Fire drill at Ozark Guidance.
Police Report
Fire Drill
PRLU or OLTC
Notice of Incident, Self-Injury
- Self-inflicted Injury
- Client used her fingernails to create a raw/reddened area on her cheek. Client was placed on self-harm precautions with constant line of sight until she can be assessed by her therapist. No nursing care was rendered for reddened area; Client was instructed to wash area with soap and water.
- Licensing follow-up: Unannounced visit conducted this date. Licensing verified documentation for current self-harm precautions, and client was observed within LOS of staff.
PRLU or OLTC
Notice of Incident, Self-Harm
- Self-Harm
- Client bit her hand during phone call time. Nurse assessed, and no skin was broken or bleeding. Client processed with staff and was placed on self-harm precautions x7 days.
- Licensing follow-up: Unannounced visit conducted this date. Licensing verified documentation for current self-harm safety plan, and client was observed within LOS of staff.
PRLU or OLTC
Notice of Incident, Self-Injury
- Self-inflicted Injury
- Staff reported to nurse that client had been attempting to bang her head, and upon nurse arrival, client was scratching her forearm. Client was taken to the comfort room to process. Nurse noted a quarter size knot to client’s forehead, no complaints of pain.
- Licensing follow-up: Unannounced visit conducted this date. Client was observed within LOS of staff during visit, and client has not had any other attempted self-harm episodes this week. Facility continues to address her behaviors using interventions on her individualized behavior management plan.
PRLU or OLTC
Notice of Incident, Sexual Contact
- Peer Sexual Contact
- Client reported to staff that peer inappropriately touched her private area in their room on the night of 2/17/23. Corrective Action Plan: Therapeutic group to be conducted by therapist on peer-to-peer boundaries, reeducate no touching by residents to each other on the unit, residents were separated units for safety, reeducate staff on appropriate supervision throughout the night, and residents will process with their therapist.
- Licensing follow-up: Unannounced visit conducted this date. The allegation was screened out by the Child Abuse Hotline. The peer involved is on “bed block” status, meaning no other children can share a room with her until facility clinical staff determines safety.
PRLU or OLTC
Notice of Incident, Self-Injury
- Self-inflicted Injury
- Client attempted to self-harm with a comb, and the comb was removed by staff. Client then began to bite her hands and rubbed off scabs on her arm, causing them to bleed. Client processed with staff and her picked scabs were covered and cleaned. Client was given her PRN anxiety medication and self-harm precautions were initiated x7 days.
- Licensing follow-up: Unannounced visit conducted this date. Client was receiving individualized help with schoolwork in the cafeteria due to behavior issues in the classroom today, within LOS of 2 staff. Licensing verified client had current LOS safety plan documentation.
Police Report
Hang Up
Hang up with no answer on call back. No emergency.
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 and 12/5/22.
PRLU or OLTC
Children's Records Review, Personnel Record Review, Visit Compliance Report
- Licensing Specialist: Michele Sutton and Chelsea Vardell.
- Licensing Specialist reviewed records for 5 children and 11 staff. Licensing viewed fire drills and storm drills; Facility was in compliance with safety requirements. Licensing conducted a brief walkthrough of the milieu area, and facility has implemented a “Shout out” bulletin for staff and residents to write encouraging messages, added wallpaper to common area, and implemented a “Feelings Wheel” on units to assist residents with processing their emotions with staff.
- Regs out of compliance –
- 904.1.h – Copy of social security card or documentation it has been requested needed for 1 resident.
- 904.1.i – Copies of immunizations or documentation they have been requested needed for 1 resident.
- 105.3 – All pre-service documentation was not documented in all 11 personnel records.
- 105.13 – Training documentation shall include date, hours, topic, and source. Training records for all 11 personnel only contained the date and topic of training.
- 105.10 – Each personnel file shall have 10 hours of psychiatric specific training before being counted in the staff/child ratio. All 11 personnel records did not have 10 hours documented.
- 107.4 – Personnel records should include documentation that they have been made aware of the need to protect the confidentiality of children in the use of social media. Documentation was only found in 1 of 11 personnel files viewed.
- 103.2.a – AR Child Maltreatment regulatory check was not initiated within 10 days of hire for 1 personnel. (CEO reports this is likely due to termination of HR Director on 01/09/23).
- 105.15.h – 10 personnel records did not have 3 references from non-relatives in their file.
- TA –
- 105.15.c – Please ensure all personnel have some form of verification of their qualifications (high school diploma, GED, or college diploma).
Police Report
Hang Up
Hang up with no answer on call back. No emergency.
PRLU or OLTC
Notice of Incident, Self-Harm
- Self-harm
- RN was called to unit due to client biting her hand; No injuries noted. Client accepted an exit due to peers being loud and spent 30 minutes in the quiet room. Client placed on self-harm precautions x 7 days.
- Licensing follow-up: Licensing completed visit to facility and observed client within LOS of staff. Client’s safety plan ended on 02/21/23 and there have been no additional self-harm incidents. No additional follow-up needed at this time.
PRLU or OLTC
Notice of Incident, Self-Harm
- Self-harm
- Client became upset about having to move units. Client stole a walkie from staff 2 separate times, attempting to self-harm with them; Client was placed in 2 physical holds to retrieve the contraband. Client later attempted to get to the fire alarm on her unit, and staff intervened. Client then grabbed keys from a staff member’s neck, stating she was going to escape; The keys were promptly retrieved by staff. Client was eventually able to regulate emotions, and no injuries were sustained. Client was placed on self-harm precautions with constant LOS, as well as assault and property destruction precautions.
- Licensing follow-up: Licensing discussed incidents with CEO, who reported the client stole keys by breaking a lanyard and obtained the second walkie after staff had taken them off to complete the restraint. CEO reported the client’s behaviors have stabilized and client expressed she liked her new unit better than she thought she would.
PRLU or OLTC
Notice of Incident, Self-Injury
- Self-inflicted Injury
- While in the bathroom, client repeatedly punched herself in the face causing minimal bleeding from nose. Client was physically blocked by staff and was able to process with staff. Client’s face was washed and no visible injury was noted. Self-harm precautions with constant LOS in place.
Police Report
Hang Up
Hang up calls from the front desk with no answer on call back. No emergency.
PRLU or OLTC
Notice of Incident, Self-Injury
- Self-inflicted Injury
- Client became triggered due to another peer self-harming. Client obtained a staple and used it to make superficial abrasions on her forearm. Staff removed the staple, and the abrasions were cleaned. Client placed on self-harm precautions x 7 days.
- Licensing follow-up: During facility visit, the CEO confirmed client remains on self-harm safety plan.
PRLU or OLTC
Notice of Incident, Suicide Attempt
- Suicide Attempt
- Client became escalated due to multiple triggers and used her shirt to tie around her neck. The shirt was removed by staff and no injuries were noted. Client scored low risk on C-SSRS and was placed on suicide precautions x 7 days.
- Licensing follow-up: Licensing completed record review at facility and noted client to have updated/current self-harm safety plan and treatment plan.
PRLU or OLTC
Notice of Incident, Self-Harm
- Self-harm
- Client attempted to self-harm by biting herself and trying to hit herself in the face; Staff intervened. There were no breaks in the skin upon assessment. Client placed on self-harm and assault precautions x 7 days (client bit staff who intervened).
- Licensing follow-up: Licensing completed record review at facility and CEO confirmed that client remains on self-harm safety plan.
PRLU or OLTC
Notice of Incident, Self-Injury
- Self-inflicted Injury
- Client began punching themselves in the face while in the bathroom, and a physical hold was initiated to maintain safety. Nurse noted client had a slight nosebleed prior to the restraint; No other injuries noted. Client placed on self-harm precautions with constant LOS.
- Licensing follow-up: Licensing completed record review at facility and CEO confirmed that client remains on self-harm safety plan.
PRLU or OLTC
Notice of Incident, Self-Harm
- Self-harm
- Client began biting themselves, with staff using blocking techniques to prevent injury. No injury was noted; Self-harm precautions continued.
- Licensing follow-up: Licensing completed record review at facility and noted client to have updated/current self-harm safety plan and treatment plan.
PRLU or OLTC
Notice of Incident, Self-Injury
- Self-inflicted Injury 1
- Client was physically restrained after breaking a light bulb in the ceiling and holding on to the broken glass. Glass was removed from client and the unit was swept clean. Client sustained 2 small cuts that were cleaned and covered. Client placed on self-harm precautions x 7 days.
- Licensing follow-up: Licensing completed record review at facility and noted client to have updated/current self-harm safety plan and documented restraint with appropriate order to initiate.
PRLU or OLTC
Notice of Incident, Self-Injury
- Self-inflicted Injury 2
- Client began scratching at forearm with fingernails, and staff intervened. Superficial scratch noted to client’s forearm. Client placed on self-harm precautions with constant LOS x 7 days.
- Licensing follow-up: Licensing completed record review at facility and noted client to have updated/current self-harm safety plan and treatment plan.
PRLU or OLTC
Notice of Incident, Self-Injury
- Self-inflicted Injury 3
- Client began punching herself in the face. Staff used blocking techniques to prevent injury and client processed with staff. Client received ice pack due to minimal swelling to side of nose. Self-harm precautions continued.
- Licensing follow-up: Licensing completed record review at facility and noted client to have updated/current self-harm safety plan.
PRLU or OLTC
Notice of Incident, Self-Injury
- Self-inflicted Injury 1
- Client attempted to use her fingernails to self-harm and attempted to bang her head on the wall. Client was taken to the comfort room, where she shut herself in the bathroom and attempted to hit herself in the face, punch the wall, and bang her head, all of which were blocked by staff. Client was able to de-escalate, and a cold pack was provided for discomfort to client’s knuckle. Self-harm precautions continued.
- Licensing follow-up: Licensing completed record review at facility and CEO confirmed that client is on self-harm and assault precautions due to recent behavioral disturbances.
PRLU or OLTC
Notice of Incident, Self-Harm
- Self-harm
- Client began punching herself in the face. Staff used blocking techniques to prevent injury and client processed with staff. No injury noted.
- Licensing follow-up: Licensing completed record review at facility and noted client to have updated/current safety plan to address her self-harm behaviors.
PRLU or OLTC
Notice of Incident, Self-Injury
- Self-inflicted Injury 2
- Client escalated due to increased sound on unit and began to pick scabs on her arms with her fingernails. Client’s wounds were cleaned and covered. Earbuds will be offered to reduce noise stimuli. Self-harm precautions continued.
- Licensing follow-up: Licensing completed record review at facility and CEO confirmed that client remains on safety plan and individualized safety contract to address her self-harm behaviors.