Resident at facility broke open a nail polish glass bottle and used the glass to cut her wrists. Unable to control bleeding. Transfer of care.
Police Report
Suicide Threat
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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 |
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
Police Report
Suicide Threat
Resident at facility broke open a nail polish glass bottle and used the glass to cut her wrists. Unable to control bleeding. Transfer of care.
PRLU or OLTC
Notice of Incident, Suicide Attempt, Visit Compliance Report
Resident had become upset prior to the incident related to a food sensitivity that staff was discussing with her. Resident appeared to calm down and was painting her nails with another resident, then she broke the glass nail polish bottle and started to self-harm by cutting her left arm. There was scant bleeding and staff called for nurse support in the gym. Staff attempted to remove glass, and when the nurses arrived at the scene, resident then cut her left forearm deeper causing a round 3 cm deep laceration and in the process also cutting her right finger. Resident was restrained and nurses applied pressure and first aid was administered to the resident’s left arm and right finger. Resident was transported to Washington Regional Medical Center ER and sutures were applied to her lacerations. Upon her return to PRTC, a referral to Conway Behavioral Healthcare was made and she was accepted for admission in the evening of 11-15-23.
Licensing Specialist: Jarred Parnell
A visit was conducted to review video footage of the reported incident. In the video, the resident can be seen sitting on the basketball court near the basketball goal painting her nails with another resident. The resident proceeds to break a bottle of nail polish and began to self harm. Staff member notices the resident has a piece of the glass bottle. From 12:43 until 12:50 when a nurse entered the room and restrained the resident the resident had possession of the broken bottle. Nursing staff who entered the room were unaware the resident had a piece of glass. Staff interacting with resident prior to the nursing staff entering the room, were aware the resident was self harming with a piece of glass.
Facility cited 1007.2: The resident had the piece of glass for 8 minutes before the staff removed the glass from the resident’s possession.
Resident was moved to acute care and facility has removed all glass nail polish bottles as part of the safety plan. Staff were also educated on supervising residents during gym time and advised not to participate playing sports with the residents.
PRLU or OLTC
Accidental Injury, Notice of Incident
Resident was outside playing a game with his peers in the gaga pit when the resident ran and tripped hitting his face into the side of the gaga pit. Nurse assessment: Resident had busted his mouth, moderate amount of bleeding noted, and had a 3cm laceration on his bottom lip with a puncture wound from his top teeth. The resident’s top teeth were also chipped and broken from the gum-line.
APRN Karen Reynolds gave orders to send resident to Arkansas Children’s Hospital of Northwest Arkansas for further assessment. While at the emergency room the MD at Children’s Hospital noted resident to have a superficial lip laceration. No stitches required, leave wound to self-heal. He will be following up with a local dentist.
PRLU or OLTC
Accidental Injury, Notice of Incident
Resident was seen by APRN on 11/9/23 complaining of hurting his hand a few days ago after playing football outside with his peers. An x-ray was ordered and came back as possible fracture . APRN notified and gave order to Ozark Orthopaedics of Fayetteville Arkansas to evaluate and treat. He received a finger splint and will follow-up with hand specialist.
Police Report
Missing Person
Officers responded in reference to 3 juveniles that escaped from Piney Ridge. Staff captured all 3 juveniles and officers responded to location of staff and children.
Police Report
Criminal Mischief
On November 5, 2023, at approximately 4:40 PM, unit 1386 was parked at Piney Ridge located at 4253 N. Crossover Road after transporting three juvenile runaways back to the facility (Incident 2023-74373).
While officers spoke with staff to create a plan for the three juveniles to be removed from the patrol unit and into the facility without running away, two of them began bending the back metal partition in the patrol unit. On the in car Axon Video, both subjects can be seen grabbing the top of the metal partition, and bending it downward to gain access to the rear storage area of the patrol unit. Once they had bent the partition down, both subjects grabbed loaded magazines from a carrier vest and concealed them in their pants. As staff and officers were getting the subjects out of the vehicle, staff noticed the bulge in their pants and searched them discovering the magazines. All magazines were returned and no other items were located missing or on the subjects.
Citation Issued to both juveniles for Criminal Mischief 1st Degree (Felony).
PRLU or OLTC
Elopement, Notice of Incident
Three residents were able to pull a picnic table to the fence and jump over. Staff immediately went to follow them and nursing called the police. The staff were able to maintain the location of the residents and with the assistance of the police they were returned to Piney at approx. 1700.
While in the police car it is alleged that 2 of the residents caused some damage to the police car and stole magazines of bullets. Unsure how many they took, however upon returning to facility this was discovered and they were returned to the police. Both have felony criminal mischief charges pressed against them. Resident1 has court 11/14/2023 and Resident2 has court 11/7/2023 at 1330.
Prior to the incident, staff to client ratio was 2:11 outside. Two residents from west unit were supposed to be transitioning in, however they were refusing and then Resident3 from North unit joined them when his unit was transitioning out. Upon return to the facility the residents were placed on RTU, elopement precautions, and will have a staff remain with them. This will be revaluated every 24 hours. We are also making room changes, the three residents will now be on three separate units.
PRLU or OLTC
Accidental Injury, Notice of Incident
While resident was in the gym he threw a basketball up and it got stuck between the wall and goal. Resident disregarded the staff directs and tried to climb the basketball goal to retrieve the ball. Resident fell approx. 2-3 feet during his climb down the pole and landed on his left wrist/arm. He was immediately assessed by nursing with swelling noted to his left wrist and complains of pain from wrist to elbow. Resident was given medications and ice pack for pain. X-ray was ordered in house and showed acute left radial fracture. Resident was taken to Arkansas Children’s Hospital and fracture was confirmed. Resident returned with a cast to his left arm. He has a follow-up this Thursday at 11am at UAMS orthopedics.
10/24/23 – Licensing inquired if there was video footage. Facility responded that the video footage is no longer available.
PRLU or OLTC
Accidental Injury, Notice of Incident
Resident was playing football when he fell onto his left hand/wrist area. Resident presented with pain and swelling. X-ray was ordered in house and showed minimal buckle fracture of the distal radial metaphysis. Orders were received to take resident to Physician Specialty for follow-up. Pain medication and ice was given prior to initial x-ray being done.
Resident followed up with Ozark Orthopedics on 11-2-23 (it is noted that UAMS refused to see resident without payment up front). Diagnosis: X-ray confirmed fracture to wrist and comparative x-ray also found fracture to finger. The wrist fracture is suspected to be a recreational injury where he fell on his wrist. He does not know how he obtained the index fracture. He was given a soft cast which he has already torn off. He reports no pain.
PRLU or OLTC
Medical, Notice of Incident
On 10/9/23, client was seen by APRN as follow up due to a possible infected bug bite (he received a dose of Rocephin and started Kelfex 500 mg on weekend). APRN ordered that he be taken to Arkansas Children’s Hospital. Client was seen in the ER and stayed overnight for observation. He received IV antibiotics and fluids and the area was drained by the physician. Client returned to facility 10/10/23. He will be on oral antibiotics for 1 week and follow-up with APRN on 10/13/23.
Licensing requested the hospital discharge paperwork from facility. The facility responded the hospital did not know what the bug bite was from, the antibiotics cleared the bite and the resident is doing well.
PRLU or OLTC
Notice of Incident, Peer Altercation
Client was seen by the APRN and reported right hand pain. He was sent to Ozark Orthopaedics and received an x-ray that showed acute 1st metacarpal fracture. He was encouraged to not participate in physical activities and not manipulate or take off the soft cast. Ozark Orthopaedic will contact PRTC for a follow up appointment in approximately one week. He quickly hit a peer on 9/27/23 in the face, this is the only documented time lately that client hit something.
Licensing reviewed nursing notes for client. The resident complained of pain on the day of the incident (9/27/23). No other nursing notes state the resident complaining of pain up until the visit to the Ozark Orthopedics.
PRLU or OLTC
Visit Compliance Report
Licensing Specialist: Jarred Parnell.
A buildings and grounds inspection was completed. Areas observed: Common areas for all of the units, rooms on the south unit, cafeteria, gymnasium, and the computer lab. Ratios and sleeping arrangements were reviewed during the walkthrough and daily schedules/activities were discussed with staff.
PRLU or OLTC
Acute Placement, Notice of Incident
Client was transported to Arkansas Children’s Hospital to be assessed for acute care due to displaying aggressive and unsafe behavior. Client was accepted at Conway Behavioral Health. It is unknown whether he will return to facility.
Police Report
Elopement
Officer responded to facility in reference to missing juveniles. An employee stated that two boys were in the back outside area and jumped the fence. BOLO (be on the lookout) was issued for both residents.
Officer later responded to Springdale to recover the two missing juveniles that had ran away from Piney Ridge earlier in the day. Springdale Police Department had contacted them after they went to the business to turn themselves in. Officer transported both juveniles back to Piney Ridge.
PRLU or OLTC
Elopement, Notice of Incident
At approximately 1245, 2 residents were outside for free time and quickly scaled the fences toward the apartment complex/parking lot. Staff members followed but lost sight of the residents. Police were called at approximately 1300 and assisted in search. At approximately 0002 on 9/20/2023, both residents returned to the PRTC accompanied by a Fayetteville police officer. The residents reportedly went to a gas station and asked the employee to call PRTC to say he wanted to come back. No significant injuries were noted. One of the residents made a statement of smoking a vape with THC with two children “who were like our age”. Because of this, UA of both residents was obtained. Both residents were placed on Elopement precautions, restricted to the unit, and separated from being on the same unit.
Licensing Specialist followed up with the facility for the ratio at the time of the elopement: 4:14 (4 staff to 14 residents).
PRLU or OLTC
Notice of Incident, Peer Altercation
Resident became escalated and quickly hit a peer multiple times as staff was intervening. Resident was placed on assault precautions at the time of the incident. In-house X-ray results: Acute angulated distal 2nd metacarpal fracture to right hand. His index and middle fingers were buddy taped and resident was placed on no sports for six weeks. PRN Ibuprofen 400mg and an ice pack were administered and resident was transported to Ozark Orthopedics where he was assessed and treated.
On 9/8/23, facility informed Licensing that there is no video footage of this incident to review.
Medicaid Inspection of Care
Corrective Action Plan, Inspection of Care Report
Deficiencies were noted during the Inpatient Psychiatric Inspection of Care (IOC) conducted on 08/29/23.
PRLU or OLTC
Notice of Incident, Self-Harm
Resident complained of pain to his right hand (it is suspected it is related to him hitting walls). His hand was assessed, APRN was notified, and order for x-ray was obtained. X-ray showed no fracture or dislocation. Re-assessment completed by nurse, patient denies any pain at this time.8
Police Report
Hang Up
911 hang up call. No sounds of distress.8
PRLU or OLTC
Notice of Incident, Self-Harm
Resident reported on 8/10/23 that he was having pain in his right hand. Resident was assessed and x-ray was completed, showing an acute angulated distal 5th metacarpal fracture. Upon questioning, he reported that he hit a wall earlier in the week. Resident went to Ozark Orthopedics on 08/11/2023. Upon return he has orders for buddy ring to small finger daily, ice to area and range of motion of fingers and no gripping. Resident denies any pain at this time. Will follow-up with Ozark Ortho in 7-10 days.
PRLU or OLTC
Visit Compliance Report
Licensing Specialist: Jarred Parnell.
Licensing Specialist visited facility and reviewed 14 personnel files and 7 children’s files. All files were complete upon review.
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.