Blue Hall and Green Hall observed. All areas observed furnished, clean and in good repair. Bathrooms clean and sanitary with functioning sinks, toilets and showers.
PRLU or OLTC
Visit Compliance Report
PRLU or OLTC
Notice of Incident, Self-Harm
On 4/24/23 at approximately 2010, resident used a piece of plastic to rub off old scabbing on forearms. RN called to unit for support. RN processed with resident and resident gave up contraband. This event resulted in minor bleeding that was tended to by nursing. No further incident occurred. Resident has since been placed on a self-harm precaution safety plan with constant line of sight. Therapist will determine appropriate duration and individualization of safety plan.
PRLU or OLTC
Notice of Incident, Peer Altercation, Self-Harm
On 4/19/23 at approximately 1715 while on the unit, resident was involved in a verbal altercation with a peer that progressed to a brief physical altercation. Staff was able to intervene promptly to separate the residents. After this event, resident began scratching her arm with her fingernails. Staff was able to intervene and verbally de-escalate the resident. No skin was broken from scratching, and the area was noted to be slightly reddened. No nursing care was needed. Because of this event, resident was placed on a self-harm precaution safety plan with constant line of sight. Clinical will decide the appropriate amount of time for these precautions and determine if individualization of safety plan is needed.
PRLU or OLTC
Complaint Survey
Complaint #AR00029928 was in compliance.
PRLU or OLTC
Notice of Incident, Self-Harm
On 4/15/23, resident approached RN stating she needed some bandages because she “self-harmed in the shower.” Resident noted to have superficial cuts to her left forearm, per RN. When asked what she used, she reported that she used her fingernails. No first aid required. Resident placed on a self-harm precaution safety plan with constant line of sight as a result of this event.
PRLU or OLTC
Maltreatment, Notice of Incident, Visit Compliance Report
Date/Time of incident: 04/11/2023, approximately 1930. On 4/13/23, it was reported by [Redacted] that Staff 1 placed her into a physical hold in her bedroom, leaving scratch marks on right hand. Staff 2, witness, reported that no physical hold occurred. Due to the allegation, a hotline call was placed, and a report was taken and accepted (Ref #REDACTED). Staff 1 has been suspended, pending completion of state investigation. Immediate Actions Taken: Camera footage reviewed, statements provided, right hand assessed, captured, and documented by Nursing, Arkansas Child Abuse Hotline called. (Report accepted, Ref # REDACTED) Staff 1 suspended pending completion of investigation. Licensing Specialist: Clayton DeBoer.
PRLU or OLTC
Notice of Incident, Self-Harm
At approximately 1735, resident became dysregulated while on the unit. Staff attempted to verbally deescalate, but resident continued to escalate. She then obtained a calculator from a peer’s belongings, broke it, and began using a piece to attempt to self-harm with on her right wrist. Staff support was called, and the items were removed from the resident’s possession. Staff remained with resident afterwards to process event, and resident was able to regulate without further incident. There was a small superficial wound on resident’s right wrist not rendering nursing care. Because of this event, resident will be on self-harm precautions with constant line of sight.
Medicaid Inspection of Care
Corrective Action Plan, Inspection of Care Report
Deficiencies were noted during the Inpatient Psychiatric Inspection of Care (IOC) conducted at the facility.
This IOC visit was upon request of DPSQA (Division of Provider Services and Quality Assurance) to follow up on a recent IOC inspection conducted on 10/6/22, 12/5/22, and 2/6/23.
PRLU or OLTC
Notice of Incident, Suicide Attempt
It was reported to RN by therapist that resident self-reported that she had been hoarding her medication ion a cup in her bedroom and took them all together the previous night. Upon assessment of resident by RN, there were no deviations from baseline as far as mental, cognitive, or physical functionality. Residents room was searched, no contraband found. No camera footage availed upon preview. In order to prevent recurrence resident will be required not to be wearing long sleeves during medication passes. Since her current medications cannot be crushed (per APRN), thorough mouth checks will be conducted after each medication pass. Per APRN, restrict bathroom for one hour after all med pass throughout the day/night. therapist preformed c-SSRS, scoring resident high risk. As a result, resident was placed on suicide precaution safety plan with constant line of sight until further determination by therapist.
PRLU or OLTC
Arrest, Notice of Incident
At approximately 1100, resident became escalated related to staff cleaning up area and removing unnecessary items. She began pushing past staff to access items being removed. She then jumped the nurse’s station in the milieu and had to be escorted out of the area by staff for safety. She proceeded to grab a marker, throw it on the floor, and stomp on it. She grabbed a sharp piece of the marker and verbalized she was going to “stab that man” in reference to a staff member. She then charged at the staff member and had to be placed in a physical hold to maintain a safe environment. Once in the hold, the contraband was removed from her hand. Resident remained dysregulated during hold, making verbal threats and continuing to attempt to assault staff. Because of the severity of the attempted physical attack against staff, paired with the physical attack at a RN from 3/28/23, a decision was made to call law enforcement for further assistance. When law enforcement arrived in the milieu, resident physically and verbally calmed down. When she was able to verbalize that she will maintain safe behaviors, she was transitioned out of physical hold. Law enforcement arranged for transport to JDC and resident was detained and removed from facility at approximately 1200.
Police Report
Aggravated Assault, Arrest
Upon officers arrival, 3 staff members were laying on juvenile in a restraint. Staff reported juvenile had a marker that she wasn’t supposed to have, and had broken it and attempted to stab him with it after he attempted to retrieve it. Officer placed juvenile under arrest and she was transported to JDC and given a court date.
PRLU or OLTC
Notice of Incident, Self-Harm, Visit Compliance Report
At approximately 1925, resident began hitting their head on the wall. Staff attempted to verbally de-escalate and physically block residents attempts at harming themselves but were unable to. Due to the immediate threat for bodily injury, a physical hold was initiated. When resident was able to emotionally regulate and verbalize that they will maintain safe behaviors, they were transitioned out of the hold. Per RN report, no injuries were sustained from this event. Resident placed on a self-harm precaution safety plan with constant line of sight. Therapist will meet with resident to discuss duration/individualization of safety plan. Licensing Specialist: Kendra Rice.
PRLU or OLTC
Notice of Incident, Self-Harm, Visit Compliance Report
At approximately 1330, client became dysregulated while on the unit and began punching herself in the face with her first. She was escorted off unit onto the milieu where staff attempted to verbally de-escalate the situation and physically block her attempts at harming herself but were unable to. A physical hold was initiated by staff to maintain residents’ safety. Because of the severity of emotional dysregulation, a one-time emergency medication was administered to help resident regain control of emotions. Resident was transitioned out of physical hold when she was calm and able to verbalize that she will maintain safe behaviors. Once out of the restraint, she stopped actively communicating with staff and began punching herself in the face again. A brief physical hold was initiated until resident was able to regulate emotions. She expressed she was not interested in processing events but verbalized that she will be able to maintain safe behaviors post release. Once transitioned out of hold, resident went to nurses’ station where a minimal amount of dry blood was cleaned around nose. No visible injuries sustained from event. No further incidents occurred. Because of these events, will remain on current self-harm safety plan with constant line of sight. She will be seen by therapist to determine duration/individualization of precaution. Licensing Specialist reviewed camera footage for a provider reported incident on 4/1/2023.Licensing Specialist observed resident talking on the phone before going onto the Orange Unit. She entered her unit in the day area and sat in a chair. Licensing Specialist was unable to observe resident picking or hitting her nose due to the lighting of the room on camera footage. Staff members (2:1) were observed escorting the resident off the unit. Once off the unit, resident was escorted to the milieu area. Licensing Specialist observed resident being placed in a restraint due to the aggression being displayed. The nurse was observed on the phone. Resident was observed attempting to harm herself more. Licensing Specialist observed resident receiving a medication via syringe. Resident was able calm down and restraint ended .Ms. Sara Kroon (Director of Nursing) informed Licensing Specialist the dried blood that was cleaned from around the resident’s nose came from her picking and hitting her nose area. Resident is no longer on safety precautions. Licensing Specialist: Kendra Rice.
PRLU or OLTC
Notice of Incident, Self-Harm, Visit Compliance Report
It was reported to RN by resident that she had bitten her arm multiple times today out of frustration. She was noted to have two bite marks on her left arm and three on her right arm. None of which have broken any skin. Resident will be placed on self-harm precautions with constant line of sight. Clinical will determine the appropriate length of time this precaution will be in place and individualize as needed. No nursing care needed to be rendered. Licensing Specialist reviewed documentation for a provider reported incident on 3/31/2023.Due to timeframe being unknown, camera footage was not available for review. Per documentation, resident reported that she bit her arms (right and left) out of frustration. Resident’s skin was not broken, no medical care was needed. She was encouraged to explore other coping skills. [REDACTED] (Director of Nursing) informed Licensing Specialist that resident has been removed off safety precautions. Licensing Specialist: Kendra Rice.
Police Report
Hang Up
Caller stated she did not have an emergency. No sounds of distress heard.
PRLU or OLTC
Notice of Incident, Self-Harm, Visit Compliance Report
At approximately 1400, resident was in the classroom when she became dysregulated by another peer. She began attempting to self-harm by scratching herself. In response to this, staff members attempted to verbally deescalate and physically block self-harm attempts, but resident continued to self-harm with more aggressive attempts. In response to this, she was placed into a physical hold to maintain her safety. Resident stated to RN that she was going to continue to self-harm after she was released. After several de-escalation attempts by different staff members, resident continued to be an imminent threat to herself and a one-time emergency medication was administered. Resident was able to calm herself and verbalize maintaining safe behaviors and was transitioned out of physical hold. Resident sustained a small abrasion on her left hand from her nails while she was scratching herself. Resident will continue to be on self-harm precautions until otherwise stated by clinical. Psych APRN notified for medication adjustment in relation to continued episodes of self-harm. Licensing Specialist reviewed camera footage for a provider reported incident on 3/30/2023.Licensing Specialist observed residents in the classroom sitting in different areas with staff present. Licensing Specialist observed what appeared resident and a peer having a verbal disagreement. Resident walked away and sat to the side of the classroom out of camera view where it was reported that she was attempting to scratch herself. Licensing Specialist observed the other residents being removed from the classroom and resident being placed in a physical restraint. The ratio was 4:1. Licensing Specialist observed resident trying to break free from the physical restraint. A few minutes later, Licensing Specialist observed a nurse on the phone. Minutes later, Licensing Specialist observed resident receiving medication through a syringe. Licensing Specialist observed resident calm down and released from the restraint. She was able to sit up and process with staff. [REDACTED] (Director of Nursing) informed Licensing Specialist that resident’s medication adjustment has been helpful in relation to her self-harm episodes. Licensing Specialist: Kendra Rice.
PRLU or OLTC
Technical Assistance, Visit Compliance Report
- Licensing Specialist: Chelsea Vardell.
- Review of the agency’s current mandated reporter policy determined it does not comply with A.C.A. 12-18-402 nor the Minimum Licensing Standards. Please ensure facility policy is updated to reflect the need of all staff to report directly to the child abuse hotline without delay. The updated policy shall be submitted to the Licensing Unit by 04/13/23 and all applicable staff shall be retrained on the updated policy within 2 weeks of the policy going into effect.
- TA –
- 110.9 – Any owner/operator, employee, foster parent, or volunteer in a child welfare agency shall immediately notify the Child Abuse Hotline if he or she has reasonable cause to suspect that a child has been subjected to child maltreatment, died as a result of child maltreatment or if they observe a child being subjected to conditions or circumstances that would reasonably result in child maltreatment.
- 102.3.h -Child Maltreatment/Mandated Reporter policy; according to Arkansas law, including, procedures to ensure that alleged, suspected, or witnessed incidents of maltreatment are reported to the Child Maltreatment Hotline, and documented as required by these or other applicable rule or laws.
Police Report
Assault
On March 28, 2023 at approximately 6:18pm I answered a citizen assist phone call and spoke with a Sara Kroon(W/F DOB: 9/23/94) she explained that she is a nurse at Perimeter of the Ozarks trauma facility at 2466 S 48th St B as was assaulted by a resident earlier today. Kroon explained that she was working when she noticed that a resident identified as was banging on a door requesting her belongings and banging on a door when she confronted her and told her to stop, the then became agitated and began to attack Kroon with the hairbrush and also punching her in the face. Kroon stated that she was able to get away she then called the police to file a report. I advised Kroon to take pictures of her injuries and send them to my PD email as she explained she had visible marks on her. Kroon explained that is a resident of the facility and the only legal guardian she has is DHS. She provided me with the contact info for her case worker as [REDACTED]@DHS.AR.GOV. I have not received any images from the victim at this time. It should be noted that the suspect will be dismissed from the facility in two days for the assault. No further at this time. I have attempted multiple times to gather the pictures of injuries had sustained when she was struck by [REDACTED]. [REDACTED] has not been able to send me the pictures or return my call. I have attempted to get in touch with the DHS case worker in charge of . I have called the number, left voice mails, and emailed them with no response. It was my understanding was moved to a different behavioral heath facility in the state. At this time due to the victim not cooperating by sending me the evidence of the crime, I will be placing this case as inactive pending further leads. I will be forwarding this case to my supervisor for review.
PRLU or OLTC
Notice of Incident, Self-Harm, Visit Compliance Report
While in the classroom, client began punching herself in the face repeatedly after having a verbal disagreement with a peer. Staff attempted to physically block her attempts at harming herself but were unable to. A physical hold was initiated by staff to maintain residents’ safety. Therapist called to assist with verbal de-escalation. Resident was transitioned out of physical hold when she was able to regulate emotions and verbalize ability to maintain safe behaviors. No injuries sustained from event. Because of this incident, was started on a self-harm precaution safety plan with constant line of sight. She will be seen by therapist to determine duration/individualization of precautions. Licensing Specialist reviewed camera footage for a provider reported incident on 3/28/2023. Licensing Specialist observed residents in the classroom sitting in different areas with staff present. Licensing Specialist was unable to observe the verbal altercation between resident and peer due to the angle of the camera and where the resident was sitting. The other residents were removed from the classroom. Licensing Specialist observed resident being escorted from where she was sitting off camera to the middle of the classroom. Licensing Specialist observed the ratio ranging from 3:1 and 4:1, The resident was placed in a restraint. During the actual restraint, Licensing Specialist observed the resident’s feet on the camera footage. Resident was in the restraint for 19 minutes before she was released and able to process with staff. [REDACTED] (Director of Nursing) informed Licensing Specialist resident is no longer on any safety precautions. Licensing Specialist: Kendra Rice.
PRLU or OLTC
Notice of Incident, Self-Harm, Visit Compliance Report
Resident became dysregulated on the unit after a disagreement and began to verbally assault a staff member and hit her head on the wall. The staff member attempted to diffuse the situation by physically blocking resident from head banging and, in the process, resident physically attacked staff member by hitting and scratching her. A physical hold was initiated to maintain a safe environment. While in the hold, resident continued to attempt to assault staff by scratching, kicking and biting. RN and staff attempted to deescalate resident, but resident continued to attempt to hit her head on the floor, bite at and scratch staff. Because of continued self-harm and aggressive behavior, an emergency medication was administered. No injuries resulted from restraint. There is a small scratch and erythema on forehead from hitting her head on the wall before the restraint. Will continue to monitor for any deviations from baseline. Resident was placed in paper scrubs. Assault and self-harm precautions with constant line of sight were initiated, and clinical will follow up to determine an appropriate end date for the precautions. Licensing Specialist: Kendra Rice.
PRLU or OLTC
Monitor Visit, Visit Compliance Report
- Licensing Specialist: Michele Sutton.
- Licensing conducted walkthrough and followed up on an incident involving resident and whether resident is accessing educational and recreational programming while programming separately in comfort room. Resident was observed to be 1:1 with staff during visit, and books/school materials were in the comfort room. Facility continues to search for an appropriate discharge placement due to acuity of resident behaviors.
- All units were calm at time of visit. Residents currently on spring break. Licensing viewed 6 rooms with no concerns noted. Fire inspector was on-site to complete 2023 fire inspection.
Police Report
Hang Up
Hang up at Ozark Guidance. Upon call back, they said it was an accident and were probably trying to dial another number.
PRLU or OLTC
Notice of Incident, Self-Harm
Resident presented to RN with a 1.5-inch laceration on left forearm with no active bleeding. When RN inquired about the cause of the injury, resident stated that they used contraband to self-harm in the shower. Resident was reluctant to give up the contraband, but RN was successful in retrieving the item used. The area was cleansed with antibacterial soap and bandaged accordingly. Will monitor laceration and will notify MD if there are any deviations from baseline while healing. In relation to this, resident will continue to be on self-harm precautions with 1:1 observation, and in addition, resident’s person will be searched each shift to ensure that resident is not carrying any contraband that they can utilize to harm themselves or others.
PRLU or OLTC
Notice of Incident, Self-Harm
Resident became dysregulated on the unit after a verbal altercation with a peer. Resident began picking at old scabs from previous self-harm incidents causing mild bleeding. Staff intervened by blocking self-harm acts and verbal de-escalation. Resident was able to regulate emotions after processing with staff 1:1. Affected arm cleaned with soap and water, left open to air. Resident to remain on current self-harm precaution safety plan with constant line of sight until safe behaviors are displayed. Therapist notified for evaluation.
PRLU or OLTC
Notice of Incident, Self-Harm
Resident became dysregulated on the unit and began picking at old scabs from previous self-harm incidents causing mild bleeding. Staff intervened by blocking self-harm acts and verbal de-escalation. Resident was able to regulate emotions after processing with staff 1:1. Affected arm cleaned with soap and water, left open to air. Resident to remain on current self-harm precaution safety plan with constant line of sight until safe behaviors are displayed. Therapist notified for evaluation.