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When it was time to return to rooms, client refused to follow staff direction. Also a peer made a comment about dating her mother. Client began to grab nearby items to destroy, then went to the water fountain and spit on the faucet/spigot. Client sat in the middle of the hallway and would not move. Personal restraint was utilized to assist client to seclusion. Once in seclusion, client began to struggle with staff, broke free and entered her room and obtained sharps (metal). Sharps were confiscated, and client dove under her bed and obtained another sharp (pencil). Client was assisted from under the bed and additional sharp was confiscated. Client was moved to seclusion.

Client denies pain/injury from this incident and has no obvious injury noted. Order received to transfer client to acute for treatment/evaluation of mental status.

Program Coordinator inquired about late reporting and documentation. Facility reported documentation had to be corrected and documentation was provided. Pictures were provided for the door being repaired. Resident will be returning to the facility.

At 3:45pm, client was placed on freeze due to physical aggressiveness toward staff. Client was placed on Run Risk (RR) around 5 p.m. after fleeing out of the house while another patient was leaving for dinner. Client began throwing personal belongings at staff, kicking chairs, and banging on doors. Due to a threat to patient safety, client was placed in personal restraint at 5:56 p.m. While under personal restraint, the patient kicked one staff member in the stomach and spit in the face of another. When the nurse asked the patient if she was in discomfort or having problems with the restraint, she said, “I have pain right above my ankles.” When the nurse asked the patient if she needed anything to relieve her discomfort, she replied, “Nothing works.” Patient continues to be hostile and aggressive on purpose.

The patient repeated multiple times that she simply wants to go to acute care and that she will do whatever it takes to get there. Due to staff injuries, the sheriff was notified and a report was submitted. Client was transferred to BridgeWay for an acute stay on 01/03/24 and she remains there at this time. On 1/5/24, the facility reported resident most likely would be returning to the facility.

Client became upset due to a family session and began banging on the front walls of the seclusion room. Client banged head on the unlocked seclusion room door and was placed in a restraint to prevent self-harm. Client was released once she calmed down, but went down the hallway and hit her hand on the wall. Client was placed in another restraint to prevent further injury. Chemical restraint was administered per nursing.

Client complained of right hand pain and was given an icepack and Ibuprofen. Area was reddened, no swelling noted. Nursing will continue to monitor. Client was transported to Rivendell for an acute stay on 11/07/23 during the evening shift. She remains at Rivendell at this time. Licensing Specialist informed that it is unknown at this time if resident will be returning to the facility.

Patient was putting a snake like fidget toy around her neck and a peer stated that she could get in trouble for playing around in that manner. She stated that she did not care as she was already on consequence. Staff informed her that unsafe behaviors would land her on other consequences. She was not pleased to hear this and threw the things down and ran out the door fleeing.

Patient was restrained to prevent elopement and escorted towards seclusion. Client was released from restraint after agreeing to remain calm. Patient voluntarily entered seclusion and began kicking and punching the wall. Client was restrained again to prevent self-harm. Additional staff arrived. Client began to process with staff but became annoyed that she was still at the school and not on her way to the house and she began digging her nails into her left arm leaving marks. Staff restrained her to further prevent this.

Patient was placed on Freeze, eyeball and FOH. Nurse noted fingernail marks to client’s left forearm where she dug her nails into arm in attempt to self harm (did not break the skin, superficial indentions noted to skin).

Patient reported to nurse that two days ago she hit her arm against the wall and bruised it. Patient was assessed initially yesterday and today it showed continued discomfort and discoloration, orders received to be evaluated at urgent care. Ortho Arkansas had the following results: Right wrist is not fractured, some swelling noted to Ulnar side of right wrist.

10/18/2023 – Licensing Specialist informed there was no fracture but resident was placed in a cast for two weeks due to bruising and swelling. Resident has a follow-up appointment scheduled for 10/8/2023 at 3:40pm.

The patient entered the seclusion room because she was unhappy and disobeyed staff directives, according to the staff. After being observed hitting her head while in seclusion, the patient was put in a personal restraint. The patient was eventually quiet enough to be taken out of the personal restraint after ten minutes. Nurse noted three self-harm marks: one bite mark just above the left wrist, one bite mark that penetrated the flesh on the wrist, and a superficial scar on the left lower arm. Patient rejected all medical attention and did not allow nurse to take vital signs. Patient placed on freeze, FOH, and eyeball. Patient received orders for transfer to acute facility.

Licensing Specialist informed that resident returned to the facility on 10/23/2023.

Nurse informed that patient had punched the wall while she was agitated last night (10/7/23). Nurse noted swelling and purple discoloration at #5 proximal aspect of digit, with abrasions on prone aspect of right hand. Orders received to have her evaluated at urgent care. Diagnosis: Sprain of R fifth finger.