Disability Rights Arkansas

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*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: Little Rock, AR

Population Served: Adolescents 12-17 years of age in need of mental health services on a 24 hour a day basis.

# of residents per unit: 12 Residents per room: 1-2 Capacity: 54

Contact with family (Calls and visit schedule): Kids have daily contact with their family either via zoom, face time calls, or phone calls. In the evening they are given time to call families and their families are welcome to call anytime during the day. Outside of Covid-19 Restrictions families can visit on the weekends and once during the week.

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

Treatment Components:

Clinical Director – LPC

Therapists: 8 full-time therapists (4 LAC, 3 LCSW, 1 LPE-1); 1 part-time/contract therapists (1 LCSW)

Treatment modalities offered: EMDR, TF-CBT, ARC, Brain Spotting, Trauma-Focused Family Therapy, Reactive Attachment Multi-Family Group

# of individual therapy sessions/week: 2-3x/week

# of group therapy sessions led by a licensed mental health professional/week: 2-4x/week

# of family therapy sessions/week: 1x/week

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PRLU or OLTC

Notice of Incident

  • Suicidal/Threatening Behavior
    • Client became upset after breaking a watch which staff took and indicated they would try to fix. Client screamed and started flailing around on the ground. Client was placed in seclusion and indicated he wanted to kill himself, putting his hands around his throat as to choke himself. Client continued to fight staff at which point a chemical restraint was implemented, during which client punched staff in the face multiple times and spit on staff. Client was placed on eyeball and remains at facility.
    • Specialist followed up on 3/8 and reviewed video of incident. No licensing concerns or improper holds viewed during seclusion, restraint, or chemical restraint.

PRLU or OLTC

Notice of Incident

  • Suicidal/Threatening Behavior
    • Client had been upset and processed with 4 different staff regarding the issue. Client tried to choke herself in which staff intervened. Nurse assessment: Client complained of slight pain to neck area. Staff debriefed with client about what happened and what caused her to try and choke herself. No follow-up details.

PRLU or OLTC

Notice of Incident

  • ER Visit (Self-inflicted Injury)
    • Client became angry due to receiving a consequence for being sexually inappropriate. Client went to her room and punched the wall, causing immediate swelling/bruising to the left 5th digit knuckle. Client was given Ibuprofen and ice pack. FOH and eyeball status ordered. Client taken to Urgent Care (3/4) for x-ray. Client’s hands were bruised and swollen, no fractures; Ice and Tylenol recommended.
    • Follow-up: Urgent Care Note – No fractures to either hands contusion/bruising of both hands. Recommendations: ice hands. Can wear ace wraps for comfort. Take over the counter Tylenol/Ibuprofen.

PRLU or OLTC

Notice of Incident

  • Urgent Care (Accidental Injury)
    • Client was in a hurry going back into game room and tripped on the bumper between the gym and game room, spraining her ankle. Client was sent to Urgent Care for x-ray.

Police Report

Battery Second Degree

Staff stated J1 became disrespectful/upset while in group therapy and was kicked out. J1 began cursing at staff and swinging a chain around, in which he hit staff on the forehead and lip. Staff restrained J1 until he calmed down. J1 charged with Battery Second Degree. While on scene, J2 started acting out, threatening to kill staff, and spit on staff. Pulaski County Juvenile Intake approved the intake of both juveniles. J2 charged with Terroristic Threatening 1st Degree. Both taken to JDC.

PRLU or OLTC

Notice of Incident

  • Threatening Behavior
    • Client asked staff if he could get client because she was being rude to clients/staff. Staff member went to check on client, who was banging her head on shelves. Client went to her room and continued to bang her head on the wall, kick things, and cuss out staff. Client entered seclusion room. After exiting seclusion, client stated she wanted to be placed on eyeball because her peers had been placed on this precaution and she felt like she was being treated differently. Staff explained eyeball status to client. Client was cooperative for the rest of the night.

PRLU or OLTC

Notice of Incident

  • ER Visit (Accidental Injury)
    • Client stated he hurt his right thumb while playing flag football and didn’t feel any pain until the next day. Client was taken to Urgent Care to receive x-ray. It was stated he had a sprain, and a prescription was called in. The radiologist called later and stated he had a small chip in his right ligament injury in which they are referring him to ACH on Monday for recommendations. It was advised to let his hand rest until the appointment.
    • Specialist followed up: Client appears physically/mentally stable. Splint reapplied to right thumb.

PRLU or OLTC

Notice of Incident

  • ER Visit (Accidental Injury)
    • Client slipped and fell on pine gumballs that were on ground while walking outside. Client was assessed and transported to ER.
    • Specialist followed up on 2/17: Client returned from ACH in stable condition and was diagnosed with right ankle sprain. A walking boot was provided for support for 1 – 2 weeks. Tylenol and Ibuprofen can be alternated for pain.

PRLU or OLTC

Notice of Incident

  • Restraint/Assault on Staff
    • Client became upset in classroom and attempted to hit teacher with his fist. Client was then restrained, and the momentum landed client and staff on floor. Client then purposefully hit his head on floor during restraint and continued to struggle. Client calmed down and returned to house. Nurse’s note: Client has abrasion above and below right eye from carpet burn, triple antibiotic ointment applied.
    • Specialist visited facility on 2/16 and viewed video. At no time during video are licensing concerns observed.

Police Report

Battery

Staff stated after juvenile’s peer had received a punishment for violating rules, juvenile got angry and got into a physical altercation with staff. Juvenile caused 2 minor lacerations to staff’s forehead and nose. Juvenile was cited for Battery 2nd and received court date of 3/1/22.

PRLU or OLTC

Notice of Incident

  • ER Visit (Arm Pain)
    • Client reported he was not feeling well, dizziness, lightheaded, headache, nausea, and pain with numbness and tingling in/down right arm. He had reported sharp pain in his arm the previous day and couldn’t recall any recent injuries or overuse. Client transported to ER, especially given past medical history. Neurologist doesn’t feel MRI is necessary at this time. Labs obtained; IV fluids administered. Will update as more information becomes available. No follow-up details.

PRLU or OLTC

Notice of Incident

  • Restraint/Assault on Staff
    • Client became upset due to another crisis going on in the house. Client began to yell, scream, and throw clothing items at staff. Client was placed in personal restraint. Client debriefed with staff afterwards.
    • Specialist visited facility on 2/8: Client stated she had no injuries and was upset due to another peer having issues. She was remorseful for acting out and hitting staff. Client was able to have a positive phone call with guardian. Staff stated the staff involved in the incident spoke with the guardian as well and client was doing better.

Police Report

Assist Citizen

Staff stated juveniles were acting defiant and they could not control them. Juveniles were upset they couldn’t go outside to play, but staff stated it was against protocol to let juveniles out under 40 degree weather. Multiple juveniles threw fruit trays. Juvenile stated staff member was acting aggressive towards them and not allowing them to go outside. Juvenile advised staff member struck him on his face with a table approx. 3-4 times. No visible injuries observed.

PRLU or OLTC

Notice of Incident

  • Suicidal/Threatening Behavior
    • Client was yelling/cursing at staff to give him his tray. Staff stated they would if he would calm down. Client got permission to take a timeout in the back area. He then removed a metal handle that locks a seclusion room and held it in the air, acting as if he was about to hit staff with it. Client dropped it after staff began talking to him, and he began crying and returned to his room. He picked up a pencil that was hidden under his bed and stuck the pointed end to his throat. Staff removed the pencil. Client was placed on eyeball status (suicide watch). No follow-up details.

PRLU or OLTC

Visit Compliance Report

  • Buildings and grounds conducted, and MARs checked for 5 clients.
  • TA –
    • R911.15.f – Pull strings found in 3 sets of pants. Staff notified immediately and strings were removed. House staff reminded of the importance of removing items that could be used to inflict self-injury.

PRLU or OLTC

Complaint Survey with POC, Revisit Survey

  • Complaint #AR00027729 was substantiated.
  • Regs out of compliance –
    • N 209 – Facility failed to ensure the state designated Protection and Advocacy group was notified of a suicide attempt for 1 resident who was placed in locked seclusion.
  • Plan of Correction –
    • Instruction sheet for responding to a serious incident was updated on 1/26/22 with simplified list for those sending notifications and posted to staff portal. UR and Records Compliance Director handed out the updated instructions and went over it with all Managers, the Executive Team, and all members of the department. Facility’s Performance Improvement Committee will continue to monitor incidents sent.
  • A revisit was conducted on 02/14/22 for all deficiencies cited on 01/14/22. All deficiencies have been corrected, and no new noncompliance was found.

PRLU or OLTC

Notice of Incident

  • ER Visit (Accidental Injury)
    • Client was playing sports in indoor gym and landed on right ankle, causing immediate pain/swelling. Staff provided ice, elevation, and shoe was removed. Client was transferred to ACH via ambulance at 5:58pm.
    • Specialist followed up via email on 1/21: Staff advised there was no fracture. Client resides in Rose House.

Police Report

Medical Emergency

Nurse at facility stated juvenile was playing volleyball and rolled her ankle. Officer confirmed with juvenile what had happened. Juvenile was transported to ACH by MEMS.

PRLU or OLTC

Notice of Incident

  • Suicidal/Threatening Behavior
    • Client stated to morning staff that it was going to be a bad day for everyone. Client grabbed a disinfectant wipe of staff’s desk and squeezed the excess solution into his mouth. Poison Control was called for further instructions, who stated there shouldn’t be any adverse side effects. Client then hit peer, resulting in seclusion. After punching door in seclusion, client calmed down. Upon video review, it was discovered that client was not supervised during seclusion. The seclusion room was also not free of hazards, including client’s bed. No staff noticed that client tied sheet around his neck. Client was transported to acute placement at Pinnacle Point.
    • Specialist visited facility on 1/26 and reviewed video for 1/19 from 7:30 – 8:00am. Hazardous items were in seclusion room and staff walked away for considerable amount of time after client entered. 

PRLU or OLTC

Notice of Incident

  • Suicidal/Threatening Behavior
    • Client told staff about being rude to peer the previous day, and staff gave client 30 minutes of table time for being rude. Client walked away from group (outside playing kickball) and began picking up rocks, trying to hide them. Client refused to walk back to house and began walking towards the street instead. Restraint began outside of Mabee house. Client continued to move towards street and continued to struggle while restrained in street. Help arrived and moved client out of street into house. After call with guardian, client began to scratch arms and grab the phone cord. Treatment Team felt client met criteria and need for acute placement. Client’s guardian refused to consent to acute placement and picked client up at facility. Client was discharged AMA at 7:54am. No follow-up details.

PRLU or OLTC

Notice of Incident

  • Suicidal/Threatening Behavior
    • Client’s phone call with guardian did not go well and client began to destroy property and hit a wall mirror in her room. Staff escorted client to the seclusion area. While in seclusion, client stated she would hang herself and kill herself tonight because she could not go on staying at the facility. Client put a sheet around her neck at which time a restraint was used by staff. Client debriefed afterwards with staff. Client was placed on eyeball precautions.
    • Specialist visited facility on 1/04/22 and viewed video of incident from 1/02/22 started at 1:30pm. Client had no incidents while on eyeball and client reportedly is still on eyeball.

PRLU or OLTC

Visit Compliance Report

Facility visited and incident report was reviewed, no video footage available. Clients are now in the same house but in a different hallway. Staff roster and sleep log reviewed and were in compliance with Licensing Standards. Sleep checks were conducted every 30 minutes and initialed. Staff ratio was 1:6. Interim Corrective Action reported as children being separated.

PRLU or OLTC

Notice of Incident

  • Suicidal/Threatening Behavior
    • Staff issued a high-level hold after client attempted to attack a peer. Client was taken to the seclusion room while resisting the restraint. While in seclusion, client began making suicidal comments. Staff intervened after client tried to tie a string around his neck. Client then tried to use socks to choke himself and tried to do the same with his pants. Staff intervened and took items. After client calmed down, staff processed with client.
    • Staff reported to licensing on 12/30 that client was doing well and continues to reside at facility. Video footage was observed of incident that occurred on 12/4 starting at 5pm at Chestnut House. No improper restraints or physical injuries were observed happening to client by staff. Facility is working with DCCECE Licensing to implement plan for timely reporting in the future. Plan involves nursing staff sending a brief notification when attending incident (This incident was reported on 12/30/21).

PRLU or OLTC

Visit Compliance Report

  • Hickory House viewed and MARS reviewed for 4 residents.
  • Regs out of compliance –
    • R409.6 – Outlet cover shall be replaced in room 2. Holes in wall were observed in rooms 1 and 8.
  • TA –
    • R411.5 – Bed frame had to be removed due to child using it to stand on as he broke ceiling fixtures.