several injuries up and down her arms from what appeared to be fingernail marks in attempt to self-harm. Licensing also viewed the resident’s bedroom which was completely empty. The CEO reported that the resident’s mattress, bedding, and clothing were removed, as she is staying in the comfort room until she can become stable and rejoin the unit.
  • 5/31/2023 – Licensing Specialist followed-up with facility regarding resident’s precautions. Licensing Specialist informed that resident had been discharged into an acute setting.
  • 6/1/2023 – Licensing Specialist inquired if resident will be returning to the facility. Licensing Specialist informed that resident will not be returning to the facility.

PRLU or OLTC

Maltreatment, Notice of Incident, Visit Compliance Report

On 6/1/23, we received a call from Arkansas State Police that they wanted to come in and interview a client about an allegation that was made, but no further detail was provided at that time. Today, 6/2/23, CEO spoke with State Police and was able to determine that the allegation was made against staff in relation to a physical restraint that occurred with on 5/23/23. Client alleged that during a restraint there was a moment where she “couldn’t breathe.” Per internal policy, the restraint in question was reviewed by [REDACTED], Director of Nurse (DoN). After reviewing the video, it appears that a physical restraint occurred involving the staff in question. She was attempting to activate the fire alarms at the facility so she could elope from the facility. Staff tried to stop her. She threatened to assault staff. She attacked a nurse and other staff members. She had to be restrained. She was redirected multiple times, but she continued to assault staff. Staff spoke to a doctor, who authorized her to have “Emergency medication”. Once the emergency medication was administered, she was able to calm down and go to bed.

On 5/24/2023, she was involved in another incident and had to be separated from a peer. She again became violent with staff and was once again restrained. She received medication again to calm her down. Speaking about the incidents later, client said that she was restrained by only male staff. She said that when they restrained her on 5/23/2023, they choked her with a sweater, and she could not breathe. She said the restraint left bruises on her knees and arms. Corrective action: continue to review all restraints as they occur. Retrain all staff and residents about the appropriate reporting process and who their advocate is. Staff has been suspended until completion of investigation. Licensing narrative: Licensing Specialist reviewed camera footage on 5/23/23. Licensing Specialist informed maltreatment was closed. Licensing Specialist: Kendra Rice.

PRLU or OLTC

Notice of Incident, Self-Harm, Visit Compliance Report

On 5/22/23, RN was called to unit where she observed resident attempting to self-harm with a bobby pin she obtained. When RN arrived, she was non-communicative and was refusing to give up the contraband. The RN called for physical removal of the bobby pin. Once the contraband was obtained, resident became aggressive with staff and continued to use her fingernails to scratch at arm. For safety reasons, resident was placed in physical hold. Resident continued to escalate while in the restraint and was given im medication to assist emotional regulation. Resident on self-harm precautions with constant line of sight, therapist informed for individualization/duration of safety plan.

Licensing narrative: 5/24/23 – licensing visited facility and looked at resident’s bedroom which was clear and empty. Resident is currently saying in the comfort room wearing paper scrubs due to continued self-harming behaviors. Licensing Specialist: Chelsea Vardell.

PRLU or OLTC

Notice of Incident, Peer Altercation, Self-Harm, Visit Compliance Report

On 5/22/23, resident was involved in a physical altercation with a peer after a verbal disagreement. Resident began hitting her peer until she was separated by staff. After being separated, resident began self-harming. The nurse was called and tried to process with patient and offered a stress ball to use for a coping mechanism. Patient refused stress ball, and persistently refused to give up contraband. When the nurse called for retrieval of contraband, patient became assaultive and began hitting and kicking nurse and assisting staff. She was able to restrain from further assaulting staff by assistance with verbal de-escalation. No further incidents occurred. RN noted a lateral scratch on her leg as a result of the self-injurious behavior that required no medical attention. She has been placed on assault precautions for 7 days as a result of this event. Self-harm precaution safety plan with constant line of sight plan in place.

Licensing narrative: four hours of video footage reviewed on 5/22/23. Client can be seen shutting her bedroom door and blocking it from the inside. Staff make entry into room. Struggle takes place between resident, nurse, and MHT inside room on the bed as the resident appears to be keeping something from them before staff are able to obtain it. Licensing Specialist: Chelsea Vardell.

PRLU or OLTC

Notice of Incident, Self-Harm

On 5/20/23, RN called to the unit for additional support where resident was in the hallway picking at self-harm spots on her arms. Staff tried to stop the self-harming by blocking attempts and verbally de-escalating. Resident began to hit her head on the wall with enough force to cause injury and began kicking her legs at staff. Due to concerns for safety, the nurse called for a physical hold and contacted the provider. Resident was transitioned out of the hold when they appeared relaxed and calm and could verbalize ability to remain safe. Resident taken to nurses’ station where existing self-harm wounds were cleaned and covered. No injuries sustained from physical hold. Resident will be on a self-harm safety plan including constant line-of-sight monitoring for a period to be determined by the therapist.

PRLU or OLTC

Notice of Incident, Self-Harm

5/19/23 at about 7:10 AM staff reported that resident had removed bandages and began to self-harm by picking her scabs until they started bleeding again. Resident was able to be verbally de-escalated but would not disclose why she was upset. She only stated to staff that she felt like she had done something wrong and was mad at herself. Area was cleaned and patient was instructed to return to nurse after her hygiene was complete so that the are could be rebandaged. Safety plan initiated. Therapist to consult with resident to determine if additional precautions are needed and the length of time they will remain.

Police Report

Assault Simple, Battery 3rd Degree

Upon my arrival, I made contact with staff member [REDACTED]. [REDACTED], who works with Perimeter, stated that on 05/17/2023 at approximately 1930 hours, she was called to assist in restraining a female patient, who was in the process of self-harming. The patient had been there since November, and is there because of self-harm and suicidal ideations. Smith stated that had somehow gotten a piece of a pen cap, or possibly the spring from inside a click pen and was scratching herself on her forearm. As Smith and the other staff entered and attempted to restrain she bean to resist them. Smith described as manic, and in one of her regular fits. Smith took arm and put it behind her back, and as she did, the piece of the pen client had in her hand, nicked the tip of Smith’s left thumb, causing it to bleed. Client was then successfully restrained. During the struggle, had been bleeding, and Smith’s fingers intermingled with blood. Smith went to the hospital and was cleaned up and checked for contamination before being quickly released. Smith stated she wanted to press charges against because of the contamination of the blood. Smith stated that this is regular behavior for as she constantly resists any attempt to restrain her, which happens frequently. She stated she did not feel that client harmed her on purpose, or had any other intention than to harm herself and resist the staff as they attempted to gain control of her. I asked the staff if they would bring client out so I could speak with her. I called JDC and advised them of the situation and the charges. I spoke with JDC Intake Officer Munoz, who advised me to cite client and provided me with a Washington County JDC court date of 07/05/2023 at 0900 hours, with division 3. I spoke with and advised her of the court date and the charges. I changed the phone number and address information on her citation and she signed it, stating she understood and would appear on her court date. I was unable to change the court to JDC in my excite module, and I issued a paper ticket. Client was issued citation number [REDACTED] for battery 3rd degree.

PRLU or OLTC

Notice of Incident, Self-Harm

On 5/17/23, resident became upset after a verbal disagreement with peer. Resident was taken to the comfort room, but continued to escalate and began banging her head on the wall and scratching her neck. Resident was placed in a brief physical hold for safety, and released once safe behaviors were exhibited. Self-inflicted superficial scratches were noted to resident’s neck (no first aid required). Resident was placed on a self-harm precaution safety plan with constant line of sight, and her therapist will determine duration and individualization of safety plan.

PRLU or OLTC

Notice of Incident, Self-Harm

On 5/17/23, resident became dysregulated after a verbal disagreement with peer and began hitting her head on the wall and scratching her arms. Resident was placed in a physical hold to maintain safety. When resident was able to show safe behavior and verbalize ability to maintain safe behaviors, resident was transitioned out of the physical hold. No injuries obtained. Resident placed on a self-harm precaution safety plan with constant line of sight. Therapist notified for follow up to determine duration and individualization of safety plan.

PRLU or OLTC

Notice of Incident, Self-Harm

On 5/17/23, resident was seen self-harming with contraband she retrieved from a pen that she stole from a staff member. Staff support was called. RN arrived and attempted to de-escalate and retrieve contraband, but resident became aggressive while trying to retrieve contraband. Resident was placed in a physical hold to maintain safety. Resident continued to escalate while in the restraint. Provider notified and gave an order for administration of an intramuscular (IM) medication to assist in regulation. Resident received IM medication and was able to transition out of physical hold when safe behaviors were exhibited. No injuries noted on resident from restraint, but a staff member was injured with the piece of the pen while transitioning into the physical hold. She obtained a small laceration on her thumb with minor bleeding. Facility policies and procedures currently in place. Resident placed on self-harm precautions with constant line of sight and placed in paper scrubs. Therapist to follow up for duration and individualization of safety plan.

Licensing narrative:

  • 5/19/23 – Licensing emailed the facility to determine if this resident was already on a safety plan at the time she self-harmed.
  • 5/30/2023 – Licensing Specialist followed-up with facility on if a safety plan was already in place.
  • 5/31/2023 – Licensing Specialist informed that resident discharged on 5/31/2023.

PRLU or OLTC

Notice of Incident, Self-Harm

On 5/17/23, resident was seen self-harming with an object she obtained on her forearm. Additional staff and RN called to assist. Staff/RN attempts to de-escalate were unsuccessful and resident became physically aggressive towards staff while trying to retrieve contraband. Resident was placed in a physical hold to maintain safety. When resident was able to show safe behavior and verbalize ability to maintain safe behaviors, resident was transitioned out of the physical hold. No injuries obtained. Resident placed on a self-harm precaution safety plan with constant line of sight. Therapist notified for follow up to determine duration and individualization of safety plan.

Licensing narrative:

  • 6/7/2023 – Licensing Specialist inquired about the contraband that resident used to self-harm.
  • 6/8/2023 – Licensing Specialist informed that resident attempted to self-harm with a piece of a paper cut.

PRLU or OLTC

Notice of Incident, Self-Harm

On 5/16/23, resident became very dysregulated in the classroom and moved into the hallway. Once in the hallway, resident began picking at self-harm spots on her arms. Staff tried to stop the self-harming by blocking attempts and called the nurse for support. The nurse then showed up and attempted to redirect. Resident then attempted to hit her head on the wall with enough force to cause injury. Due to concerns for the resident’s safety, the nurse called for a physical hold and contacted the provider. I reviewed the current oral medication with the provider. After explaining the situation to the provider, the nurse returned to restraint. Resident appeared relaxed and calm. The restraint was ended. After the restraint, resident willingly received a one-time PRN medication to assist with continuation of emotional regulation, and this medication was well tolerated. She was compliant and seemed calm enough to rejoin the milieu. A physical assessment following the restraint found no injuries from this incident and only a minor exasperation of the existing superficial abrasion on residents’ forehead. The provider also made adjustments to resident’s current medication regimen for mood stability. Resident will be on a safety plan including constant line-of-sight monitoring for a period to be determined by the therapist.

PRLU or OLTC

Notice of Incident, Peer Sexual Contact, Visit Compliance Report

On 5/16/23, Tennessee reported to [REDACTED], that [REDACTED] “Pulls down her pants to show her dangaling.”. She stated that [REDACTED] talks about masturbating and talks often about sex.

Corrective action: report entered in the online child abuse and neglect portal (Report, #[REDACTED]). Clients were separated by units. [REDACTED] was placed on a sexual misconduct precaution safety plan with constant line of sight until she is asleep for 15 mins. Therapist to further process events with both residents and develops individualized programming to tailor each need.

Licensing narrative: Licensing requested any documentation of the accusation that made against to include, but not limited to, dates, times, and location of when these events allegedly took place. Licensing Specialist: Chelsea Vardell.

PRLU or OLTC

Visit Compliance Report

Buildings & grounds conducted from 9:45 AM – 11:30 AM. Outdoor play area observed to have toys on the ground, but no trash or safety hazards. Orange unit observed to be furnished and in good repair. Client’s rights posted, bathrooms clean and sanitary with functioning sinks, toilets, and showers. Staff/client ratio 2:10.

Regulations our of compliance: 908.8 – client [REDACTED] am meds (3) were not initialed. Licensing Specialist: Clayton DeBoer.

PRLU or OLTC

Notice of Incident, Self-Harm

On 5/15/23, resident was seen picking a spot on their face with their fingernails and smearing blood around. Resident was assessed by RN, superficial wound was cleaned and covered. No further incident occurred. Resident places on self-harm precaution safety plan with constant line of sight as a result. Therapist to determine duration and individualization of safety plan.

PRLU or OLTC

Notice of Incident, Self-Harm

On 5/15/23, RN was called to blue unit where he observed the resident opening skin on left arm in attempts to cause damage by self-digging into skin with fingernails. Resident was noted to be aggressively yelling at peers and threatening staff during at this time. To maintain the safety of herself/others, and to remove from overstimulating stimuli, the resident was escorted off the unit to the comfort room. During the escort, the resident was fighting staff via kicking with intent to injure. To maintain the safety of the resident and staff, a physical hold was initiated. Resident was transitioned out of the hold when safe behaviors were exhibited and was given a PRN ordered medication per resident request. Resident continued to process 1:1 with staff in the comfort room until able to return to unit. No injuries occurred during restraint. Resident was placed on a self-harm and assault precaution safety plan with constant line of sight as a result of this event. Therapist to determine duration and individualization of safety plan.

PRLU or OLTC

Notice of Incident, Peer Sexual Contact

On 5/12/23, reported to her therapist that [REDACTED] has been forcing to date her. Client reported that [REDACTED] “Pulled her pants down and kissed her butt, kissed her lips and other inappropriate places, and squeezed her chest.”

Corrective action: call placed to the child abuse hotline. Report accepted, #[REDACTED]. Clients were separated by units. [REDACTED] has also had a room change which will result in no roommate. This will remain in place until otherwise noted by the treatment team and therapist. [REDACTED] was placed on a sexual misconduct precaution safety plan with constant line of sight until she is asleep for 15 mins. Therapist to further process events with both residents and develop individualized programming to tailor each need.

Licensing narrative:

  • 5/15/2023 – Licensing contacted the agency for guardianship information and the staff report that was completed at the time of the call.
  • 5/31/2023 – Licensing Specialist followed-up with the facility on safety precautions. Licensing Specialist informed that resident was still on precautions and residents are still separated.
  • 6/29/2023 – Licensing was made aware that this report was called back into the and has now been accepted for investigation referral the assigned investigator is [REDACTED] with [REDACTED] and he has granted licensing permission to contact the agency.
  • 7/5/2023 – Licensing Specialist contacted the facility for information regarding a safety plan for the residents, and inquire about the which unit they are staying in.
  • 7/7/2023 – Licensing Specialist contacted the facility for information regarding a safety plan for the residents, and inquire about which unit they are staying in because a response was not received.
  • 7/7/2023 – The facility responded the residents are on different units, one is on orange and one is on blue, and their safety plan is expired, but they are on a strict peer restriction which means they are not aloud to be around each other. The facility was instructed the residents need a new safety plan because they are involved in an active maltreatment case and the safety plan will need to run the duration of the investigation.

PRLU or OLTC

Notice of Incident, Self-Harm

Staff called nurse to unit and reported patient has been self- harming. Patient has been picking at previous wound on leg and making it bleed again. Patient initially non-communicative but after trying to process, nurse was able to get the patient to talk and quit picking at area. Patient stated that the unit had gotten too loud because of two other residents arguing. They were also able to be de-Escalated. Patient requested PRN medication, and it was given by nurse as ordered. Leg was also assessed, cleaned, and bandaged. Self-harm precautions in place, and therapist notified to discuss with patient if any other precautions are needed and the duration of it.

Police Report

Missing Juvenile, Runaway Juvenile, Suicidal

At 1735 hours, caller advised juvenile ran away from facility. At 1748 hours, caller advised the juvenile was at 2710 S 48th with a nurse; Officer responded to location and juvenile was transported to NWMC for suicidal ideations. Juvenile was returned to facility at approx. 1930 hours.

PRLU or OLTC

Notice of Incident, Self-Harm

On 5/10/23, resident became upset and began hitting their head on the wall and scratching their skin with intent to injure themselves. Verbal de-Escalation and blocking techniques were unsuccessful, and resident had to be placed in a brief physical hold. Resident was transitioned out of hold when safety criteria was met. Superficial scratches noted on the skin, no nursing care required. Resident placed on a self-Harm precaution safety plan with constant line of sight, and will meet with therapist to determine duration/Individualization of safety plan.

PRLU or OLTC

Complaint, Notice of Incident, Visit Compliance Report

The Springdale Police Department called to report they are concerned about Perimeter of the Ozarks. Licensing was informed that last weekend during an elopement, the resident was located and staff refused to come to the hospital to pick up the resident. After threatening the staff with a citation, 2 to 3 hours later, the staff from Perimeter of the Ozarks showed up at the hospital. The Police Captain stated his officers were told by Perimeter staff that once a resident runs away, they are no longer responsible for them. The Captain was also concerned about the length of time it takes Perimeter staff to let them into the facility when they respond to a call.

Licensing narrative: 5/18/2023- Licensing requested the facility policy regarding what steps the facility takes when a resident elopes. The facility reports that the CEO has reached out to the Springdale Police Department and resolved the issues. The CEO has provided the Police Captain with her direct phone number in the event the department cannot reach staff when calling the facility’s main phone line. The CEO has also stated that the staff will be retrained on the facility’s procedures on bringing a resident who has eloped from the facility back to the building once they have been deemed safe to do so by either the police department or hospital physician. Licensing Specialist: Chelsea Vardell.

PRLU or OLTC

Notice of Incident, Self-Harm

On 5/10/23 at around 20:00 patient creates a superficial self-harm wound on her left forearm. Nurse cleaned the wound and bandages it. Patient reported she did it due to the unit being loud and her recent court appearance. Patient was placed on self-harm precautions. Therapist to consult with resident to determine if any other precautions are needed and to discuss length of them.

Licensing narrative: 5/11/2023- email sent to the facility requested further information including resident guardianship and the cause of the unit being “Loud”.

PRLU or OLTC

Notice of Incident, Self-Harm

On 5/10/23 at 20:00, patient self-harmed by scratching self with a piece of plastic on forearms. Staff processed with patient. Contraband was retrieved by staff. RN cleaned wound and assessed patient. Placed on self-harm precautions. Therapist to consult with patient to see duration of precautions and if anymore are needed.

Licensing narrative:

  • 5/11/2023 – Licensing emailed the facility to determine what the plastic was that the resident used to self-harm.
  • 5/30/2023 – Licensing Specialist followed-up with facility on the plastic that the resident obtained.
  • 6/7/2023 – Licensing Specialist inquired about the piece of plastic that resident self-harmed with.
  • 6/8/2023 – Licensing Specialist informed it is unknown how the resident obtained the piece of plastic. It was reported that the piece of plastic was small in size.

PRLU or OLTC

Notice of Incident, Self-Harm

Resident created a superficial self harm wound on her left forearm with her fingernails. Reported that she did it because the unit got too loud. Assessed, cleaned, and bandaged by RN. Resident placed on self-harm precautions. Therapist to consult with resident to determine if additional precautions are needed and the length of time they will stay in place.

PRLU or OLTC

Elopement, Notice of Incident, Visit Compliance Report

At approximately 5:27 PM, the CEO was notified by AOC via phone that while residents were in the gym, which has 2 unlocked outside doors (Leading to the fenced/Locked area). While in there, 2 residents escalated and staff walkied for support. At this time, a resident exited the gym in attempts to leave the property. One staff member followed. At this time, a staff member intercepted and was able to get to the gate opening before exited. Staff stated the gate was ajar with no chain. As the staff attempted to keep her inside the fenced area, resident saw a 2nd staff coming in for assistance and as result, escaped the staff. That was when the staff notified and he notified the CEO. CEO informed to have police called. At this time, [Recated] Director of Nurse (DON) also called CEO at 5:31 PM as she was driving home and noticed the resident. CEO informed [REDACTED] police were notified and that her number would be provided to the police if she is able to keep vision on the resident and communicate with police resulting in a hopeful quick pick up. Regional CEO was notified at 5:35 PM. At approximately 6:20 PM CEO was notified the police had located resident and DON was heading back to property and complete notification process of incident. At 6:27 PM DON was notified by police they were taking to the hospital as she stated she would “kill everyone in the building” and “suffocate all of the kids.”. CEO began communicating with sargent [REDACTED] police about next steps. It was agreed we would take the resident back for stabilization if they could transport her back to us. It was agreed police would remain present until she was safely in a locked area and a person search was conducted.

Licensing narrative: 5/11/2023- licensing emailed the facility for further information. Facility visited 5/15/23 in response to self-Report elopement of client. Gate outside of gym doors observed to be chained/Locked. Per staff report, this gate is to remain chained/locked at all times when not in use. Kitchen staff left gate unlocked when client eloped.

Regulations out of compliance: 907.2 – gate outside of gym doors observed to be chained/Locked. Per staff report, this gate is to remain chained/locked at all times when not in use. Kitchen staff left gate unlocked when client eloped. Licensing Specialist: Clayton DeBoer.