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, Self-Harm, Visit Compliance Report

Client demanding to go out the front door. Client was encouraged to calm down. Client feeding off peer limit peer. Client began kicking the front door and hitting the wall with her right hand. Client then ran to restricted area and personal restraint was initiated. Encouraged client to relax, refused and continued to struggle with staff. Client was able to calm down and was released from restraint. Encouraged client to take good care of her hands because she will have them for life. Right hand 3-5th digit knuckles noted to be bruised and swollen. Limited ROM with mild/moderate pain, complains of numbness to 5th digit, capillary refill >3 seconds. Client not stable enough to go to urgent care with single staff supervision. Client shared that she wanted to kill herself. Encouraged client to make good choices, to give her future self a chance. Client voiced suicidal ideation once again, and the call was made to transfer to acute. Will continue to monitor. Client left for ACH ER, possible transfer to acute from there. Licensing Specialist: Kendra Rice.

PRLU or OLTC

Notice of Incident, Self-Injury, Suicide Attempt, Visit Compliance Report

Client placed in unlocked seclusion at this time as she attempted to force her way out this area without permission and de-escalation. Staff used their bodies to prevent her from leaving the seclusion room while providing verbal support. During this time client is observed to strike the wall of the seclusion room door with her fist. Client observed to say “I don’t fucking care.” and “I don’t want to fucking be here.” 4:13pm Unlocked Seclusion End: Client was able to force her way out of the seclusion room, and she agreed to sit with staff and talk. Unlocked Seclusion ended at this time. Patient Debriefing date/time: 03/14/2023 4:20pm: Client was given an option of talking to staff are going back to seclusion. Client chose to come out and talk with staff. Client was angry but willing to accept her consequences. Client said that she was not angry at staff anymore. Nursing Assessment date/time: 03/14/2023 4:15pm: Client reportedly in personal restraint. Upon my arrival, client was in seclusion room struggling with staff. Client agreed to sit and process with staff. Client began to calm down as she was processing with staff. Complains of right hand injury, 3rd-5th digits knuckles noted to be swollen, bruised and reddened. Client struck the wall with her right hand. Denies numbness/tingling, has full/active ROM, capillary refill <3 seconds. Ice pack refused, PRN OTC pain relief refused. Client denies other pain/injury from this incident. Client has no other obvious injury from this incident. Client was offered icepack and PRN medications again, refused. Encouraged client to use medication/icepack for pain/swelling. No other needs identified now, will continue to monitor. 2nd Nursing Assessment date/time: 03/14/2023 4:16pm: Client refused PRN OTC medication and icepack. Will continue to monitor. Guardian was notified on 03/14/23 at 4:20pm and 4:40pm. Was able to get a hold of her mother on the 2nd call. first call voicemail left. Licensing Specialist: Kendra Rice.

PRLU or OLTC

Notice of Incident, Self-Injury, Suicide Attempt

  • Suicide Attempt, Self-inflicted Injury
    • Client was upset about “freeze” status and charged into the milieu hallway, then kicked the front door open. Client was placed in a restraint and then locked seclusion due to continued aggression. While in seclusion, she punched the wall and obtained a pen that fell off of staff’s lanyard during restraint. Staff entered and placed client in a restraint to retrieve the pen. Locked seclusion resumed and client removed her sweatshirt and attempted to tie it around her neck. Staff retrieved the shirt, and client forced her way out of seclusion and agreed to sit with staff and talk. Nurse assessed client and noted R hand 3rd-5th digits knuckles were swollen, bruised, and reddened. Client refused ice pack and pain medications.
    • Licensing follow-up: On 03/16/23, Licensing reviewed video footage with no concerns noted. Staff reported client had her hand evaluated at the hospital and was transferred to acute placement.

Police Report

Disturbance

Upon Officer’s arrival, staff stated a juvenile had assaulted 2 staff members and MEMS were needed. Staff 1 stated that after juvenile became angry, he was placed in a restraint and the seclusion room. Staff 1 stated that while in the seclusion room, he attempted to restrain juvenile by placing him against the wall and facing away from him, during which the juvenile threw his head backwards, hitting Staff 1 in the head. Staff 2 confirmed the same incident told by Staff 1, and stated that during the restraint, the juvenile swung his arm around and pulled on Staff 2s ear, pulling the earring out of his ear lobe. Officer observed Staff 1 had a large knot above his left eye and Staff 2 had a small laceration to his left ear. The facility requested the juvenile be transported to the hospital so he could be placed in acute care, and reiterated they did not wish juvenile to be charged and taken to jail. Juvenile was taken out of handcuffs and MEMS transported him to the hospital.

Police Report

Assist Ambulance

Officer responded to assist MEMS with a suicidal juvenile. Upon arrival, staff advised the juvenile was completely calm and compliant. While waiting on the ambulance, staff made the decision to transport the juvenile to the treatment facility in the company van; MEMS canceled.

PRLU or OLTC

Medical, Notice of Incident

  • Medical
    • Client was transported to the ER due to inability to hold anything down and continuing to throw up and/or dry heave. Client reported he feels shaky on the inside and like he’s going to pass out.
    • Licensing follow-up: Licensing was informed on 02/23/23 that client was still in the hospital and was discharged from the facility to his guardian. Client’s discharge was previously scheduled before his hospital admission. No licensing concerns noted.

Police Report

Information

Officer responded at approximately 1720 hrs for a runaway juvenile. Officer spoke with staff and responded to the area where the juvenile was located. Juvenile was on the side of the road speaking to a staff member. Officer transported the juvenile back to the facility.

PRLU or OLTC

Medical, Notice of Incident

  • Medical
    • Client was on sick status as of 02/18/23 due to not feeling well. Night shift reported client had trouble sleeping and had been refusing food. Nurse noted poor PO intake, asleep majority of the day, profound weakness, poor urination, c/o “not feeling well and N”, arouses to verbal/tactile stimuli but falls asleep shortly after. Client was taken to ACH ER. Diagnosis: Migraine (resolved with medications). Client returned to facility.
    • Licensing follow-up: Licensing was informed client was diagnosed with a migraine when discharged from ER. No licensing concerns noted.

PRLU or OLTC

Buildings and Grounds, Visit Compliance Report

  • Licensing Specialist: Kendra Rice.
  • Facility visited from 11:15am – 1:30pm. Census: 31. Walkthrough completed of Mabee, Rose, Chestnut, and Sturgis houses. Areas observed: bedrooms, bathrooms, laundry rooms, milieus, comfort rooms, seclusion rooms, kitchen areas, grounds, and group rooms. Licensing and staff discussed chair at Mabee House that was worn out in the seat area; The chair was removed.

Medicaid Inspection of Care

Inspection of Care Report

Deficiencies were noted during the Inpatient Psychiatric Inspection of Care (IOC) conducted on 02/02/23.

PRLU or OLTC

Notice of Incident, Peer Altercation, Self-Injury

  • Peer Altercation, Self-inflicted Injury
    • Client began yelling at peer during a card game and hit his peer several times in the head. Staff stepped between them and asked client to go to his room. Once in his room, client punched his door several times and then punched his bed. Nurse noted R hand was swollen at the 3rd and 4th digits with redness/bruising noted. Client was taken to the ER for an x-ray. X-rays negative for fracture; Client has a splint to wear for comfort. Both residents were placed on freeze.
    • Licensing follow-up: Licensing reviewed camera footage on 02/17/23. No licensing concerns noted.

PRLU or OLTC

Notice of Incident, Self-Injury, Suicide Attempt, Visit Compliance Report

  • Suicide Attempt, Self-inflicted Injury
    • Client became upset due to being placed on pause for cursing and required locked seclusion due to physical aggression towards staff. While in seclusion, client wrapped a sweater and t-shirt around neck (staff removed both), scratched himself with his watch, bit his wrist, urinated on the door/floor, masturbated, and smeared and spit blood on the window. Order was obtained for client to be transferred for acute treatment, and wound care was provided for client’s wrist.
    • Licensing follow-up: Licensing reviewed camera footage on 02/06/23 and did not observe any licensing concerns. Client is scheduled for discharge on 02/07/23.

Police Report

Assist Ambulance

Staff advised officer upon arrival that juvenile was suicidal and acting out. Officer stood by while MEMS transported juvenile to the hospital.

Police Report

Disturbance

Officers responded due to 2 juveniles attempting to fight staff and another patient. Upon arrival, all juveniles involved were separated. Staff advised that J1 was antagonizing peers all day and calling J2 and J3 the “n-word”. Staff stated J1 hit J2 in the face, bit a staff’s arm, and bit another peer on the leg. Charges were not pursued at this time.

PRLU or OLTC

Accidental Injury, Notice of Incident

  • Accidental Injury
    • Client stated his knee popped out of place while playing basketball. Client stated he couldn’t walk, and staff assisted him to the nurse for assessment. Client was then transported to the ER for evaluation.
    • Licensing follow-up: Client diagnosed with acute knee pain at ER. No licensing concerns noted.

PRLU or OLTC

Maltreatment, Notice of Incident, Visit Compliance Report

  • Maltreatment
    • Client reported to his therapist that a staff member grabbed him by the arm and left a bruise. Therapist noted a small mark on client’s arm. Child Abuse Hotline was called and accepted. Two staff members were suspended pending investigation.
    • Licensing follow-up: Licensing requested witness statements (none), reviewed nursing notes, and reviewed camera footage on 01/18/23. CACD investigation was unsubstantiated. Licensing informed facility that staff would need to be retrained (physical restraint) before returning to work. Training roster received on 02/21/23.

PRLU or OLTC

Notice of Incident, Suicide Attempt, Visit Compliance Report

  • Suicide Attempt
    • Client began to “severe limit test” after dinner and began instigating peers, slamming doors, turning lights on and off, and continued to be oppositional with staff. Client was walked to the seclusion room, where he attempted to choke himself with his clothing; Staff intervened and removed clothing. Client agreed to take PRN to help him calm down. No injuries were noted and client was placed on close observation.
    • Licensing follow-up: Licensing reviewed camera footage on 01/18/23 and did not observe any licensing concerns.

Police Report

Assist Ambulance

Officer responded to assist MEMS with transferring juvenile to the hospital.

Police Report

Battery

Officer responded for a disturbance between 3 juveniles. Upon arrival, officer observed several staff restraining J1 with their combined body weight. J1 was placed in hand restraints and inside patrol unit. Witnesses stated J1 attempted to attack J2 and was placed in a restraint, during which he assaulted staff.

Police Report

Assist Citizen

Staff advised officer that juvenile was throwing books, being openly defiant, and won’t follow instructions. Staff stated juvenile hit him prior to being placed in a restraint and attempted to cut herself with plastic. After talking with officer, juvenile began picking up the books she had thrown. Staff stated they were attempting to get juvenile transferred to an acute facility.

Police Report

Disturbance

Staff advised officer that juvenile was aggressive, throwing items, and attempting to hit staff. Juvenile made multiple statements about wanting to die. MEMS transported juvenile to hospital for evaluation.

Police Report

Disturbance

Staff advised officer that juvenile assaulted staff after refusing to return to his room. Juvenile was also bullying a peer, and kicked another peer.

PRLU or OLTC

Medical, Notice of Incident

  • Medical
    • Client woke up to use the bathroom and when he was about to exit the bathroom, he collapsed on the floor. Client stated he was hot and nauseous. When client stated he was ready to get up, staff helped client into a rolling chair and brought him to the nurse’s station. Upon nurse assessment, hives were noted to upper thighs, and client reportedly bumped his head during the fall (no bleeding or swelling noted). Client received Benadryl (50 mg) and was transported to the ER.
    • Licensing follow-up: Licensing was provided with client’s ER discharge paperwork (Diagnosis: Vasovagal Syncope). No follow-up visit recommended. No licensing concerns noted.

PRLU or OLTC

Notice of Incident, Suicide Attempt, Visit Compliance Report

  • Suicide Attempt
    • Client became upset with peer and began to yell, scream, flip chairs, and began to walk towards peer as if to fight him. Client was placed in a restraint and then locked seclusion. Client was placed in another restraint after attempting to choke himself. Client was able to calm down shortly after. Upon nurse assessment, no injury was noted and client denied any pain or injury.
    • Licensing follow-up: Licensing viewed camera footage. A ball was observed in the seclusion room where client was, and client picked it up and began biting the ball and spitting out pieces. Staff asked client to stop biting the ball, and after client threw the ball against a wall, he began choking himself and staff entered to intervene. Licensing spoke with staff regarding the ball that was left in the seclusion room. Facility cited for R911.6.

PRLU or OLTC

Notice of Incident, Self-Injury, Suicide Attempt, Visit Compliance Report

  • Suicide Attempt, Self-inflicted Injury
    • Client was instigating another peer attempting to fight and was placed in a restraint after continued behavior. Client was placed in locked seclusion due to unpredictable behavior. Client began banging on the door, threatened to kill peer, and attempted to put a piece of a ball he found in the seclusion room down his throat to choke himself. Staff initiated restraint to retrieve object and client threw it on the floor. Client received an oral chemical restraint shortly after. Nurse noted micro-abrasions to client’s hands and forearms from scratching and hitting the walls and door (no bleeding or swelling noted).
    • Licensing follow-up: Client was placed on close observation. Licensing viewed camera footage and observed client picking up a piece of a ball off the floor from a previous incident. Staff entered and client was placed in a restraint while staff picked up the remaining pieces of the ball off the floor. Facility cited for R911.6.