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 [email protected]

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

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

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.

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.

Police Report

Missing Person

375 10-12 at Zion/Randall, 375 tran to Piney with juvenile BM 574. Staff have not seen the subject during canvassing, subject was brought straight to facility from [REDACTED]. Subject went on an outing on 6/9 to Lake Fayetteville. No friends or relatives in area. Subject has been at Piney Ridge for 3 weeks. Has case worker out of NE – Info at nurses station. Unknown if parental info is available. Legal guardian is case worker. Staff are canvassing the apartment complex. Another staff member is at the gas station. Unknown destination. Subject is not from the area, is from NE, unknown city. Meet caller at front of 2805 East Zion Road in lobby. Caller is walking there now. Staff member REDACTED], no cell phone, no notes or verbal threats of running away. No alternate mode of travel. Subject is aggressive – could be aggressive with officers. Subject wrestled a staff member and climbed over the fence. Last seen climbing over the fence into Valley Lake Apartments. No injuries. Primary language is English. Picture is available at Piney Ridge facility. No pets with subject. There is a pool at Valley Lake. Last seen by staff member – not caller. Escaped patient from Piney Ridge, has gone to Valley Lake Apartment. Caller is pursuing and does not have any info with him. Wearing green sweatshirt and black pants.

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.