Disability Rights Arkansas

Piney Ridge Treatment Center

*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: Fayetteville, AR                   Population Served: Children and adolescents ages 7-17 with sexually maladaptive behaviors and other co-occurring psychiatric conditions.

# of residents per unit: Up to 32 Residents per room: 1, 3 or 4 Capacity: 102

Contact with family (Calls and visit schedule): Typically, bi-weekly phone calls. Visits with family are scheduled (frequency or schedule not provided).

Restraint utilized? Yes Chemical Restraint utilized? Yes Seclusion utilized? Yes

Treatment Modalities:

Clinical Director: LPC's                    Therapists: 8 full-time therapists (2 LMSW, 1 LPC, 3 LAC, 2 LPC); 1 part-time/contract therapist (LAC)

Treatment modalities offered: TF-CBT, CBT and other modalities individualized for resident and needs.

# of individual therapy sessions/week: 1-2

# of group therapy sessions led by a licensed mental health professional/week: 3

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PRLU or OLTC

Accidental Injury, Notice of Incident

On 7/8/2023 during recreational therapy, client reportedly hit her head face-first onto a wall while playing a sport. She continued the activity with no issue, however later in the day she developed a nosebleed and out of an abundance of caution, she was taken by staff to the physician’s specialty hospital for evaluation and treatment. She returned with a diagnosis of a bloody nose and needs no further treatment at this time.

Licensing narrative: 7/13/2023 – Licensing Specialist reviewed the provider reported incident.

PRLU or OLTC

Notice of Incident, Suicide Attempt

Client reported to a nurse that he removed a battery out of a remote and ingested it. On call APRN, notified via telephone at 2043, orders were received to transport the resident to Northwest Children’s Hospital Emergency Room for evaluation. A safety protocol with C-SSRS was completed, to which the resident scored high on. On call psychiatrist was notified via telephone at 2146 and orders were received for suicide precautions for 24 hrs. The resident was to be in continuous line of sight, bathroom privileges with the door cracked and staff posted at the door, mattress in the hallway with one blanket. Transport team and a nightshift RN transported the resident to Northwest Children’s Hospital at 2206 and returned at 2346. Per the emergency room physician, the battery was identified through an abdominal x-ray, and was noted past the stomach, and into the intestines and would pass on its own. No new orders were received. APRN, Tammie Smith notified via telephone. Resident given PRN Miralax medication to assist in passing the foreign object, and safely went to bed in the hallway. Resident placed on self-harm precautions for 24 hrs. And a clear liquid diet was implemented.

Licensing narrative: 6/30/2023 the provider reported incident was reviewed by Licensing Specialist jarred parnell. Licensing Specialist will contact the treatment center to inquire further about the incident. Licensing Specialist will inquire further about , the residents access to batteries in devices, staff ratios, staff location at the time of the incident, and actions being taken by the treatment center pertaining to the incident. 7/3/2023 Licensing Specialist reached out to facility regarding the provider reported incident. 7/5/2023 – Licensing Specialist spoke to [REDACTED] over the phone regarding the incident. Residents were in the classroom watching TV The residents are not doing school work right now but still have time in the classroom for other activities. Residents were allowed access to the t.V remote while watching TV Staff will limit access to TV Remotes for residents by keeping the remotes out of the classrooms and at the desk of the receptionist. When staff or residents want to watch TV The staff in each classroom will go and retrieve the remotes from the receptionist. Only staff will handle remotes for the residents. Staff will also check the remotes before the residents leave the classroom to ensure the batteries are still in the remote. Staff ratio for the classroom is 1:6. Ronissa said struggles with depression and it is unclear what the resident was trying to do by swallowing the battery but may be related to self-harm. Was monitored by staff and passed the battery with no issues.

PRLU or OLTC

Notice of Incident, Suicide Attempt

Resident reported that he swallowed an AAA battery. APRN was notified and x-ray was ordered. X-ray confirms foreign object in abdomen. APRN consulted children’s hospital and ordered for him to be taken in for consult. Resident was taken to Children’s Hospital via our transportation. The resident reports that the took the battery out of the classroom. He got it from a reading device he was using.

Corrective action taken by the agency or follow up done: resident returned from the hospital with orders to monitor for 2 days, clear liquids and then have a follow-up x-ray to make sure the object is moving as it should. Risk assessment was complete, the resident is on self-harm precautions and has a staff with him at this time.

Licensing narrative: Licensing Specialist will inquire about the health of the resident and any special health requirements administered by staff for the resident pertaining to the reported incident. 6/29/2023- facility responded stating that the resident complained of pain on 6/28/23 so he was taken to the hospital where he was given a laxative and stayed overnight for observation. The resident passed the battery and has been released back to the facility. 7/5/2023 – specialist spoke to [REDACTED] regarding the incident. Residents were in the classroom watching TV. Residents were allowed access to the TV remote while watching TV. Staff will limit access to TV remotes for residents by keeping the remotes out of the classrooms and at the desk of the receptionist. When staff or residents want to watch TV, the staff in each classroom will go and retrieve the remotes from the receptionist. Only staff will handle remotes for the residents. Staff will also check the remotes before the residents leave the classroom to ensure the batteries are still in the remote. Staff supervise the residents in the classroom as if the residents were doing school work. The staff to resident ratio is 1:6. Swallowed the battery because he saw another resident do the same and received a lot of attention. Resident was referred to acute treatment but was not accepted to acute treatment.

Police Report

Battery

When I arrived on scene, I met with the caller/victim’s father. He stated on June 22nd, Piney Ridge called him and advised his son was involved in an altercation with another child. They told him his son was okay, but it was up to him if he wanted to press charges. He spoke with his son on today’s date, and stated he wanted to press charges. I spoke with [REDACTED] who stated on Thursday morning, he was talking with his friends, and another child overheard. The other child, identified as [REDACTED] thought was talking about him. [REDACTED] approached [REDACTED] as [REDACTED] was sitting in a chair against a wall. [REDACTED] stated there were kids sitting on either side of him and he could not get out. [REDACTED] began swinging at [REDACTED] with closed fists, hitting him nine times total with both his right and left fists. [REDACTED] stated he was able to cover up his face with his arms, and [REDACTED] hit him three or four more times in the chest. [REDACTED] stated there were cameras that would have captured the incident. I spoke with the nurse on duty at the time of the altercation. She stated her office did not have a direct line of sight of where [REDACTED] was sitting when he was attacked, but she walked out when she heard the commotion. She stated she saw everyone standing up, but the altercation was over when she walked over. She stated her report included other children’s stories that [REDACTED] was hit unprovoked. She included the details of the incident in her nurse’s report.

PRLU or OLTC

Visit Compliance Report

Licensing Specialists reviewed three (3) personnel files: (Behavioral health associate), (Therapist), (Registered nurse). Personnel files reviewed complied with the minimum licensing standards.

Licensing Specialist reviewed four (4) children files: [REDACTED]. All children’S files reviewed complied with the minimum licensing standards. Licensing Specialist: Kendra Rice.

PRLU or OLTC

Elopement, Notice of Incident

Client was outside with the remainder of his unit and staff. He became upset and pulled a board off of the perimeter fence in the west outside area. Staff member retrieved the board from the resident and stood in front of the gap of the fence. At this moment two other residents started to posture each other, and the staff member stepped away from the fence opening and client scaled the fence. A staff member followed, and the police were notified at 14:45. A responding officer intercepted the resident walking down the street. The resident was returned within 30-45 minutes from the incident. He was assessed for injuries and none were noted or reported.

Licensing narrative: Licensing Specialist informed there was no camera footage of this incident. Resident was placed on elopement precautions. A review of his medication was completed and some of his medication has been changed.

PRLU or OLTC

Visit Compliance Report

The program coordinator visited the facility and discussed the new building the facility is having made. The CEO discussed the layout of the new facility and showed a diagram of ways they have designed the building to ensure better programming and safety for their residents. The projected completion date for the new building is December of 2024. Licensing discussed how the facility checks to ensure their overnight staff are completing appropriate visual checks on the residents during overnight shifts. The facility reports they do video checks, they schedule a floater to relieve staff who need to go on break or use the restroom, and they have a shift supervisor who monitor staff actions so they can address and identify any needs for retraining. A walkthrough of the facility was conducted of the MPR room, cafeteria, outside recreation area, south unit(Rooms 400, 401, 404, and 408), south unit dayroom, west unit (Rooms 101, 102, 103, and 106), and the west unit dayroom. The facility reports they stopped doing seclusion at their facility and have instead turned those rooms into storage areas for staff to keep activities for the children.

These areas were viewed during the walkthrough. Ratios were observed as follows: Explores classroom 3:15 + 1 teacher, Math class 2:15 + 1 teacher, English class 3:13 + 1 teacher, and a class transitioning was observed 3:12 in the hallway. We could not view the bathroom in 102 as it is currently being repaired. The west unit dayroom bathroom had very low water pressure in the bathroom sink so that you could not wash your hands properly. The facility reports the faucets are a poor design, but they have extra since they take time to arrive when ordering. The facility, put in a work order for the faucet and reports it will be replaced by the end of today.

Regulations needing technical assistance: 912.3 – bathroom in the dayroom of the west unit had a sink with very little water pressure. Licensing Specialist: Chelsea Vardell.

Police Report

Criminal Mischief

Spoke with caller. There is no damage. I advised I would come speak with staff at Piney Ridge. I advised staff and was given a tour of the facility. Caller was okay with just notifying staff. Caller lives at [REDACTED]. Not throwing rocks anymore right now but advised they probably will. Unknown how many kids are out there, caller can hear them yelling & hollering. This is an ongoing issue. Caller’s windows have been broken out before. Caller lives at [REDACTED]. Kids in the complex next door (Piney ridge) throwing rocks at caller’s building.

PRLU or OLTC

Notice of Incident, Suicide Attempt, Visit Compliance Report

Client was not responding to staff while she was in the restroom. The nurse opened the door to find her in the shower floor with pants tied around her neck. Nurse was able to get the pants off from her neck, respiratory rate and pulse within normal limits. Resident originally reported she was playing the choking game, but then started crying because she missed her mom. Complete assessment was done, she scored low on suicide risk assessment, and however she was placed on self-harm precautions and monitored closely. Upon re-assessment the resident was no longer upset, no injuries from having the pants around her neck.

Licensing narrative: licensing requested the facility to retain any video footage of this incident for review and send all nursing/staff notes to the program coordinator. 5/17/23- licensing received a copy of the nursing notes. 5/25/23- licensing visited the facility and was informed there is no video footage available for review. The resident was in her own bathroom that is inside her own bedroom when the incident occurred. Licensing Specialist: Chelsea Vardell.

Police Report

Battery, Disturbance

Caller reported patient has injured other patients, broken cameras, stabbed a staff member with a pencil, attempted to set off the sprinkler system, and is currently punching a wall in the dayroom. Patient has received emergency medication but none are working. Patient has been separated from other patients and is with staff, and currently has a screw and is threatening to stab someone with it.
Upon officers arrival, 3 staff members reported they were assaulted by juvenile after he became increasingly angry. Staff attempted to restraint juvenile but were unsuccessful. Staff stated they were able to get the juvenile in a central room and locked the doors, keeping him from wandering the facility and causing more damage. Once inside that room, juvenile began destroying property totaling approximately $1200 in damages. Staff member stated this behavior started the night before after juvenile destroyed some property and was “not allowed to play and have fun after last night’s incident so he became upset.” Officers made contact with juvenile who was acting calm and was arrested and transported to JDC without issue.

PRLU or OLTC

Notice of Incident, Visit Compliance Report

Client was in the North Dayroom and found out that his level was dropped. He became escalated and threw items, kicked the door and staff attempted to de-escalate. He then started hitting his shoe against the video camera on the unit and ripped it off the ceiling. He was restrained for safety as he continued to be escalated and during the restraint he kicked and hit at staff and received emergency medication. Client was released per protocol, and he continued the physical aggression toward staff and was placed in a supine hold for additional intervention, but was not able to be safely held. He then tore down additional cameras and pulled bolted down row of seats up on the unit, apparently obtaining a screw. He punctured a staff member’s arm with the screw (No apparent serious injury) and pushed and hit other staff members. The LPN called the administration and asked for intervention by the Fayetteville Police Department (FPD). The FPD were contacted, and they came to the facility and took the resident to the local Juvenile Detention Center where he is charged with criminal mischief and 3 charges of battery. At this time, a final decision has not been made of whether or not he will return to the facility.

Licensing narrative: Licensing visited facility, but was informed that there is no video footage of the incident because the resident broke the cameras during the incident. Resident has since returned and is no longer having major violent outbursts, but the facility reports he is making minimal progress with the treatment. Licensing Specialist: Chelsea Vardell.

PRLU or OLTC

Medical, Notice of Incident

Resident came to nurses’ station crying, reporting stomach pain. She was assessed, APRN was notified, and orders were given to send to ER to rule out appendicitis. Resident was transported via EMS to AR Children’s Hospital. Resident left via EMS at 2340, and a staff went with her as well. She returned via Piney Transportation approximately 07:00 05/09/2023. She had a CT scan, lab work and an ultrasound. She was discharged with diagnosis ovarian cyst. She will be treated with anti-Inflammatory for the pain as directed.

PRLU or OLTC

Accidental Injury, Notice of Incident

On 5/8/2023 reported that while playing kickball in the gym he slid into a wall. RN on duty notified APRN, K. Reynolds. APRN ordered an x-ray of the right ankle and foot. X-ray report shows normal x-ray examination of the foot. No follow up required at this time.

PRLU or OLTC

Medical, Notice of Incident

On 5/3/23 it was reported by staff member that resident was non-responsive while in the cafeteria. The nurse did sternal rub and resident was responsive for a moment, and then went back to non-responsive state, breathing even and unlabored, vs bp 156/95, pulse 118, r 16, t 98. APRN Karen Reynolds was notified and gave order to send patient to Physician Specialty Hospital for evaluation and treatment. Staff transported by van. He was taken via staff and a nurse. He returned from the hospital. No new diagnosis or change in medication. The ER was able to pull old records and show that he did have a history of irregular heart rate.

PRLU or OLTC

Notice of Incident, Self-Harm

At approximately 0850 client was observed to be irate by staff. He stated that he was angry and then punched the wall with his closed fist. Swelling was noted on his right hand, and he received an x-ray in house. There were not significant findings on the x-ray.

PRLU or OLTC

Accidental Injury, Notice of Incident

Client reportedly called for help after slipping and falling as she got into the shower. She stated that she felt like her ankle twisted and it was in pain. The medical provider was contacted, and an x-ray was ordered of the right ankle. The x-ray came back negative for fracture or soft tissue swelling.

PRLU or OLTC

Accidental Injury, Notice of Incident

Client was outside playing basketball with peers from his unit. The resident fell down and twisted his ankle and stated he heard a loud popping sound. He was provided first aid; the medical provider was contacted, and an x-ray was performed. In addition, [REDACTED] went to Ozark Orthopaedics and he did not have a fracture. He has a follow up appointment on 5/1/23.

PRLU or OLTC

Buildings and Grounds, Visit Compliance Report

  • Licensing Specialist: Kendra Rice.
  • Facility visited from 1:45pm – 3pm. Census: 91. Areas observed: gym, units (East, West, North, & South), computer lab, classrooms, cafeteria, dining room area, game room, garden area, and courtyards. Residents must display safety to participate in gardening, and the garden is behind a locked fence. CEO reported the facility has been seclusion free as of 03/01/23 and seclusion rooms are being used as storage closets. MARs reviewed for 5 residents.

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 04/14/23 and all applicable staff shall be retrained on the updated policy within 2 weeks of the enactment of the updated policy.
  • 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.

PRLU or OLTC

Altercation, Notice of Incident, Peer Altercation, Visit Compliance Report

At approximately 1005, the North unit was lining up after community group to go to class. Client 1 pushed and then quickly hit client 2. Staff intervened on the situation. Client 2 was assessed by nursing; order was received to take him to Arkansas Children’s hospital due to possible fractured nose. He was having trouble breathing out his nose and reported numbness. Client 1 reported pain to his right hand. He was assessed and order received for x-ray to be completed in house. Resident was taken to Children’s hospital where he had a CT scan that confirmed a [REDACTED] . He returned to facility with ibuprofen every 6 hours for pain, and a follow-up with ENT on 04/03/2023. Client 1 had x-ray completed in house of his hand and shows no fracture or dislocation. He will be treated for pain as needed and also follow-up with APRN as needed. Client 1 was placed on precautions for the behavior and was on increased observation. Licensing Specialist: Kendra Rice

PRLU or OLTC

Notice of Incident, Peer Altercation

Client was pushed in the cafeteria by another resident, [REDACTED], during horseplay. She hit her left temple are on the floor. Nursing assessment shows pupil equal and reactive, no issues noted. Nursing informed the APRN who ordered the resident to go to the emergency room for assessment. She was taken to Arkansas Childrens ER. She returned at 2250 with an order for ice and ibuprofen. No new injuries were found.

PRLU or OLTC

Accidental Injury

Client was playing basketball in the gym and went to catch the basketball and hit the ball with his pinky. He complained of pain 5/10 and was given ice and analgesic. APRN notified and x-ray was ordered to be obtained in house. The result of x-ray was obtained on 3-17-23 and he was diagnosed with a fracture to his pinky finger. He was taken to Ozark Orthopedics on 3-17-23 and a splint was placed. He was discharged on 3-17-23 to the care of his father and his father was aware of follow up needed. Interim Action Narrative: Resident was assessed and provided with ice and analgesic. APRN notified and x-ray ordered. Diagnosis: . Resident evaluated at Ozark Orthopedics and splint provided.

PRLU or OLTC

Accidental Injury, Notice of Incident

  • Accidental Injury
    • Client was playing basketball in the gym when he rolled his ankle, and stated he heard a pop when he landed. Ice and Ibuprofen were provided and an in-house x-ray showed an oblique fracture. Client was taken to the ER where a soft cast was applied. Client has a follow-up appointment with an orthopedic clinic scheduled.
    • Licensing follow-up: Licensing received report late due to staff illness and staff who sent notification did not have the correct email for the Licensing Specialist. No licensing concerns noted.

Police Report

Welfare Concern

Caller with CPS in Florida needing a welfare check on juvenile. Juvenile is listed in an investigation in Florida and they need an officer to make sure he is not injured and has no bruises. Officer spoke with juvenile and did not observe any marks, injuries, or bruises on juvenile. Juvenile informed officer of a scar on his leg from a dog bite.