Licensing Specialist: Kendra Slade
Licensing completed an after-hour visit from 5:15 – 6:15 pm for the PRTFs at Youth Home. All houses were in ratio and no issues were noted by Licensing.
PRLU or OLTC
Visit Compliance Report
PRLU or OLTC
Notice of Incident, Self-Harm
Client was escalated since the beginning of the shift and was non-compliant and not following staff directions. Client earlier in the day was jumping on furniture, not staying in her area, grabbing things that did not belong to her, scratching her cuts and making them bleed, banging on tables and chairs, and putting objects over her face and head. Client reported she was hungry and this is why she was acting out. Client then continued to escalate and began walking around the room and not following directions. Client continued to scratch her scabs and cuts. Client would not comply and continued to do unsafe behaviors and would not accept redirection. Client began tearing things off the wall and was restrained.
Client was transported by MEMs to Rivendell Behavioral Health for acute hospitalization at 6:25 pm. Client has been making suicidal comments and has been self-harming for the past 6 days. She required at least 3 personal restraints in the past 3 days in order to stop her from self-harming, including this evening after being accepted for acute care.
PRLU or OLTC
Acute Placement, Notice of Incident
Therapist talked with client about his ongoing aggressive behaviors and the safety concerns around this problem. He was informed that he would be going for acute treatment at Rivendell Hospital. He was upset and cried on a heap of laundry on his bedroom floor for a few minutes. After talking further with his therapist he calmed down and was able to acknowledge the safety concerns. He was then willing to pack some changes of clothes. He was able to be transported by MEMS without incident at 5:05 pm. Client was scheduled to be discharged on 10/8 and will not be returning from acute.
PRLU or OLTC
Notice of Incident, Self-Harm
Client had spent much of this day upset and was observed punching walls and the window of her bedroom when being held accountable for behaviors. Client ignored repeated redirections to stop these behaviors and refused to be seen/assessed by nursing staff. Client was upset that another client was able to go to the outing today and she wasn’t. She began hitting the window and threw a chair several times causing a hole to be placed in the wall. She then barricaded herself behind the door and continued to not respond to staff. Client then refused meds from staff. MEMS was called to transport the client to Arkansas Children’s Hospital for potential acute placement. Client transferred to Pinnacle Pointe Acute on 10/7/24 from ACH. Tentative Safety Plan upon return to Youth Home after discharge from acute: Client will likely be on Close Observations and possibly Frozen until she restores with others upon her return. Safety plan will be finalized closer to discharge from acute.
PRLU or OLTC
Accidental Injury, Notice of Incident
Patient states that he was bending down and accidentally hit his head on the dresser/shelf in room. Nursing Assessment 10/3/24 Time 6:50 PM: Pt came to nurse’s station stating that he had hit his head on dresser by accident when he went to stand. Upon assessment, pt has superficial laceration about 1.5cm in length to posterior L side of head. Patient was taken to ER to rule out concussion. Diagnosis: Head Injury.
PRLU or OLTC
Medical, Notice of Incident
Pt taken to Urgent Care d/t bloody stool. Pt reports that she has had 2 episodes today. Nurse assessed 1x episode at about 530pm. Stool is bright red, BM is small/scant. Urgent Care told staff that pt should go to ER. Pt has been at ER since about 615pm. Diagnosis: Generalized abdominal pain and constipation. Treatment includes Miralax and diet change.
PRLU or OLTC
Aggressive Behavior, Notice of Incident
Client came home from school very excited with peers. Client quickly turned angry and tried to barge out of the door. Client was restrained for threat to safety. Client continued to struggle with staff to be released from restraint and was given IM Thorazine 50mg right gluteus maximus. Once calm, client was released from restraint and complained of pain to right forearm and right gluteal muscle. Ibuprofen x 2 administered. Client was provided peapod to decrease anxiety. Client was transported to BridegeWay for an acute stay on 09/26/24.
PRLU or OLTC
Visit Compliance Report
Licensing Specialist: Kendra Slade
Program Coordinator received a phone call on 9/19/24 regarding some concerns that were mentioned regarding a resident being placed on freeze at Chestnut House during camera review. Camera footage was reviewed of the incident in question for 9/13/24. Program Coordinator was informed of expectations and safety concerns for being placed on freeze.
PRLU or OLTC
Notice of Incident, Self-Harm
After receiving a consequence after being observed throwing up a gang sign with peer, client returned to house and began to punch the wall. Client was redirected by staff to stop and was able to accept the information. Client was sent to Urgent Care for her injuries. Diagnosis: Contusion of right hand. Per provider, Pt is to keep cast on until reveal on 9/25/24.
PRLU or OLTC
Aggressive Elopement, Notice of Incident, Visit Compliance Report
While in class, patient was struggling with a peer instigating him. Patient charged at a peer, shoving a teacher in his class. A personal restraint was initiated. Patient fought the restraint and his feet tangled with staff’s feet, causing all of them to fall to the floor. Patient attempted to bite staff members while in the restraint. Patient cried and screamed. Patient was offered PRN several times but declined. Once client began to calm down, nurse offered a chemical by mouth and client accepted. Client took chemical restraint by mouth. Client proceeded to elope from the school but walked back to the house with staff.
Youth Home Additional Comments: Concerns were made about the initiation of the restraint, feeling as if the approach may have been too aggressive, furthering pt’s escalation. Video review shows that one team member may have been attempting to use “team control” CPI hold but it was not communicated, making the initial restraint ineffective. This will be further discussed/trained with team member.
Licensing Specialist: Kendra Slade
On 9/18/2024, Program Coordinator reviewed camera footage. Staff were not observed preventing the resident from breathing. Resident was observed yelling and struggling to get out of the restraint. The resident was also observed displaying physical aggression towards staff.
PRLU or OLTC
Notice of Incident, Self-Harm
Client received feedback from staffing that didn’t include her being taken off extra supervisory precautions, despite struggling with excessive hair pulling for two days prior. Client attempted to utilize the comfort room. She was observed hitting the walls of this room with significant force. When staff attempted redirection, client escalated, storming down the hall. Due to her being escalated and her unpredictability in this moment, and her increasingly unstable behaviors of the last couple of days, client was restrained. Due to pt remaining unsafe and showing no signs of calming, an order was given for a chemical restraint. Client denied injuries.
The attending physician was notified and provided orders for the patient to be transferred to an acute care facility via MEMS. Facility reported resident was discharged on 9/16/2024 and provided documentation.
PRLU or OLTC
Visit Compliance Report
Licensing Specialist: Kendra Slade
Program Coordinator Kendra Slade reviewed two (2) personnel files. Both files reviewed complied with the minimum licensing standards.
Police Report
Disturbance, Police Report
Officer responded to Youth Home in reference to a disturbance. Upon arrival, officer made contact with a staff member who advised a resident in her class began interrupting the class and ignoring orders. The staff member stated she asked the resident to be seated, and he said “Bitch make me” and proceeded to aggressively push the staff member while she was seated in her chair.
Secondary teachers proceeded to restrain the resident and walk him out of the classroom. While doing so, the resident hit a classmate on the side of his head with a closed fist. No injuries were reported. T
he resident also assaulted a staff member once in the hallway. The resident was cited for Battery in the 3rd degree and given a court date.
Police Report
Battery, Police Report, Redacted
Officer responded to Youth Home in reference to a disturbance. Upon arrival, officer made contact with resident involved who stated his classmate called his mother a name and he “snapped”. The resident stated he tackled the classmate and punched him five times in the head. The classmate complained of soreness to the back of his head but stated he was not injured. The resident was arrested and provided with a court date. After he received a court date, the resident was released back to school staff.
PRLU or OLTC
Notice of Incident, Peer Altercation
Staff was called out of the room for a situation in another class. Client got up and started walking toward peer stating that he heard peer had been talking about his mother. Staff asked peer to step out in the hall to get him out of the classroom and away from client. Client went around staff and ran out into the hall and started hitting peer in the head. Pulaksi County Sheriff’s Office was called to campus. Per nursing note peer reported no complaints.
PRLU or OLTC
Aggressive Behavior, Notice of Incident
Client was being a disruption and not following directions in the classroom and D-zone staff was asked for assistance. Client proceeded to continue to walk around in the room and threatened the teacher in the class and threatened to hit her and cussed at her. He walked up to her face and pushed her out of her chair and D-zone staff immediately escorted the client from the classroom after that. Client was placed in a personal restraint and continued to fight back and try to get out of the hold. While escorted towards the d-zone, he punched one staff member 2-3 times in the chest after escaping one hand from the hold and was quickly continued to be escorted by staff towards the d-zone. Once calm, client was released but was placed in another restraint due to attempting to exit the d-zone. Client soon calmed down and was released.
Upon assessment, patient has a dime size area of skin abrasion. Patient also states that his fingers are sore on his right hand from hitting the staff. Pulaski County Sheriff’s Office was called to the scene to allow staff to make a report/press charges. Patient was cited and released, as well as given a court date.
PRLU or OLTC
Aggressive Self Harm, Notice of Incident
Resident was observed “bowing up” on staff threatening to punch them. Resident was asked what was going on and replied “this place is just like all the others.” Resident began walking around the milieu throwing things off staff’s desks and flipping over furniture. Resident then walked towards the front door and with one kick, kicked it open and went outside. Resident was placed in a personal restraint and escorted back into the house. Resident was released in the comfort room and punched the window. Staff continued talking with him and he was able to calm and be assessed by the nurse. Resident was sent to Urgent Care to have their hand x-rayed. Diagnosis: Right hand sprain.
PRLU or OLTC
Notice of Incident, Peer Altercation
Peers were in conflict in class and pt was inserted into the conflict. Pt expressed not wanting to pick sides but a peer charged at pt, swinging fists. Pt raised her fists to fight back. Pt was placed in a personal restraint and escorted away from her peer. Pt began swinging to hit peer several times but once she was guided away from peer, she ceased in attempting to fight. Pt contracted for safety and cried about her head hurting due to being struck by peer. Nurse assessed patient and she was transported to Arkansas Children’s Hospital for further evaluation and to rule out concussion. Diagnosis: cervical pain, facial injury. Discharged with C-collar. Follow up with AR Children’s Surgery Specialty Nurses for C-spine clearance. CT scan of facial bones showed No acute traumatic findings.
To be noted: She has a splint on her (R) hand/arm following punching the wall at some point over the weekend/Monday. Urgent Care findings: Right hand swelling and tenderness to touch, no fracture.
Youth Home Actions that might have prevented injury: If staff had called for help, perhaps additional staff could’ve helped separate the class sooner. However, multiple pts were escalated in the school at the time, making help difficult to come by.
PRLU or OLTC
Aggressive Behavior Acute Placement, Notice of Incident
Resident became aggressive after learning she would be transferred to an acute facility. The resident tried to rush past staff, continuing to escalate and was placed in a restraint. The resident attempted to strike staff and claw at their hands. MEMs was called and transported the resident to Arkansas Children’s Hospital for evaluation before transporting her to acute care.
PRLU or OLTC
Accidental Injury, Notice of Incident
Resident complained of blurry vision and dizziness after hitting her head on a door. The resident was assessed by nursing. Poor cognition noted. Seizure-like presentation noted. MEMS was notified and transported the resident to Arkansas Children’s Hospital for further evaluation and treatment.
Police Report
Disturbance, Police Report
Officers responded to the facility regarding a disturbance. Staff advised officers that a resident was hitting staff and would not follow instructions. Officers stood by to contact EMS transport if necessary.
Police Report
Disturbance, Police Report
Officers responded to the facility regarding a disturbance. Staff told officers that a resident would not comply with rules, threw objects, and attempted to hit staff. Officers requested MEMs to transport the resident to acute care.
PRLU or OLTC
Notice of Incident, Self Harm Acute Placement
Resident became dysregulated and began displaying unsafe behavior. Resident attempted to put a broken rubber hair band around her neck to choke herself. She began climbing and jumping off furniture in a reckless manner. Resident was restrained after trying to break a popsicle stick after displaying unsafe behavior. Resident got into her peers’ belongings and tried to remove them. Staff continued verbal de-escalation.
Resident was transported by MEMs to Pinnacle Pointe for an acute stay. She will return to Youth Home once she discharges from acute.
PRLU or OLTC
Elopement, Notice of Incident
While walking back to the house from dinner, a resident and two peers rushed by staff in an effort to elope. The resident was later brought back to the facility by the Pulaski County Sheriff’s Department. The resident was assessed by nursing. Multiple scratches to both legs and arms were noted. No open bleeding was noted. Respirations were even and unlabored. Fluid intake was encouraged to prevent dehydration. The resident was placed on run risk, house restriction, and freeze.
PRLU or OLTC
Elopement, Notice of Incident
While walking back to the house from dinner, a resident and two peers rushed by staff in efforts to elope. The resident was later brought back to the facility by Pulaski County Sheriff’s Department. Resident was assessed by nursing. Multiple pink scratches and bug bites noted on legs. No open bleeding was noted. No bruising.