Perimeter Behavioral of the Ozarks / Woodridge of the Ozarks

Staff reported resident was taken off the unit due to her reporting that she was being triggered by another resident screaming. Once off the unit, resident began banging her head on the wall and window near the comfort room. Resident had to be placed in a restraint for safety and because she was not able to be verbally de-escalated. Resident was released from the restraint after calming down and no longer being a threat to herself. Resident to remain on self-harm precautions.

Staff reported resident had been sitting in a corner facing away from them and they were concerned she had been self-harming. When staff went to check on resident they discovered resident was ripping up their paper scrubs. Staff requested the ripped up pieces which the resident initially refused to hand over. Resident eventually became agitated and gave staff scrub pieces but then went down hallway and began banging their head on the wall. Resident eventually was able to be redirected and verbally de-escalated. Resident will remain on self-harm precautions.

Resident began banging her head on the wall and hitting/kicking staff. Resident was placed in a physical hold to maintain safety, and released once she was able to regulate and contract for safety. No injuries sustained. Resident placed on self-harm and assault precautions with constant line of sight.

Staff reported resident became escalated due to being told they could not have their blanket over their head. Staff asked resident to remove blanket and resident became verbally aggressive. Staff removed blanket and resident took contraband out of their pocket and started attempting to self-harm with it. Staff retrieved object. Resident then began banging their head on the wall. Staff placed hand on wall to prevent injury. Resident continued to escalate and had to be restrained. Once restrained resident was able to de-escalate and return to demonstrating safe behaviors. Patient placed on self-harm precautions.

11/1/2023 – The facility reported the contraband was a piece of plastic, it was unknown where it came from.

Staff reported resident became dysregulated due to another resident “telling lies” about them. Staff tried to process but resident was unable to be de-escalated. Resident continued to bite and hit herself and had to be restrained. While restrained, resident was able to process and verbalize plan for safety. No injury occurred. Resident placed on self-harm precautions.

Staff reported that resident was picking at scabs on their arm. Resident continued to escalate and eventually ripped the head off of another resident’s stuffed animal and took a plastic piece off of it and began trying to self-harm on their arms and thighs. Resident was able to eventually be de-escalated and staff was able to obtain the plastic piece. Resident was given basic first aid and will continue to be on self-harm precautions.

Resident became dysregulated due to another resident being too loud. This resident threw a cup of water across the unit and when staff tried to redirect her, she began hitting herself in the head. Staff tried to physically block her from hitting herself and resident began assaulting staff. Resident was placed in a restraint for safety. While restrained resident was able to calm down and verbalize plan of safety. Resident placed on self-harm and assault precautions.

Staff reported resident became upset and took a staff’s notebook from the staff table and started to take it apart. Resident took a piece of the metal from the notebook and attempted to self-harm with it. Resident was restrained for safety and staff were able to retrieve the piece from resident. Patient remained escalated while restrained and required emergency medications. After emergency medication administration resident was able to calm down.

Licensing Specialist inquired about the corrective action regarding the metal binders. 10/31/2023 – Metal Binders will no longer be used.

Staff reported resident became upset after they were caught passing and receiving notes. Another resident gave the staff the notes and then this resident began pinching her arms repeatedly trying to self-harm. Resident was able to be de-escalated with no injury other than reddened skin spots on her arms. Resident placed on self-harm precautions.

Staff reported that resident was chewing on her finger. After being given an alternative safe for chewing, they then began self-harming on their hand. Upon staff trying to redirect resident the resident tried to bite staff. After some time staff were able to verbally de-escalate and resident quit self-harming. Resident to remain on self-harm precautions.

Staff reported resident was refusing to return to classroom and began self-harming by scratching her arms. Resident was able to be verbally de-escalated and returned to classroom. No injury reported, just reddened area of skin. Resident on self-harm precautions.

Staff reported resident was scratching at her skin while under blanket. Staff retrieved blanket and redirected patient. No injury occurred as resident did not break open skin. Resident remains on self-harm precautions and will be extended.

Resident was self-harming and being verbally aggressive to staff. Staff tried to verbally de-escalate and physically block resident from self-harming. Resident in response tried to bite staff multiple times and hit staff with their noise canceling headphones (given to decrease stimulation). Resident had to be restrained for safety. Once resident was restrained they were able to calm down and de-escalate. Resident placed on assault and self-harm precautions.

Resident was self-harming with a small piece of plastic, it is not known where the resident obtained the plastic.

Staff reported that resident was picking at old self-harm scabs. Nurse was notified and able to de-escalate resident. Nurse provided basic first aid and covered areas. Resident remains on self-harm precautions.

Resident began self-harming by scratching arms, pulling out hair, and banging head against the wall, and was placed in multiple brief physical holds to maintain her safety. Resident would re-escalate almost immediately after being released from physical hold requiring continued further intervention to maintain safety. Resident received IM medication as ordered by the provider to assist in emotional regulation. Resident was able to regulate emotions and maintain a calm demeanor with safe behavior after several interventions and processing with staff. Because of the lengths of intervention required for regulation/stabilization, provider placed resident on a 1:1 observation status. She was moved out to the comfort room for 72hrs on a 1:1 status and was given paper scrubs.

Resident began scratching at their old self-harm wounds and was re-opening them. Staff tried to redirect and verbally de-escalate patient but was unsuccessful. Resident had to be restrained for safety from 15:41-15:45. Upon release patient was able to voice she would remain safe. Nurse provided basic first aid. Resident placed on self-harm precautions.

Resident became triggered due to another resident on the unit self-harming. Staff began verbally de-escalating this resident and eventually were able to get them to quit picking open their old wounds. Patient will remain on self-harm precautions.

Staff reported that patient was banging her head into the wall and scratching her left arm in multiple places with her fingernails. Nurse was called and staff attempted to process with patient. Patient refused to process and became verbally aggressive with staff. Resident had to be placed into a physical restraint for safety due to continued self-harm. Doctor notified and order was given for one time dose medication. Resident calmed down after administration of medication. Nurse provided basic first aid. Patient placed on self-harm precautions.

Staff reported they found resident in their room self-harming under their blanket instead of sleeping. Resident was self-harming with a crayon. Resident refused to process or accept by mouth medications from the nurse. Crayon was retrieved and resident placed on LOS constant and self-harm precautions.

Resident became upset and started pinching her arm in order to self-harm. Staff blocked her hands from arms and resident attempted to bite staff. While staff were trying to process with her, resident took her glasses off and broke off earpiece leaving a sharp piece exposed. Staff retrieved and took the piece off the unit before resident could self-harm with it. Resident then went down the hall way and started banging her head on the wall. Staff blocked this but resident continued to escalate and had to be restrained. Resident was eventually able to calm down and was able to be verbally de-escalated. Resident on self-harm precautions.

Resident was in the classroom when a teacher gave her a crayon to color with. Resident became upset and began rubbing the crayon on her skin making a red mark. Staff took the crayon and resident began scratching the area with her nails. Staff were able to verbally de-escalate with no further issues. Resident remains on self-harm precautions.

Resident became upset because of comments made by another peer. Resident went to the end of the hallway and began trying to self-harm. Staff verbally de-escalated resident. Resident successfully pulled off a previous scab. No other injury reported. Nurse provided basic first aid. Resident on self-harm precautions.

Staff was notified resident had been using a bendy pencil to self-harm with. Staff were able to retrieve the broken bendy pencil that patient had hidden in her scrub pants. Patient gave up the bendy pencil willingly after some processing with staff. Resident would not report where the pencil came from. Resident will remain on self-harm precautions until improved behaviors.