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

  • Accidental Injury
    • Client was playing basketball when he fell and heard a pop sound from his leg. Client was taken to ER; No broken bones were found.
    • Client should rest and use ice and no physical activity until healed.

PRLU or OLTC

Notice of Incident

  • Aggression/Fighting
    • Client became escalated after meeting with the nurse, started screaming, and ran out the front door. Client was placed in hold and escorted back to house from school in van by staff. Client was placed in seclusion after continuing to threaten staff/peers. While in seclusion, client wrapped shirt around neck. After shirt was removed, client calmed down and was assessed by nurse. Client had imprint of concrete on forehead, but no laceration. No follow-up details.

PRLU or OLTC

Notice of Incident

  • Accidental Injury
    • Client was playing football when he collided with another peer and his foot was kicked on accident. Client was advised to get X-ray.
    • Specialist emailed facility to find out outcome of ER visit; Facility will get back with specialist after checking with Nursing team.

PRLU or OLTC

Notice of Incident

  • Suicide Attempt
    • Client was observed with hoodie wrapped around his neck; After staff removed hoodie, client began destroying property and was put in physical hold and placed in seclusion. While in seclusion, client took off his shirt and tried to put it around his neck; Staff removed shirt and administered chemical restraint after client became more calm and stated that he was hungry and wanted to come out to eat dinner.

PRLU or OLTC

Complaint Survey with POC, Revisit Survey

  • Complaint #AR00027557 substantiated.
  • Regs out of compliance –
    • N 132 – Facility failed to ensure a personal restraint was performed in a safe and appropriate manner for 1 client.
    • N 189 – Facility failed to ensure a staff debriefing was conducted after the use of a restraint for 1 client.
    • N 124 – Facility failed to ensure staff were retrained in the appropriate application of a personal restraint for 1 client who were subject to the inappropriate application of a personal restraint.
  • Plan of Correction – A training video was developed to demonstrate appropriate and inappropriate holds; The proper use of a post intervention debriefing is described in a training video that must be completed by staff; All ESIs will be reviewed by the Unit Managers for appropriate use of CPI techniques. All retraining will be reported to the Chief Clinical Officer on a monthly basis. An update to the Ethical Standards Policy #1405 was approved that added duty to intervene for all staff if they observe misconduct.
  • During the Revisit Survey conducted on 11/30/21, facility was found to be in compliance with program requirements.

PRLU or OLTC

Notice of Incident

  • Medical
    • Client was sent to Urgent Care due to eye pain and blurred vision. Client was not able to be seen and was taken to ER.
    • Specialist emailed to find out outcome of ER visit; Facility will get back with specialist after checking with Nursing team.

PRLU or OLTC

Notice of Incident

  • Aggressive, Threat to Safety, Maltreatment
    • Client became escalated and aggressive when his peer laughed at him, resulting in a restraint hold. During hold, client scratched, head butted, bit, and kicked staff members. Client was placed in locked seclusion. After the nurse came to assess, client stated he was choked by staff member during restraint. The nurse found multiple reddened areas around neck. Child Abuse Hotline was called and accepted; Outcome: Exempt.
    • 10/27/21 Follow-up: Alleged staff member was terminated by facility. Facility was cited for regulation 905.7.

PRLU or OLTC

Notice of Incident

  • Sexual Incident
    • Client reported that peer has been sexually inappropriate in general with her over the past few weeks. Client stated the peer has asked her to play strip poker, kissed her, and climbed on top of her in the middle of the night and proceeded to gyrate on her. Client stated she stays awake most nights because she is scared to go to sleep as they are roommates. Child Abuse Hotline was called and accepted.
    • CACD gave Specialist permission to contact the agency. Clients are both assigned to separate dorms, classroom, and group sessions. Staff have been informed to keep clients separated during outside time, meal services, and other activities.

Police Report

Runaway Juvenile

Officers responded at approximately 14:08 hours for a Juvenile that ran away from facility into the nearby woods. Officers located Juvenile, and after being resistant, Juvenile was placed in handcuffs. After Juvenile calmed down, handcuffs were removed and he was transported back to facility by staff; Officers followed. Juvenile advised he was mad because he was grounded for not going to bed on time, advised he would calm down.

Police Report

Battery

Staff stated when he spoke to Juvenile about racial slurs and using the N word, Juvenile became upset and ran outside. Staff stated he followed him, and Juvenile picked up a metal pipe and hit staff in the head with it. Officer observed large knot on staff’s head. Officer placed Juvenile in handcuffs. Juvenile was cited, given a court date, and released back to facility care.

PRLU or OLTC

Revisit Survey and Workload Reports, Validation Survey with POC

  • Regs out of compliance –
    • N209 – Facility failed to ensure the Office of Long-Term Care was notified of a serious occurrence for 1 client who had an injury requiring out of facility medical care.
  • Plan of Correction –
    • Director of Nursing developed a short training module for all nursing staff that is available on electronic learning system. All nursing staff must complete this module by 10/14/21. An update to facility’s Incident Report Policy #413 was approved on 9/27/21 and includes the instructions for sending incident reports to all regulatory agencies/bodies. The list of serious incidents that have been sent to OLTC will be checked on a monthly basis and reported through the facility’s Performance Improvement Committee.
  • Facility was found to be in compliance with program requirements during the Revisit Survey conducted on 10/15/21.
  • Survey Team Composition and Workload Report –
    • Surveyor 1 onsite 23.5 hours 8am – 6pm; 11.5 travel hours, 1 off-site report prep hours (09/08/21 – 09/14/21).
    • Surveyor 2 onsite 23.5 hours 8am – 6pm; 10.50 travel hours, 1 off-site report prep hours (09/08/21 – 09/14/21).
    • One surveyor onsite 2.5 hours 8am – 6pm; 2 travel hours, 1 off-site report prep hours (10/15/21).

PRLU or OLTC

Notice of Incident

  • Sexual Abuse
    • Client was accused of groping 3 peers in inappropriate areas (buttocks, genitals). Peer stated he didn’t inform staff of this when it was occurring because he was “terrified” of client beating him up. Child Abuse Hotline was called and accepted. A member of the AR State Police Crimes Against Children has begun an investigation and will interview residents on 09/14/21.
    • On 9/22/21: Facility completed Corrective Action disciplinary for all 3 staff that were working that shift. Had discussion with all 3 staff regarding what was seen on the video and how they could have better supervised the area. Retraining for all staff involved was scheduled for 9/27/21.
    • On 9/20/21: Specialist emailed staff for video of incidents to be saved. On 9/29/21, the investigation was still pending.

PRLU or OLTC

Visit Compliance Report

  • Specialist viewed video of an incident involving resident; No issues found. Specialist reviewed med logs for 5 residents.
  • TA –
    • R912.3 – Battery was dead in one of the faucets in the bathroom at Chestnut Hall.
  • Regs not correctable –
    • R908.8 – Meds for 1 resident were not documented on 8/11/21. This is for a controlled substance.

PRLU or OLTC

Visit Compliance Report

  • Specialist conducted building and grounds check on QRTP at Cartwright House. All looked good regarding general safety and the facility appeared to be in full compliance in reference to the building and grounds; Specialist reviewed 4 children’s records with no issues found. Facilities records in great order.
  • Regs out of compliance –
    • R406.4.d – Ensure all staff are trained in medication documentation. The med logs must contain the initials of the person administering the medication. Compliance date is 8/30/21.

Police Report

Welfare Concern

Officer was advised to check welfare of Juvenile for Florida Dept. of Child Services. Officer made contact with Juvenile who stated he was “fine”; Officer advised case worker.

PRLU or OLTC

Visit Compliance Report

  • Specialist conducted building and grounds inspection at Mabee, Chestnut, Sturgis, and Rose Houses. All meds were locked and stored properly.
  • TA –
    • R908.8 – Medications not logged properly for child in Chestnut House. Not correctable. Ensure all meds are logged properly.

PRLU or OLTC

Visit Compliance Report

  • No regs noted out of compliance.
  • TA –
    • Mabee House only has one bathroom while preparing and remodeling another bathroom. Agency will notify Specialist when bathroom remodeling is completed.

Police Report

Suicide Threat

Staff stated that Juvenile had swallowed an unknown amount of glass, and was scratching and biting herself. MEMS transported Juvenile to ACH for evaluation.

PRLU or OLTC

Notice of Incident

  • Other
    • Client barricaded himself in his room with the door closed. Peer flipped table due to commotion; Client broke out the fire extinguisher and began spraying at the staff around the room. No follow-up details.

Police Report

Missing Person

At approximately 15:10 hours deputies were advised a Juvenile had just ran off from facility. In a short amount of time while gathering information from social worker, Staff stated Juvenile had been found.

Police Report

Battery

Staff stated that after being told to go to his room, Juvenile had caused a disturbance in the house, slapped a staff member, and expelled a full fire extinguisher inside the home (spraying 4 staff members). Juvenile was contained in isolation room, banging on doors and windows. Juvenile was arrested and transported to Juvenile Intake. Juvenile was also transported to ER because he might have been hitting his head on a wall.

Police Report

Battery

Staff stated a Juvenile made threats against her and threw a towel at her, then returned and hit Staff with a closed fist in the back of the head. Staff stated she wanted to press charges. Juvenile was cited with a court date in juvenile court.

Police Report

Battery

Staff advised Officers that Juvenile got into a disagreement and altercation with another student. At the end of the altercation, the Juvenile jumped on the hood of another employee’s vehicle, and began hitting the front glass. Staff stated Juvenile punched Staff member several times and bit another Staff’s hand. Juvenile admitted to all that happened.

Police Report

Suicide Threat

Officers responded to facility in response to Juvenile actively cutting her wrist and Staff was attempting to restrain her. Upon Officers arrival, Juvenile was laying on a mat on the floor; Staff stated she had attempted to cut her wrist with her fingernails throughout the day, and had been making statements about killing herself. Staff stated the Juvenile’s Guardian advised them to send her to Bridgeway for help. MEMS transported Juvenile to Bridgeway for treatment.

PRLU or OLTC

Visit Compliance Report

  • Facility received citing for regulation 404.6. Staff member used inappropriate hold techniques while performing a hold on client. (Incident 2/24/21)