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-Injury

  • Self-inflicted Injury
    • Client returned to their unit after a phone call and used small pieces of plastic to make 2 superficial scratches to their left forearm. The contraband was removed, and the scratches were cleaned and covered. Self-harm precaution safety plan was implemented. C-SSRS performed with client scoring zero.
    • Licensing follow-up: Licensing observed unit during facility visit. Unit was in ratio and no safety concerns/maintenance issues were identified. Licensing did not view client’s room as she was standing in front of the door stating she “hates DHS”. DON stated client is on self-harm precautions and facility staff will monitor her room for safety.

PRLU or OLTC

Notice of Incident, Self-Injury

  • Self-inflicted Injury
    • Client used plastic cap to make superficial cuts to their arm. Client’s wound was cleaned, and self-harm safety plan extended. The plastic cap was from a Christmas present that client received; This was given to staff. 
    • Licensing follow-up: During facility visit, Licensing followed up with staff regarding client’s frequent self-harm behaviors. Client’s therapist stated that due to client’s chronic self-harm behaviors that haven’t increased or changed, an acute referral is not appropriate at this time. Facility has implemented a no plastic policy on the units. Licensing reviewed LOS documentation and safety plan for client and checked her room for obvious safety hazards. The loose screw in her room was fixed and no contraband was found.

PRLU or OLTC

Notice of Incident, Self-Injury

  • Self-inflicted Injury 1
    • Client stood on a cafeteria table and attempted to use the plastic pieces of the light cover to cut her arm. Additional staff arrived and talked client into getting off table. Nurse assessed and noted client’s arm to have superficial scrapes over existing wounds that required no first aid. Client was placed on 1:1 status and RTU.
    • Licensing follow-up: During facility visit, staff provided LOS and safety plan documentation. Client was observed to be 1:1 with an MHP during visit. Staff reported the care team plans to have a meeting to determine if a referral to an acute facility is needed for client.  

PRLU or OLTC

Notice of Incident, Self-Injury

  • Self-inflicted Injury 3
    • Client used pieces from their soap bottle to make superficial cuts to their arm. No first aid required; Contraband was removed. Self-harm and Suicide Precaution safety plans initiated after event and response to C-SSRS scale.
    • Licensing follow-up: During facility visit, Licensing followed up with staff regarding client’s frequent self-harm behaviors. Client’s therapist stated that due to client’s chronic self-harm behaviors that haven’t increased or changed, an acute referral is not appropriate at this time. Facility has implemented a no plastic policy on the units. Licensing reviewed LOS documentation and safety plan for client and checked her room for obvious safety hazards. The loose screw in her room was fixed and no contraband was found.

PRLU or OLTC

Notice of Incident, Self-Injury

  • Self-inflicted Injury 2
    • Client used the tip of her glasses to poke a hole in her skin (left forearm), about the size of a small nail. The glasses were turned in to the RN. Client’s wound was cleaned with no further medical attention needed. Client was placed on self-harm precautions x 7 days.
    • Licensing follow-up: Client is currently on LOS precautions per her safety plan. No additional follow-up required at this time.

Police Report

Hang Up

Hang up; No sounds of distress. No answer on call back. Staff advised no emergency.

PRLU or OLTC

Notice of Incident, Self-Injury

  • Self-inflicted Injury
    • Client stood on a cafeteria table and attempted to use the plastic pieces of the light cover to cut her arm. Additional staff arrived and talked client into getting off table. Nurse assessed and noted client’s arm to have superficial scrapes over existing wounds that required no first aid. Client was placed on 1:1 status and RTU.
    • Licensing follow-up: During facility visit, staff provided LOS and safety plan documentation. Client was observed to be 1:1 with an MHP during visit. Staff reported the care team plans to have a meeting to determine if a referral to an acute facility is needed for client.

PRLU or OLTC

Self Report Visit, Visit Compliance Report

  • Licensing Specialist: Chelsea Vardell
  • Licensing visited facility and discussed 3 incidents of self-harm by client on 12/11/22 (used broken light socket cover), 12/13/22 (used piece of shampoo bottle), and 12/23/22 (threatened to swallow screw). Licensing conducted walkthrough and cited facility for several issues found. Licensing encouraged facility to document how and when staff are complying with any doctor’s orders (safety precautions) and discussed the facility using paper cups with hygiene products to eliminate residents using plastic bottles to self-harm.
  • Regs out of compliance –
    • 9.911.6 – Loose outlet covers (2) in the cafeteria, protruding screw in the window of room 305, and broken light switch cover reportedly used to self-harm by client on 12/11/22 (already corrected). Repair by 12/30/22.

PRLU or OLTC

Notice of Incident, Suicide Attempt

  • Suicide Attempt
    • Client tore the elastic piece from the waist band of her paper scrubs and attempted to tie it around her neck. Staff intervened and no injuries were noted. Client will remain on suicide precautions x 7 days and will stay in paper scrubs. Resident scored high on C-SSRS.
    • Licensing follow-up: The client is not being assessed for acute care, because it is believed the attempts are more attention seeking behaviors as the client could not reach her parents via telephone for the holidays. The client has had no reported self-harm attempts since she was able to reach her parents via phone.

PRLU or OLTC

Notice of Incident, Self-Injury, Visit Compliance Report

  • Self-inflicted Injury (1)
    • Client self-harmed with a staff bathroom key that was left on the common room table by staff. Client created 2 superficial wounds on her arm that were cleaned.
    • Licensing follow-up: Facility visited on 12/29/22. It was determined that a few weeks ago, staff were allowed to use a single restroom on each unit as a “staff bathroom” so that staff did not have to leave the unit out of ratio to use the restroom on the administration hall. After the key was left out on the table, a resident used it to self-harm. DON stated the keys were collected and the unit bathroom for staff no longer allowed, but stated someone must have returned the key to the unit. DON stated this could have been due to staff shortages during the holiday. The key has again been collected and is no longer on the unit. Facility cited 907.2 for lack of supervision, as client was noted to be high risk for self-harm and had an event earlier in the day.

PRLU or OLTC

Notice of Incident, Self-Injury

  • Self-inflicted Injury (2)
    • Due to noise on the unit, client used her fingernail to create 2 fingertip sized scratches on her arms. The wounds were cleaned, and client was placed on self-harm precautions x 7 days. Order was restored to the unit.
    • Licensing follow-up: The incident report was reviewed and determined to have no further investigation needed.

PRLU or OLTC

Notice of Incident, Self-Injury, Visit Compliance Report

  • Self-inflicted Injury (3)
    • Client used an eyebrow razor to make 4 superficial cuts that were already healing. Client got the razor from “makeup day” when staff brought in their own makeup products and client stole the razor from a makeup bag.
    • Licensing follow-up: Facility visited on 12/29/22. DON reported that staff are no longer allowed to bring in outside makeup to be used on residents and moving forward, “makeup day” will only be allowed for residents on a certain treatment level as a reward. The facility will then purchase that makeup for the resident to ensure no cross contamination occurs with sharing makeup.
    • Facility cited for 907.2 (for lack of supervision, as client had already self-harmed 2 other times earlier in the day and was on active self-harm precautions) and 910.1 (grounds shall be kept free of safety hazards).

PRLU or OLTC

Notice of Incident, Suicide Attempt

  • Suicide Attempt
    • Client picked and scratched at her arms with her nails, then ripped off a piece of her shirt and wrapped it around her neck. Staff intervened and removed object; Reddened area noted to client’s neck. Client admitted she wanted to hurt herself and agreed to wear paper scrubs. Client scored high on C-SSRS and will be on suicide precautions x 7 days.
    • Licensing follow-up: Facility visited on 12/29/22. Licensing inquired why the client was not assessed for self-harm if she was considered “high risk”; DON reported that the attempts were believed to be client’s response after she was unable to reach her parents on the phone during the holidays. Once the client was able to reach her parents, she has not had another self-harm event.

PRLU or OLTC

Notice of Incident, Self-Harm Attempt, Visit Compliance Report

  • Self-harm Attempt
    • Client was dysregulated and grabbed a screw off the cafeteria doorframe. Client placed it in her mouth and threatened to swallow it, before giving it to a staff member. Client processed 1:1 with staff and returned to the unit. No injuries occurred.
    • Licensing follow-up: Licensing visited facility on 12/29/22. Staff reported they originally thought the screw came from the doorframe, but the screws appear different, so they are unsure where it came from. Licensing discussed self-harm precautions with staff.  Facility was cited for several safety issues (see 12/29/22 Visit Compliance Report).

PRLU or OLTC

Technical Assistance, Visit Compliance Report

  • Licensing Specialist: Kendra Rice.
  • Licensing completed intent training with POTO staff. Areas in the classroom and on the milieu need to be repainted. The Incident Log was reviewed and copies of 6 incidents were taken to be reviewed and follow up will occur to address any concerns.

PRLU or OLTC

Technical Assistance, Visit Compliance Report

  • Licensing Specialist: Chelsea Vardell.
  • Visit conducted from 1:30pm – 4:30pm. Licensing presented intent training to 2 groups of staff and collected sign-in sheets for all staff in attendance. The training covered sections 107, 108, 109, 110, and the entire 900 section of the Minimum Licensing Standards.

Police Report

Call Report, Medical

Caller reported juvenile has passed out twice, BP is 86/58 and pulse 118. Juvenile transported to hospital.

Medicaid Inspection of Care

Inspection of Care Follow Up Report

  • Included: IOC (follow up report), CAP
  • Multiple deficiencies noted. CAP must be completed within 30 calendar days (CAP submitted and approved).

PRLU or OLTC

Complaint, Notice of Incident, Visit Compliance Report

  • Complaint
    • Complaint received stating client was given the incorrect dose of medication which lead to increased aggression and harm to others. Client was then discharged, and parents were notified via email that they had 72 hours to pick the patient up, 15 hours away. No aftercare plans were made.
    • Licensing follow-up: Licensing reviewed client records. Client was admitted on 11/28/22 and arrived with limited paperwork and bottles of pills (a 60 mg bottle and 80 mg bottle). The nurse assumed the 80 mg bottle was the current dosage, but the actual dosage prescribed was 140 mg. The APRN signed off on the medications after reviewing and adjusting them the following morning. The guardians were notified of the adjustments but were not provided a full list of current meds which would have reflected the lower dose of the specific medication she arrived with. Client exhibited violent behaviors throughout her stay, prompting an emergency 72-hour discharge on 12/20/22. The guardians were then provided a list of medications upon discharge, and they discovered the incorrect dose of medication. CEO advised that the client had several aggressive/violent behaviors at her previous facility, therefore, the facility does not believe the medication changes caused behavior prompting emergency discharge. Licensing investigated this complaint and provided TA on 01/04/23 regarding standard 902.10.f. Licensing complaint unfounded. DON stated that moving forward, the facility plans to complete a nurse review and medication reconciliation for each new resident to ensure meds/dosages are correct and will follow-up with guardian to ensure accuracy.

PRLU or OLTC

Notice of Incident, Property Damage

  • Property Damage
    • Client damaged the fire sprinkler resulting in the fire alarm being triggered, and widespread flooding through the units/milieu. All residents were taken to the back courtyard until deemed safe by the fire department. Once back inside, client stated she planned to elope but was unable to do so. Client was placed on attempted elopement precaution safety plan with constant line of sight, and property destruction safety plan.
    • Licensing follow-up: Facility visited on 12/29/22 and camera footage reviewed. The client is observed escalating and begins destroying and throwing items, then picks up a Lysol bottle that was left out and proceeds to get on a chair and hit the sprinkler with it. Client gets on and off the chair 2 times, hitting the sprinkler both times, before getting on the chair the third time and activating the sprinkler and fire alarm.
    • The facility was cited for 910.1: Lysol was left unattended, allowing the client to obtain it. TA was provided for 905.10: Staff did not intervene while the client attempted to damage the fire sprinkler multiple times before she was successful.

Police Report

Alarm

Keyholder requested dispatch for burglary alarm. Building secured.

PRLU or OLTC

Notice of Incident, Self-Injury, Visit Compliance Report

  • Self-inflicted Injury
    • Client reported self-harming in the shower using a shampoo bottle. Superficial scratches noted to right forearm. Body and room search completed, and client was placed on self-harm precautions including LOS showers x 7 days.
    • Licensing follow-up: Licensing visited facility on 12/29/22. Licensing discussed ways facility can ensure staff are following all doctor’s orders regarding self-harm safety plans and the option of using paper cups for hygiene products to ensure residents do not use bottles to self-harm with. Facility was cited for several safety issues (see 12/29/22 Visit Compliance Report). The facility was also cited for 109.1.f due to not reporting the incident to licensing by the next business day (violation of their corrective action agreement).

PRLU or OLTC

Buildings and Grounds, Visit Compliance Report

  • Licensing Specialist: Kendra Rice.
  • Facility visited from 9:30am – 10:30am; Census: 30. Blue Unit, Green Unit, and classrooms viewed. Licensing was informed that the new CEO will be starting on 01/04/23. MARs reviewed for 5 residents. No licensing concerns noted.

PRLU or OLTC

Notice of Incident, Self-Harm, Visit Compliance Report

  • Self-harm
    • Client was involved in several verbal altercations with peers and was placed in a restraint after becoming dysregulated and attempting to damage property. Client calmed but became angry again after she was told she could not join her peers in the cafeteria for dinner. Client entered the hygiene closet and locked herself inside. Staff remained by the door and attempted to make entry until client decided to open the door. Client was placed in another restraint, during which she began banging her head on the floor and bit staff on the ankle. Client received a chemical restraint, after which she calmed down. No injuries noted. Client was placed on assault precaution safety plan.
    • Licensing follow-up: Facility visited on 12/29/22. Licensing discussed with staff alternative ways to ensure the hygiene door cannot lock from the inside. Staff reported a mechanism on the inside of the lock can be disabled; This will be completed by 12/30/22. The facility was cited for 109.1.f due to not reporting the incident to licensing by the next business day (violation of their corrective action agreement).

PRLU or OLTC

Notice of Incident, Self-Injury, Visit Compliance Report

  • Self-inflicted Injury
    • Client self-harmed with light socket cover on her forearm. The wounds were superficial and cleaned with soap and water. Client placed on self-harm precaution x 7 days.
    • Licensing follow-up: Licensing visited the facility on 12/29/22 and observed the resident’s bathroom light socket was replaced. Licensing discussed self-harm precautions with staff, and the facility was cited for several safety issues (see 12/29/22 Visit Compliance Report). The facility was also cited for 109.1.f due to not reporting the incident to licensing by the next business day (violation of their corrective action agreement).