Perimeter Behavioral of the Ozarks / Woodridge of the Ozarks

Patient had to be restrained at 08:19 in the morning. Nurse reported upon arrival patient was banging her head on the wall while staff were physically blocking to reduce the impact. It was reported that the patient would not respond to verbal de-escalation and behaviors continued to increase. Patient began attempting to self-harm by scratching at legs. Patient did not report to staff what led to this escalation. Staff did report at the beginning of the escalation the patient said that she hated herself and wanted to be free. Patient placed on precautions, self-harm safety plan initiated. Therapist to consult with resident to see if any additional precautions are needed and to determine length of time.

Licensing narrative: Licensing Specialist will follow-up with facility on what precautions were implemented. Licensing Specialist confirmed that resident was placed on a self-harm precaution safety plan.

On 7/5/23 at approximately 1820, client became angry and punched a wall twice with her right hand. Upon initial assessment, the RN noted the onstage swelling and bruising with range of motion present. The physician was notified of the event after the initial assessment. The plan of action moving forward included to continue to monitor affected area and update physician with status changes, as well as offer comfort measures including ice packs and prn pain medications for relief. Upon assessment of client’s hand today, 7/6/23, the RN noted that their right knuckle appeared moderately swollen with complaints of tenderness and lessened range of motion compared to yesterday evening’s assessment. The physician was notified of the assessment and recommended to have client sent out for x-rays to rule out a possible fracture. Client is currently at Northwest Arkansas Children’s Hospital awaiting x-ray results.

Corrective action: Work in collaboration with the treatment team to help find ways to better assist when she has anger impulses without risking self-injurious behavior. Licensing narrative: 7/13/2023 Licensing Specialist reviewed the provider reported incident. X-ray results have been requested from the facility.

On 6/5/23 at 14:18 patient had to be restrained due to trying to self-harm and trying to assault staff. Nurse who was trying to process with patient was physically blocking the self-harm attempts when patient tried to kick her. Patient had been escalating for sometime, refusing all attempted interventions and redirections. Patient refused to process or let staff know what was wrong. Safety plans initiated. Patient to consult with therapist to see if any other interventions are needed and the duration of them. Licensing narrative: Licensing Specialist reviewed provider reported incident for licensing concerns. Licensing Specialist will inquire about how the resident tried to self-harm and safety plans initiated.

• 6/9/2023: Licensing Specialist informed that resident attempted to self-harm with her fingernails.

At about 18:19 nurse was walking to med room when staff called nurse to unit. Patient was self-harming by hitting herself in the face repeatedly. Patient would not stop and had to be restrained. During patient’s restraint, patient was calm but non-communicative. Patient was released from restraint at 18:30 by staff. Patient remained non-communicative and was taken off the unit by staff to process. Safety plan was initiated. Therapist to consult with patient to see if any additional precautions are needed and length of time.

Licensing narrative: Licensing Specialist will inquire about the initiated safety plan.

• 6/8/2023: Licensing Specialist informed that resident was placed on 1:1 supervision.

On 5/25/23 at approximately 1500, resident obtained a nail while outside and began to attempt to self-harm with it on her arm. Staff intervened immediately, and she willingly handed the nail over. Because the contraband was noticed and retrieved promptly by staff, no injuries were sustained from this attempt. Resident processed event with therapist and was placed on a self-harm precaution safety plan with constant line of sight.

Licensing narrative: Licensing Specialist reviewed provider reported incident. Licensing Specialist will follow-up with facility regarding this incident.

• 6/7/2023: Licensing Specialist inquired about a prevention plan when residents are outside.
• 6/8/2023: Licensing Specialist informed by Director of Nursing (DON) that resident was trying to self-harm from a nail. DON informed Licensing Specialist that repairs have been made to the building and that is probably where the resident got the nail from the grounds. Moving forward, DON and risk manager have developed a checklist for staff to follow when residents are scheduled for outdoor activities. Maintenance supervisor has ben advised to check buildings and grounds when contractors are brought in for repairs.
• 6/9/2023, Licensing Specialist requested a copy of the checklist that was developed. Licensing Specialist provided with outdoor visual inspection for the facility.

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.

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.

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.

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.

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.