PRA REQUEST DOCUMENTS FOR FAMILIES FIRST – PSYCHIATRIC TREATMENT FACILITY #577000449 REQUESTOR: PBS FRONT LINE 24-Hour CCL Incident Reports 2011 – 2013 NORTHERN CALIFORNIA CHILDREN’S RESIDENTIAL OFFICE (JUNE 17, 2014) Part 1 of 3 FAMILIES FIRST, INC. 2013 24-HOUR CCL REPORTS FamJZiesE'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Monday, january 07, 2013 The time period of this report is from 7:00 21.111. (prior olficc working day) ti) 7:00 (current office working day) Incident Report 77663 (Reference #:77663 WW 2mm Voyager RTP 01/05/13 Bedroom #7 mm reported voices telling him things about his mother. He also said that hearing voices made him want to kill himself, spec caliy by going to the police station to get a gun and shoot himself or get shot. mm Logan Hess - Suicidal ldeation Other Incident Renort 77668 (Reference #:77668 Emmi: Voyager RTP 01/06/13 Side porch asked staff if we would let it him kill himself if his brother died. mm 39953319; Parls Parker 5 - Suicidal [deation Incident Report 77653 (Reference #:77653 I. I I Trailblazer RTP 12/30/12 - House was doing hand stands and fell. He tried to catch himself from falling and cracked his castSergio Sanders - Accident/Injury to Child Incident Report 77667 (Reference #:77667 I. plan I I. u.l Voyager RTP 01/06/13 Resource Center returned with more medication than he should have. mg; Angela Lira - Med Error - Missed Dose at Home Incident Report 77664 (Reference #:77664 WWI Mm Wt LEW Ranger RTP 01/06/13 Bedroom began to push into us forcefully, which at that point we initiated a standing. (20 min) Dannrt-inn' Adrian Marvin-v: - Cray-"Hur- CONFIDENTIALITY NOTE 1 The documents accompanying this transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If vou are not the intended reapient, you are hereby notified that any disclosure, copying, distribution, or the taking of an}: storm in icliancc on the contents of this information is strictly prohibited. If you have received [hh telecopy in error, please notify us by telephone immediately so that we can arrange for the whim of the original documents to us at no c05t to you Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000001 Farnz'liesE?rst, Inc. 2100 FY1211 Street, Davis, CA 95616 24 Hr. CL Report Monday, [antler-y 07, 2013 The time period of this report is from 7:00 am. (prior of?ce Working day) to 7:00 a.m. (current of?ce working day) Assisting; Anthony Aispuro-Sanchez - Assault/Aggression Incident-Report 77669 #:77669 Jade RTP 01/05/13 - Outside Quiet Room was contained both times for aggressively pushing into staff in an attempt to leave staff supervision. (83 min Miriam Instantly?: Patrick Oleson-Wheeler - Restraint Team Prone 55mg; Jesus Zamudlo 0 - Assault/Aggression Team Prone Assisting Andrew Enright Other Standing John (Nick) Moriana Other Wall-Assisted Erica Retzer Incident Report 77659 (Reference #:77659 WW 2mm Wm Ranger RTP 01/05/13 Front Yard/Quiet Room was sent to his room for cussing out a peer. He decided to leave supervision through the side door. Per his plan, he was escorted to the Quiet Room after assaulting staff. (7 min) 1mm 3mm Lanai O'Brian - Restraint Escort ggisting; Kelsey Blissett - Assault/Aggression Quiet Room Other Incident Report 77665 (Reference #177665 Ranger RTP 01/06/13 Side Porch punched a staff forcefully in the chest. (6 min) Incidentsjam modem 3mm Claudia Vazquez - Restraint Standing 3311931119; Edgar Zamora 0 - Assault/Aggression Assigg'm: Louis Braga Incident Report 77660 (Reference #:77660 Emma Ranger RTP 01/05/13 Side of House was continuously and forcefully pushing staff and punching/hitting the glass windows. (17 min) Wi?ssing; Lanai O'Brian - Restraint Team Prone witnessing: Kelsey - Assault/Aggression Standing Witnessing: Felicia Thomas Dana?! '10- Dairir?a RuH-nn CONFIDENTIALITY NOTE 2 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000002 Farm'IiesE'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CCL Report Monday, januzuy 07, 2013 The time period of this report is from 7 00 a.m. (prioi of?ce Working day; to 7:00 "current working day; Assisting: Marcos Almeida Assisting: Aaron Alston Incident Report it: 77655 (Reference #:77655 Voyager RTP 01/04/13 House was given his sleep apnea mask at 9:45 AM and did not wear it all night long. Insideu?ta?: Instdentlme: Begorting: Christian \fillela Other Incident Report 77662 (Reference #:77662 Voyager RTP 01/05/13 - House was actively attempting to stab staff, so a standing was used. Team prone was used when- continued to kick staff. (43 min) witnessing: Logan Hess - Restraint Team Prone Witnessing: Jared Hungerford - Accident/Injury to Child Standing mm Timothy Bowes - Assault/Aggression Aaron Alston David Stewart Incident Report 77654 (Reference #:77654 WW Widen: Widen: Trailblazer RTP 01/04/13 House became upset and began to walk away from me. I prompted him to run laps around the ?eld, but he refused. walked off campus and left supervision off of campus. Davis police were notified. Eduardo Villalobos - Law Enforcement Contact Assisting; Hilary Sleuter CONFIDENTIALITY NOTE 3 The documents accompanying this telecopy trans?mission may contain information that ls (till?dc?tlal and/or legally privileged The information is intended only fOr the use by the indmdual or entity names on this transmission sheet. It you are not the intended recxpient. you are hereby noti?ed that any disclosure, copying, distribution. or the takmg of any action in reliance on the contents of this telecopied information is prohibited. If you have received this telecopy in error. please notify us by telephone immediately so that we can arrange tor the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000003 Families?'rst, Inc. 2100 Fifth Street, Da Iris, CA 95616 24 Hr. CL Report Wednesday, [snugly 09, 2013 The period of this report is from 7:00 am. (prior office working day} to 7:00 a.m. (current oft-ice working day) -) Incident Report 77689 (Reference #:77689 WM Adventurer RTP 01/08/13 Outside made a statement about staff. Rem Islam Hassancin Other 551mg; Misaki Curtis Incident Report 77690 (Reference #:77690 WW Lm?nne?nsidmt Adventurer DTP 01/08/13 Bedroom attempted to strangle himself with a power cord, which at that point we initiated a standing. (27 min) Reporting: Adrian Mendoza - Restraint Standing Assiging; John (Nick) Mariana 0 - Assault/Aggression Incident Report 77691 (Reference #:77691 WW 2mm Adventurer RTP 01/08/ 13 05350PM Bedroom began to assault me, which at that point we initiated a standing. He began to struggle out, so we transitioned to a team prone. (24 min) Reperting: Adrian Mendoza - Restraint Team Prone Assisting; Cody Westergaard - Assault/Aggression Standing Incident Report 77694 (Reference #:77694 I In min Widen! a i en Ranger DTP 01/08/13 House aggressively punched staff and was placed in a team prone. - made a statement about staff as well. (21 min I . Witnessing: Lanai O'Brian - Restraint Team Prone Witnessing: Oscar Lopez 0 - Assault/Aggression My; Robert Dehn Other 55151119; Edgar Zamora Incident Report 77697 (Reference #:77697 0? ania?oni Dunn-rum "on. A. 'nridnnf I nnao:n? CONFIDENTIALITY NOTE The documents accompanying this tclecopy transmission may contain information that is con?dential and/ or legally privileged. The information is intended Only for the use by the indiwdual or entity names on this transmission sheet. If you are not the intended recxpicnr, you are hereby noti?ed that any disclosure, copying, dismbution, or the taking of any action in reliance on the Contents of this tclecopicd information is strictly prohibited. If you have received this in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000004 Fatm'IieSFir-st, Inc. 2100 Street, Dan's, CA 95616 24 Hr. CL Report Wednesday, januaty 09, 2013 "Die l?lmt' period of [his report is from 7:00 am. (prior of?ce Working day) to 7:00 am (current of?ce working day) Trailblazer RTP 01/08/13 Resource Center missed his 3 PM medication, because he left supervision without permission. Brenda Vermette - Med Error - Missed Dose at FamiliesFirst Assisting; Cristina Mendoza-Sanchez Incident Report 77703 (Reference #:77703 Emmi) Went Widen: Jade DTP 01/08/13 - Bedroom - was contained for aggressnvely charging at staff quickly, while posturing with a pencil; right after making threats to cause ysncal harm to staff. (22 min) Reynoso Trujillo - Restraint Team Prone 3:293:93; Patrick Oleson-Wheeler - Assault/Aggressnon Standing Jesus Zamudio Incident Report 77698 (Reference #:77698 Voyager RTP 01/08/13 Resource Center After several separate attempts, - still refused his 7 PM medication. minim Angela Uta - Med Error - Client Refused To Take Medication Incident Report 77695 (Reference #:77695 Widens Emnm Ranger RTP 01/08/13 Resource Center After several separate attempts, - refused his 7 PM medication. 1115mm mm mm; Angela Lira - Med Error - Client Refused To Take Medication Incident Report 77704 (Reference #:77704 Emmi: Jade DTP 01/08/13 Bedroom - attempted to strangle herself. She pushed into staff when we deterred her, so we initiated a standing and transitione to a seated when she dropped weight. Supine was transitioned when we could no longer safer hold her in a seated. (29 min) \Allrnocelnn- I nmhar? . Cute-pint Case-d Domini CONFIDENTIALITY NOTE 2 The documents accompanying this telecopy transmission may contain tnforrmtion that is con?dential and/ or legally The information is intended only for the use by the individual or entity names on this transmissmn sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no Cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000005 FarmliesE'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Wednesday, [snazzy 09, 2013 The time period of this report is from 7:00 a.m. (prior of?ce Working day) to 7:00 2.m. (current of?ce working day) Reporting: Nicole Silva - Assault/Aggression Team Prone Patrick Oleson-Wheeler Other Standing Incident Report 77705 (Reference #:77705 Winn: Rustin: Widens Jade RTP 01/08/13 OutSide was contained for pushing into staff. (37 min) Witnessing; Andrew Enright - Restraint Team Prone Nicole Silva - Assault/Aggression Team Prone Agsiging: Patn'ck Oleson-Wheeler Other Standing Incident Report 77692 (Reference #:77692 WW mam? WM Adventurer RTP 01/08/13 - Sensory Room After interfering with his peers restraint! pushed into staff and I closed the sensory room door, thereby initiating a closed door restraint. AfterI released, he pushe into staff again and the door was closed. (12 min) Mag; Islam Hassanein - Restraint Quiet Room Cody Westergaard - Assault/Aggression Quiet Room Assisting; Adrian Mendoza Incident Report 77693 (Reference #:77693 Wooden: Wm Ranger DTP 01/08/13 Back Door was pushing forcefully into staff. (45 min) Reporting; Edgar Zamora - Restraint Team Prone Claudia Vazquez - Assault/Aggression Standing John (Nick) Moriana Incident Report 77700 (Reference #:77700 [mm Voyager RTP 01/08/13 Bedroom #8 refused to use his sleep apnea machine. ?imgssing; Paris Parker Other Erica Retzer CONFIDENTIALITY NOTE 3 The documents accompanying this telecopy transmission may contain information that is con?dential md/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmisswn sheet. If you are not the intended recipient you are hereby noti?ed that any disclosure copying, distribution, or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. If you have receivcd this in error, pleas:- notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000006 FamiliesE'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Wednesday, januazy 09, 2013 The ume period of this report [5 from 7:00 mm. (prior of?ce working day} to 7:00 :1.m (current of?ce working day) Incident Report 77696 (Reference #:77696 Emma: WW Wm Trailblazer RTP 01/08/13 House threw his shoe at me. I gave- a clear limit to not be physical. - began to push forcefully into me. Chris and I initiated a standing. (22 min) Brett Atwood - Restraint Standing witnessing: Roderick Herring - Assault/Aggression Witnesging: Hilary Sleuter Eduardo Villalobos Assisting: Chris Marshall CONFIDENTIALITY NOTE 4 The documents accompanying this telecnpy transmisswn may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual at entity names on this transmission sheet If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000007 Fann'liesFirst, Inc. 2100 Fi?/1 Street, Davis, CA 95616 24 Hr. CL Report Thursday, januaty 10, 2013 The time period of this report is from 7:00 a to (poor ofiice workmg day) to 7:00 am. (current office working day) Incident Report 77724 (Relerence #:77724 Winn: Emma mm Voyager RTP 01/09/13 Voyager House made threats to harm himself. He also made attempts to harm himself by trying to consume hygiene products. mm Ming; Paris Parker - Suicidal Ideation Incident Report 77730 (Reference #:77730 WW Emmi): Trailblazer RTP 01/09/13 Davis High School was not at the pick up spot when staff came to get him. He returned an hour and a half later with Davis Police. reporting: Coronda Carter - Law Enforcement Contact assisting: Wayne Cottle 0 - Short-Term Runaway o? - Incident Report 77733 (Reference #:7773 WW 2mm Ranger RTP 01/09/13 - Resource Center After several separate attempts- refused his 7pm medications. mm mm regorting; Angela Lira - Med Error - Client Refused To Take Medication Incident Report 77727 (Reference #:77727 Voyager RTP 01/05/13 Voyager refused his CPAP device. He was asked again and he refused again. He did not wear it all night. Reporting: Christian Villela Other Incident Report 77728 (Reference #:77728 MW Emma: Wooden: Locating: gt incident Voyager RTP 01/06/ 13 Voyager was given his CPAP devnce but refused to wear it multiple times. Rggorting; Christian Villela Other CONFIDENTIALITY NOTE 1 Th:- accompanying this transmission may contain information that is con?dential and/ or legally The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended renpicnt, you are hereby notified that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this tclecopied information Is strictly prohibited. If you have received this tciccopy in error, please notify us by telcplionc immediately so that we can arrange for the of the original documents to us at no cost to yoii Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000008 Familiesli'irst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CCL Report Tbuzsda y, [manly 10, 2013 The time pcnod of this report is from 7:00 am. (prior of?ce working day) to 7:00 an). (current of?ce working day) Incident Report at: 77729 (Reterence #:77729 Wham 2mm Went Voyager RTP 01/09/13 - Voyager WI (David Stewart) offered the CPAP machine for? refused to use the CPAP machine. Watt: mm Reportim; David Stewart Other Assistim: Paris Parker Incident Report 77736 (Reference #:77736 WW 2mm Voyager DTP 01/09/13 Voyager began grabbing my breasts and trying to grabbed my throat when trying to prevent him from leaving supervision. He en exited the house through his window. moment; Kristen Warren - Sexualized Behavior Marcos Almeida 0 - Assault/Aggression Assisting; Misaki Curtis Incident Report 77725 (Reference #177725 km Voyager DTP 01/09/13 Voyager ran out of Voyager and was contained when he punched and attempted to hit with objects. (25 min) remrting: Jared Hungerford - Restraint Team Prone gm; Marcos Almeida - Accident/Injury to Child Team Prone Timothy Bowes Assault/Aggression Standing Bryce Lumbard Quiet Room Warren Incident Report 77738 (Reference #:77738 Eminent WW Went V0yager RTP 01/10/13 Voyager left staff supervision. meantime; Jeffrey Poynter - Law Enforcement Contact 0 - ShOrt-Term Runaway Incident Report 77732 (W #:77732 WW 2mm Wooden: Trailblazer RTP 01/09/ 13 Trailblazer left his martial arts class after having struggles before being left. CONFIDENTIALITY NOTE 2 The documents accompanying this telccopy transmissmn may contain information that IS con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmissmn sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000009 FamZic-SFI'rsr, Inc. 2100 Fifth Street, Davis, CA 95616 24' Hr. CL Report Thursday, fanuaty 10, 2013 The Limc period of this report is from 7:00 am. (prior of?ce Working day} to T100 21m. {current office working day) Regerting: Steven Knowles - Law Enforcement Contact Assisting: Johnny Tillis - Short-Term Runaway Assisting: John (Nick) Moriana Incident Report 77737 (Reference #:77737 nggm'ng uni; 9f Ingiggnt Qatg 91 Ingidgut Trailblazer RTP 01/09/13 Resource Center was not on campus during 7pm medication distribution and was unable to get his 7pm medications. regom?ng: Angela Lira - Med Error - Client Refused To Take Medication CONFIDENTIALITY NOTE 3 The documents accompanying this telecopy transmissmn may contain information that is con?dential and/or legally privdegcd. The information is intended oniy for the use by the individual or entity names on this transmissmn sheet. If you are not the intended reapient. you are hereby noti?ed that any disclosure~ copying, distribution, or the taking of any action in reliaIJCe on the contents of this telecopied information is strictly prohibited. Ifyou have this tclecopy In error, please notify us by telephone immediately 50 that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000010 Farm'lr'csFirst, Inc. 2100 Fifi]: Street, Davis, CA 95616 24 Hr. CL Report Tucsda y, januaty 15, 2013 The time period of this report is from 7:00 mm (prior of?ce Working day) to 7:00 a.m. (current office working day) Incident Report 77795 (Reference #:77795 I. .II pl .11 .II . Pioneer RTP 01/14/13 Hallway was forcefully hanging and ramming his head into my knees. (18 min) 3mm Steven Uline Restraint Team Prone 551m; Ariel Gamba - Accident/Injury to Child - Assault/Aggression Incident Report 77793 (Reference #:77793 WW 2mm Widens Adventurer RTP 01/14/13 Room began to assault staff, which we initiated a standing. We attempted an escort, but he dropped weight so we resumed a standing. We escorted him to the Quiet Room where we closed the door after he came towards us. (9 min) Adrian Mendoza - Restraint Escort Brian Blanco - Assault/Aggression Escort Standing Standing Quiet Room Incident Report 77792 (Reference #:77792 I. .l Mm: Emgnm an: i Iim: 91 Adventurer RTP 01/14/13 Resource Center was not on campus to receive his 7 PM medicationRemm'ng: Angela Lira - Med Error - Missed Dose at Home Incident Report 77797 (Reference #:77797 I. .l I Emma! MW Ranger RTP 01/14/13 Resource Center refused his 3 PM and 7 PM medication. Angela Lira - Med Error - Client Refused To Take Medication CONFIDENTIALITY NOTE The documents accompanying il?i?lS telecopy transmission may contain information that is con?dential and/or legally The information is intended only for the use by the individual or entity names on this sheet. If you are not the intended recrpicnt, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. lf you have received this in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you Thank vou. PBS Front Line PRA Request?(2o1 3-2011 Incident Reports) Famll'cs?rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report ucsday, january 15, 2013 The time penod of this report is from 7-00 am. (prior of?ce working day) to 7:00 am. (current of?ce working day) Incident Report 77794 (Reference #:77794 Bargain Woollen: . pioneer RTP 01/14/13 Resource Center Multiple attempts were made, but- refused his medication. Indium mm Angela Lira - Med Error - Client Refused To Take Medication Incident Report 77799 (Reference #:77799 BMW Emam WM Trailblazer RTP 01/14/13 Resource Center De was off campus without supervision during 3 PM medication distribution. He missed his 3 PM medication and 7 PM medication. Incidentlma. 3mm; Angela Lira - Med Error - Missed Dose at Home Incident Report 77800 (Reference #177800 WW Wooden: Trailblazer DTP 01/14/13 Davis High School was not present at his pick up spot alter school when staff arrived and was reparted gomg into someone's house. - Steven Knowles - Law Enforcement Contact Britney Oiguin - Long-Term Runaway Incident Report 77796 (Reference #177796 Email: Ranger RTP 01/14/13 - Resource Center W- refused his 7 PM medication. mm mm Angela Lira - Med Error - Client Refused To Take Medication Incident Report it: 77802 (Reterence #:77802 WW Brant-m Voyager RTP 01/14/13 Bedroom #8 went to sleep without putting on his sleep apnea machine. magma: Paris Parker Other Erica Retzer CONFIDENTIALITY NOTE 2 The documents accompanying this telecopy transmission may contain information that IS con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying. distribution. or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited if you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000012 FamiliesFiz-st, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report uesday, january 15, 2013 The time period (if this is from 7:00 :1 m. (prior office working div; it) ?:00 .1 (current office working day) Incident Report 77801 (Reference #:77801 Inc Main WM Lo I Voyager RTP 01/14/13 Hallway - said he was hyper and wandered up and down the hall and pushed into Paris, Angela, and I once directed to his room, so we initiated a restraint. (58 min) Witnessing; Erica Retzer - Restraint Team Prone Kristan Warren 0 - Assault/Aggression Remgmg: Jacob Babcock Assisting: Paris Parker John (Nick) Moriana Assisting: Steven Uline Assisting: Angela Lira .. t- Incident Report 77806 (Reference #:77806 WW Lregcam Eats-MM i Jade RTP 01/14/13 House claimed she swallowed a bottle of Adle and was taken to the hospital. mm Patrick OIeson-Wheeler - Accident/Injury to Child Keana West 5 - Suicidal Ideation Other Incident Report 77808 (Reference #:77808 Trailblazer RTP 01/11/13 House got out of the shower, put on his shoes, and walked out of the house without permissioni I asked where he was going and he didn't respond. I shadowed him off of campus and lost visual. Police were contacted. gem Eduardo Villalobos - Law Enforcement Contact Hilary Sleuter 0 - Short-Term Runaway CONFIDENTIALITY NOTE 3 The document: accompanying this wit-copy transmission may contain information that is con?dential and/or legally priVilegt-d. The information is intended only tor the use by the individual or entity names on this transmissmn sheet If you are not the intended recrpicnt. you Lure hereby noti?ed that any disclosure. com-"mg, distribution, or the taking of any action in rclinnu? on the contents of this telecopied information is .strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange lor the return (it the original documents to us at no Cost to you. Thank vou. PBS Front Line PRA Request (2013-2011 Incident Reports) 000013 Farni?eerst, Inc. 2100 Fifth Street, Data's, CA 95616 24 Hr. CL Report Wednesday, january 16, 2013 The time period of this report is from 7:00 :Lm. (prior of?ce working day} to 7:00 a.m (current of?ce working day) Incident Report 77819 (Reference #:77819 Emma Voyager DTP 01/15/13 - Back Hallway attempted to enter a peers room and pushed forcefully when staff attempted to physically deter him, so we initiated a restraint. (24 min) Ming; Jacob Babcock - Restraint Seated Restraint Assisting; Erica Retzer - Assault/Aggression Team Prone Kristan Warren Incident Report it: 77821 (Reference #:77821 W01: Brogan: Wows: Voyager RTP 01/15/13 Bedroom #7 mentioned cheeking his medications, and hiding them in his room. He then told me that he swallowed three this morning. momma; magnum; Witnessing: Jacob Babcock Hospitalization (5150 Hold) Reporting: Paris Parker - Law Enforcement Contact Assisting: Matthew Brown - Suicidal ldeation Assisting: John (Nick) Moriana - Short-Term Runaway Other Incident Report 77817 (Reference #:77817 Monument 2mm WW Trailblazer RTP 01/15/13 Resource Center was not on campus to receive his medication for the day. Therefore,- missed his medications. mm Maxims; Angela Ura - Med Error - Missed Dose at FamiliesFirst Incident Report it: 77816 (Reference #:77816 Ranger DTP 01/15/13 Basketball Court became extremely aggressive by ramming his body into us in attempt to leave supervision. (14 min) Remaing: Claudia Vazquez - Restraint Standing Asgiging: John (Nick) Moriana - Assault/Aggression Andrew Enright Other CONFIDENTIALITY NOTE 1 The documents accompanying this transmission may contain information that is con?dential and/or legally privdeged. The information is intended only for the use by the mdiVIdual or entity names on this transmissmn sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution. or the taking of any action in reliance on the contents of this information in strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to on. Thank PBS Front Line PRA 3-2011 Incident Reports) 000014 FamiliesHmt, Inc. 2100 Fifth Street, Data's, C4 95616 24 Hr. CL Report Wednesday, [snazzy 16, 2013 The time penod of this report I: from 7,00 a.m. (prior of?ce Working day) to 7:00 a.m. (current of?ce working day) Incident Report 77818 (Reference #:77818 MW 2mm WM Voyager DTP 01/15/13 Hallway - - continued to push into us, so we initiated a supine restraint due to- dropping down immediately, per his needs and services plan; due to aggressive behavior. (18 min) Wimg??ing: Misaki Curtis - Restraint Team Prone gem Erica Retzer - Accident/Injury to Child Am Paris Parker 0 - Assault/Aggression John (Nlck) Mariana CONFIDENTIALITY NOTE 2 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally The information is intended only for the use by the mdivtdual or entity names on this transmission sheet. lf you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this telecopy tn error, please notify us by telephone immediately so that we can amnge for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000015 Familz'esFirst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Tbutsday,]anua1y 17, 2013 The time pcnud of this report is from ".00 am. (pnot Hf?ft? working day; to 7:00 am (current working day) Incident Report 77824 (Reference #:77824 Bantam Wooden; Adventurer DTP 01/16/13 Jade House from Jade House, gave me a letter that stated that- has asked her to AWOL, smoke marijuana, and have sex with her. Instantly?: mum gem Patrick Oleson-Wheeler Other - Incident Report 77828 (Reference #:77828 . . . [1.ll I u? Jade DTP 01/16/13 - House gave me a letter with statements regarding physical abuse and hearing v0ices, and witnessing violence. It also states at- from Adventurer House asked her to AWOL and have sex with him. mum Repgging: Patrick OIeson-Wheeler - Suicidal Ideation Other Incident Report 77827 (Reference #:77827 I. .l I . ?In Emma": nan . Iimg 9f ?gym. Inciggnx Ranger DTP 01/16/13 Kitchen became assaultive by hitting me and attempting to bite me, so we initiated an escort. (1 minIns-mg?: Inn- rain Rgmr?ng: Claudia Vazquez - Restraint Escort Louis Braga - Assault/Aggression CONFIDENTIALITY NOTE I 'l'hc documents accompanying this transmission may contain mfomtatiun that CU??dC?Ilal and/ or legally priVilegt-d The information is intended only tor use by the individual or entity names (in this transmission slICCt If ynu are not the intended recipient. you are hereby noti?ed that any disclosure, Copying, distribunon. or the taking of any action 111 tulimcc on the contents of this telecopxcd information is strictly prohibited. If you have this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000016 Famb'es?'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CCL Report Tuesday, fanumy 22, 2013 The ?rm: period of this report is from 7:00 am. (prior of?ce working day) to 7:00 am. (current of?ce working day) Incident Report 77874 (Reference #:77874 hi I I '0 Pioneer RTP 01/20/13 HouseIPost Of?ce and Beyond Brig! Dgsg?gjon:- ran away off of campus and out of sight. He was brought back by the Police. Reporting; Steven Uline - Law Enforcement Contact Assisting: Erica Relzer 0 - to Child - Short-Term Runaway Incident Repert 77873 (Reference #:77873 unit 91 Incident Emmi-n page 11m of Incident Location of Incident Pioneer RTP 01/20/13 Bedroom #2 Brig! It was reported to staff that- showed his roommate his bare back side and that his roommate made him show him his bare back side. Was; Reporting: Jeffrey Kessel Other Incident Report it: 77863 (Reference #:77863 Voyager DTP 01/18!13 Bedroom #7 Bri ri went into a peers room and began to destroy things. When he started attempting to break the window, we evaded his numerous and varied assaults, we initiated a restraint. (32 min) I_n?id_e_t_?a_n ft: I id mm Witnessing: Jared Hunger-Ford - Restraint Seated Restraint Witnessing: Bryce Lombard 0 - Accident/Injury to Child Team Prone WitneSSEng: Kristan Warren 0 - Assault/Aggression Standing Reporting: Logan Hess Assisting: Timothy Bowes Assisting: Marcos Almeida Incident Report 77-865 (Reference #:77865 Reporting Uni; of Incident Emg?m Dag; Time of Incident Loc ion I ent Voyager DTP 01(18/13 Activity Center Brig: begging-ion: - reported sexual interaction with a peer at school and sexual dreams about a peer in the house. Cid Witnessing: Helen Kim Other Reporting: Logan Hess Incident Report 77862 (Reference #:77862 CONFIDENTIALITY NOTE The documents accompanying this l'clccopy transmission may contain informatiOn that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmissmn sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopicd information is Strictly prohibited. Ifyou have received this. Leiccopy in error, please notify us by telephone mimediatcly so that We can arrange for the return of the original documents to us at no cost to vou. Thank PBS Front Line PRA Request y(?101 3-2011 Incident Reports) 000017 FamiliesFitst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Tuesday, lanuaiy 22, 2013 The time period of this report is from 7:00 a.m. (prior office working day) to 7:00 am. (current of?ce working day) WW Emnm Adventurer RTP 01/ 18/13 Resource Center refused his 7 AM medication. 3min; Carolynn Navarro - Med Error - Client Refused To Take Medication -) Incident Report 77859 (Reference #177859 Brennan: Wanna: LemmiuiUncident Ranger RTP 01/19/13 Lawn missed 3 PM medication while being on a day visit with his CASA worker. Incident?am Reporting; Ashley McLemore - Med Error Missed Dose at FamiliesFirst Incident Report 77880 (Reference #:77880 Pioneer RTP 01/21/13 - House forcefully and continuously kicked into staff, despite Staff evading him. As a result, start escorted him to the Quiet Room. Beng?Lng; Sule Anibaba - Restraint Escort Kyle 0 - Assault/Aggression Nick Rammer Incident Report #2 77882 (Reference #:77882 WW Bantam Time Voyager RTP 01/ 21/ 13 - Resource Center returned from his home visit with more medication than he should have. mm mm Caitlin Scott - Med Error - Missed Dose at Home Incident Report 77866 (Reference #:77866) Erasure Jade DTP 01/18/13 - Activity Center A peer - told me that he had sexual interaction, described as 'just rubbing" at school. Indication: Logan Hess Other CONFIDENTIALITY NOTE 2 The documents accompanying this transmission may contain information that is con?dential and/0r legally privileged. The information is intended only for the use by the individual or entity names on this transmissmn sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of my action in reliance on the contents of this infomiation is strictly prohibited. If you have received this tt-lrropy in error, please notify us by telephone immediately so that we can arrangc for the return of the original documents to us at no cost to you, Thank you PBS Front Line PRA Request (2013-2011 Incident Reports) 000018 Fam'liesE'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Tuesday, january 22, 2013 The ?rm: period of this report is from 7:00 an). (prior office working day) to 7:00 atm. (current of?ce working day) Incident Report 77872 (Reference #:77872 I. . Pioneer RTP 01/20/13 - Bedroom #2 mm It was reported to staff that- roommate showed- his bare back side. Incidentlum Jeffrey Kessel Other Incident Report 77881 (Reference #:77881 I 2mm Madden: Ranger RTP 01/21/13 House - After receiving consequences for his negative interactions towards staff and his peer. - became upset and highly assaultive towards staff resulting in a restraint. (23 min) Witnessing: Claudia Vazque - Restraint Team Prone Louis Braga - asault/Aggresswn Standing WHOM (Nick) Monana Edgar Zamora Incident Report 77876 (Reference #:77876 In i Emsum mm Maximum: Voyager RTP 01/20/13 Rear Left Bedroom CPAP was put in his room. He fell asleep before putting it on, so I woke him up but he refused to put it on. momma: Ins-Manama; Erica Retzer Other Reporting: Jacob Babcock Incident Report 77883 (Reference #:77883 In 2mm I Voyager RTP 01/21/13 Bedroom #8 refused to wear his sleep apnea machine. Messing: Jacob Babcock Other Witnessing; Paris Parker Mug; En'ca Retzer Incident Report 77864 (Reference #:77864 2mm Voyager RTP 01/18/13 Bedroom #3 CONFIDENTIALITY NOTE 3 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally The information is intended only for the use by the individual or entity names on this transmissmn sheet. If you are. not the intended reapicnc. you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the Contents of this telecopied information is prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the rctum of the original documents to us at no cost to you Thank 0. PBS Front Line PRA Request (2013-2011 Incident Reports) 000019 Families?'rst, Inc. 2100 Sat-ct, Davis, CA 95616 24 Hr. CL Report Tuesday, januatyZZ, 2013 The time period of this report is from "7:00 am. (prior of?ce working day) to 7:00 a.t'n (current of?ce working day) assaulted with kicks, punches, and attempts cut and to leave supervision; so we initiated a restraint. (29 min) "t Indium Marcos Almeida - Restraint Team Prone Felicia Ward 0 - Accident/Injury to Child ?inging; Kristan Warren 0 - Assault/Aggression hogan Hess Other Assisting; Timothy Bowes Assisting; Noel Salazar Incident Report it: 77868 (Reference #:77868 WW 2mm 11 of Voyager RTP 01/19/13 Bedroom #3 began to yell when it wasn't his turn to play the Nintendo 05. He became extremely assaultive with punches and kic so I closed his door when no additional staff responded to maintain safety. (3 min) Timothy Bowes - Restraint Quiet Room Logan Hess 0 - Assault/Aggression Incldent Report 77867 (Reference #:77867 WW 2mm Trailblazer RTP 01/19/13 Davis, Ca was walking laps around the school and did not return after one of his laps. He walked off campus and had return on is own at 6:15 PM. Whitney Shettler - Law Enforcement Contact Mug; Sarah McFadden - Short-Term Runaway ?sisg?ng: Marcos Almeida CONFIDENTIALITY NOTE 4 The documents accompanying this telecopy may contain information that IS con?dential and/0r legally The information is intended only for the use by the individual or entity names on this transmissmn sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is stricrly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000020 Fam'lr'csFirst, Inc. 2100 Fi?h Street, Davis, CA 95616 24 Hr. CL Report Tuesday, januazy 29, 2013 The time period of this report is from "?00 am. (prior ot'tiCe working day) (071003111. (current of?ce Working day) Incident Report 77963 (Reference #:77963 unit 91 Insider]; Emgnm Date Iimg of Incident Location 91 Pioneer DTP 01/28/13 Parking Lot was throwing rocks at staff and the house and he also was running in the parking lot With cars drivmg by, so we ml ?3 a standing restraint per his needs and servuces plan due to his unsafe behavror of running near movmg cars. (8 min) Mi en mum Reporting? Rosa Retzer - Restraint Team Prone Kristan Warren 0 - ACCIdent/lnjury to Staff Standing 0 - Assault/Aggressaon Other Incident Report 77964 (Reference #:77964 . . I . i Voyager RTP 01/28/13 07 00PM Quret Room We physucally deterred from the front of the Qunet Room, due to aggressuvcness and unpredictability. [shut the Quret Room door 0 prevent him from charging Into me to get to an area where his peers were. (9 min) Incident Start; Witnessing. Kristan Warren - Restraint Quret Room Witnessing Paris Parker 0 - Accident/Imury to Child Quiet Room Regg?ing: Erica Retzer - Ideation Assasting. Rosa Retzer - Assault/Aggressnon CONFIDENTIALITY NOTE 1 The documents accompanying this transmission may contam information that is con?dential and/or legally privrlt-gcd. The information is intended only for the use by the indivrdual or entity names on this transmission sheet. If you are not the intended recipient. you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in on the contents of this tclt-copir-d information Is strictly prohibited. lfynu lmvt' rt ceivr'd this telecopy in error, please notify us by telephone immediater so that we can arrange for the return of the original documents to us at no Cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000021 FarmliesE'rsr, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Monday, February 04, 2013 The time pcnod of this report is from 7:00 am. (prior of?ce Working day) to 7:00 are (current office working day) Incident Report 78044 (Reference #:78044 El?n II. [1.Il Pioneer RTP 02/03/13 - House was contained after becoming aggressive and assaultive to Anthony and I. (23 min) m9; Martin Melgoza - Restraint Escort Assiging: Anthony Alspuro-Sanchez - Assault/Aggression Team Prone Standing Standing Incident Report it: 78052 (Reference #:78052 Wanna: 2mm WW Adventurer RTP 02/03/13 Kitchen was contained for pushing into staff and attempting to stab me with a pen. (6 min) IMF-4313M Instantly?; mm Adrian Mendoza - Restraint Escort Assisting: Aaron Alston - Assault/Aggression Standing Standing Incident Report 78051 (Reference #:78051 I. Elan I I. [1.ln! Enterprisers RTP 02/01/13 Adventurer House - attempted to get to tools and into a locked cabinet, while assaulting staff who was preventing him from doing so. (5 min) Tom Enos - Restraint Standing Repgging: Matthew Bettencomt - Assault/Aggression Bryce Lumbard Incident Report 78050 (Reference #9805!) WW Mom Wanna: Sapphire RTP 02/03/13 Porch asked to check in with me. She stated that she wanted to 'run in the street and run and get hit by a car." msidentm madam 3mm Luanna Toney Other CONFIDENTIALITY NOTE 1 The documents accompanying this iclet'opy may contain information that is con?dential and/or legally prmlegcd The information is intended only for the use by the individual or entity names on this transmissmn sheet. if you are not the intended rcciptent, you are hereby noti?ed that any dIsclosure, copying, distributmn, the of my action in reliance on contents of this telecnpied Information Is strictly prohibited. lfynu have received this [eh-copy In error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank vuui PBS Front Line PRA Incident Reports) FamilicsE'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Monday, February 04, 2013 The time prnod of this report is from 7'00 am. (prior of?ce working day) to 7:00 mm. (current of?ce working day) Incident Report 78042 (Reference #:78042 2mm Wm Voyager RTP 02/02/13 House an}: refused to wear his CPAP mask, despite numerous attempts between 8:17 PM and 9:18 PM. With Reporting: Logan Hess Other Incident-Reportm 78038 (Reference #:78038 Trailblazer RTP 02/01/13 Resource Center was AWOL during medication time. As a result, he missed his noon and 3 PM medication. Win11. Menuhin. [Lem Britney Olguin - Med Error - Missed Dose at FamiliesFirst Assisting: Carolynn Navarro . Incident Report 78041 (Reference #:78041 WW Emram Widen: Trailblazer RTP 02/02/13 Resource Center was AWOL during noon and 3 PM medication. As a result, he missed his medication. Britney Olguin - Med Error - Missed Dose at FamiliesFirst Incident Report it: 78039 (Reference #:78035 WW Emma: Wigwam Trailblazer RTP 02/02/13 House stated he was oing to target.? walked off campus and refused to follow staff directions to stop. The pa Ice picked up and return an at :40 AM. Jack Little - Law Enforcement Contact Sarah McFadden - Short-Term Runaway Jeffrey Kessel Inddent Report 78040 (Reference #:78040 . Went 2mm Went WW Trailblazer RTP 02/02/13 House wanted to take a walk unsupervised. When he was presented with other options, he walked off campus. The police picke im up and returned him to campus at 7:55 PM. He was not wearing any pants or underwear. Witnessing: Jack Uttle - Law Enforcement Contact Sarah McFadden - Med Error - Missed Dose at FamiliesFirst Assisting: Jeffrey Kessel Assisting: Matthew Brown CONFIDENTIALITY NOTE 2 The documents accompanying this transmission may contain information that IS con?dential and/or legally prmlegcd. The information is intended only for the use by the mdivxdual or entity names on this transmissmn sheet. If you are not the. intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. If you have received this in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000023 Families?'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Monday, February 04, 2013 The time period of this report is from 7.00 mm. (pnor of?ce Working day) to 7:00 mm. {current of?ce working day) Incident Report 78047 (Reference #:78047 Bowman: 2mm Went Trailblazer RTP 02/03/13 West Wall of Campus ran away from campus. Police found him in a nearby park wearing his underwear without pants. Sergio Sanders - Law Enforcement Contact John (Nick) Mariana Incident Report 78045 (Reference #:78045 Wooden: mm ma?aiuunsident Trailblazer RTP 02/03/13 House left campus at 2 :25 AM. Clinical and Davis PD were noti?ed. He returned on his own at 6:15 AM. gem Jeffrey Kessel - Law Enforcement Contact - Long-Term Runaway Incident Report 78048 (Reference #:78048 2mm Went Trailblazer RTP 02/03/13 South Sidewalk of 5th Street ran away from campus. Police were asked to assist in returning him. Incidentjn?; Indicating; Witnessing: Sergio Sanders - Law Enforcement Contact m; John (Nick) Mariana Incident Report 78049 (Reference #:78049 Emmi: Trailblazer RTP 02/03/13 West Side of Campus was stating that he was going to run away. Police were contacted and asked to assist, as began attempting to leave campus. Inc - Witnessing: Sergio Sanders - Law Enforcement Contact Reporting: John (Nick) Moriana Incident Report 78046 (Reference #:78046 Woollen: 2mm Widens Trailblazer RTP 02/03/13 - Off Campus asked to take space, but couldn't be patient so he went off of campus. Police picked us up and brought us back to campus. I Reporting: Sergio Sanders - Law Enforcement Contact Assig?m: John (Nick) Mariana Other CONFIDENTIALITY NOTE 3 The documents accompanying this telecopy transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient. you are hereby noti?ed that any disclosure. copying, distribution, or the taking of any action in reliance on the Contents of this information is strictly prohibited. If you have rccewed this telecopy in error. please notify us by telephone immediately so that WC can arrange for the return of the onginal documents to us at no cusr to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000024 Inc. 2100 Fi?/z Street, Davis, CA 95616 24 Hr. CCL Report Thursday, February 07, 2013 The period of report ts from 7:00 (prior oft?tee working day} to 7:00 a.m. (current otticc dzn?) Incident Report 78096 (Reference #:78096 Ranger RTP 02/06/13 - House became assaultwe towards staff after recetvmg house consequences for Inappropriater one of his peersBanal?! mug. Witnessing: Efren Sanchez-Delgado - Restraint Team Prone 3mm; Louts Braga - Assault/Aggression Standing Assustmg. Jared Hungerford Incident Report 78099 (Reference #:78099 Jade DTP 02/06/13 House got upset after a conversation With her staff this afternoon. She proceeded to leave campus with staff shadowmg her. The police were contacted and asked to aSSIst, and we were able to return- to campus. Incident Staff; 1mm Reporting: Kristin Mannque - Law Enforcement Contact Jared Hungerford 0 - Short-Term Runaway Assistth John (Nick) Mortana Assisting Ernest Perkins CONFIDENTIALITY NOTE I The documents accompanying this telccopy transmission may contain information that is con?dential and/or legally privileged. 'l-hc information is Intended only for the use by the tndindnal or entity names on this transmission sheet. If you are not the recipient, you an: hereby noti?ed that any disclosure, Coming, distribution. or the taking of any action in reliance on the contents of this telecopied infommtion is strictly prohibited. If you hau- rcu-it-ul this [ck-copy to error, please notify us by telephone so that we can arrange for the return of the origin-.1! documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000025 Famjll'esFirst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Tuesday, February 19, 2013 The time pC?Od of this. report is from 7:00 am. (print office Working day) to 7:00 am. {current office working day] Incident Report 78222 (Reference #:78222 Re "i Emma: Adventurer RTP 02/15/13 Resource Center refused to get up and take his medication at 3 PM and 7 PM. Reporting: Britney Olgum - Med Error - Client Refused To Take Medication Rachel Fader Incident Report 78233 (Reference #:78233 Pioneer RTP 02/16/13 Room attempted to leave staff's and kept repeatedly assaulting staff. (1 min) Incident Staff: Ingiggnt Txge: Restraint Type: Reporting Button - Restraint Esc0rt Marcos Almetda 0 Assault/Aggresswn Incident Report 78235 (Reference #:78235 i mum "t Pioneer RTP 02/16/13 Quiet Room was posturing and pushing into staff. Once gusded Into the Room, he began to kick and punch the door aggressuvely. (12 min) Incident sjg?: Restraint Tme: Regomng. Andrea Chiles - Restraint Quiet Room gusting; Ariel (Samba - Assault/Aggre55ion Mm; Patncua Button Incident Report 78232 (Reference #:78232 WW 2mm I Pioneer RTP 02/16/13 Resource Center refused to wake up from his nap and take his medication. Regomng: Britney Olgum - Med Error - Client Refused To Take Medication Patncua Button Incident Report 78245 (Reference #:78245 1 2mm 0 Pioneer RTP 02/17/13 Resource Center Pharmacy did not drop medication off in time for- to take his medication. Incident sun; Rggorting: Britney Olgum - Med Error - Missed Dose at FamiliesFirst CONFIDENTIALITY NOTE 1 Tim accompanying this tclt-copy transmimon may contain information that is con?dential and/or legally privileged. Tlit information is intended only for the use by the individual or cutin names on this transmission slit-(rt. lf you are not the intended recipient, you arc noti?ctl that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. Ifyou have this In crror, plcam notify us by so that can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000026 F31121'11'es?'rs t, Inc. 2100 Fifth Street, D3 W's, CA 95616 24 Hr. CCL Report Tuesday, February 19, 2013 'liit' period of this report is from 7:00 a.m. (prior uf?cc Working day} to 7:00 am. {current wm-Eting day} Incident Report 78224 (Reference #:78224 .H. EIEI. . f1.ll Voyager DTP 02/15/13 - House reported that. has been phvsacally hurting and touching- during his school transports. i ff: Incident Type: Reporting Timothy Bowes Other Incident Report 78252 (Reference #:78252 ram Date Time of Incident Magnum Trailblazer RTP 02/18/13 07' 18PM House was in- dad's car when- mom attempted to ram into the car. Incident Staff: Incident Type: Reporting Keana West Other Incident Report 78251 (Reference #:78251 Tim 1? In i trailblazer RTP 02/18/13 07 18PM House made statements about his home Visit and about his mom. Incident Staff: Insident Type: Reportth Keana West Other A55igtigg: Steven Knowles Incident Report 78227 (Reference #:78227 'n nl In Program Qate Time of Insiggm Jade RTP 02/15/13 Off Campus ran off campus, leavmg staff's to smoke as many Cigarettes she can bum. - left campus at 7:55 PM. Imidsntite?: Witnessmg: Felicra Thomas Short-Term Runaway PatriCta Button Incident Report 78243 (Reference #:78243 ?n ni Date Time of Incident i Jade RTP Bedroom #2 Client and her roornrnate barricaded themselves in there room and smoked marijuana. Police were notified and clients were Cited for possessmn of marijuana. anid-n? ?l?nrirlono- Tuna- NOTE 2 The documents this may contam information that is confidential mid/0r legally privileged. The information is only {or the use by the or entity names on this transmissmn sheet. If you arc not the mtmded rt't?iplt?nl, you arc hereby noti?ed that any disclosure, copying, distrihutinn, or the taking of any actinn in reliance on tht' of this infurmntinn is stiitilly proliiliitt'tl. ?you have received this tt'lccom' in error, plcasc notify us by immediately so that we can {or tht- return of the original documents to us at no Cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000027 Farm'IicsE'rst, Inc. 2100 Fifth Street, Davis, C4 95616 24 Hr. CL Report Tucsda y, February 19, 2013 'l'hc time period of this rcport is from 7:00 am. (prior of?ce working day) to 7:00 n.m. of?ce working day) Witnessmg: Anthony Aispuro-Sanchez - Law Enforcement Contact Reporting: Jeffrey Kessel Other Incident Report 78248 (Reference #:78248 Emma). Jade RTP 02/17/13 Off Campus Without any Signs of Visual escalation, I walked out of the back door and left out of the house and off of campus. Rationing; Jesus Zamudno - Law Enforcement Contact Assisting: John (Nick) MorIana Short-Term Runaway Incident Report 78249 (Reference #:78249 In nit In Enema: Widens Jade RTP 02/17/13 03343PM Bedroom attempted to me things around her neck in an attempt to kill herself. She tried placmg a bag over her head and pushed into staff when we deterred her from donng so. Initiated standing and transmoned to a seated when she dropped weight. (23 mm) Witnessmg: Patrick OIeson-Wheeler - Restraint Seated Restraint Nicole Silva - Accudent/Injury to Child Standing Assisting: Steven Knowles '5 - Suncrdal Ideation - Assault/Aggressuon Other Other Incident Report 78255 (Reference #:78255 'Jade RTP 02/18/13 07100PM Resource Center missed her 7 PM medication when she left campus Without supemsmn. i ff: Regomng: Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report 78254 (Reference #:78254 Jade RTP 02/18/03 Off Campus gag: - left staff supervnsion off of campus and down 5th Street. Police were notified. Witnessing: Patrick OIeson-Wheeler - Law Enforcement Contact Reporting: Jesus Zamudio - Long-Term Runaway John (Nick) Moriana Incident Report 78231 (Reference #:78231 Donnr?nn AC ?l?nridnn? Brno-"am 2. Than. A. furldond- I ?rattan n0 Tahitian. CONFIDENTIALITY NOTE 3 The documents accompanying this (ch-copy transmission may contain information that is con?dential and/or lcgally privileged. The information is intended only for the use by the indiVidu-al or entity namcs on this transmission slit-ct. If you are not intended recipient, you are hereby notified that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this in error, plcasc notify us by immediately so that we can arrange For the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000028 Families?'tst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report I . - Tuesday, February 19, 2013 The timc period of this report is from 7:00 a in (prior office Working day} to 7:00 am. (current of?ce working day) Adventurer RTP 02/16/13 Bedroom #3 barricaded himself in his room and refused to open it when staff prompted him to. He opened his WlndOW and refused to ose It when staff verbally directed him to. - left through his WlndOW approxrmately 30 seconds. Sule Anibaba - Law Enforcement Contact A5?l??j?gl Brian Blanca - Short-Term Runaway Incident Report 78258 (Reference #:78258 2mm Widens mm 1' Incident Jade RTP 02/18/13 08 00PM 5th Street left superwsron off of campus. Police were notified and she returned to campus on her own. Incident Staff: Reporting: Patrick Oleson-Wheeler Law Enforcement Contact Assusting: Keana West - Surcndal Ideation Short-Term Runaway Incident Report 78241 (Reference #:78241 . -l 4 Emmam pan Iimg 9f Loggion of Incident Jade RTP 02/16/13 Bedroom #2 Brief Description: Client and her roommate barricaded themselves in there r00m and smoked marijuana. Police were notified and clients were Cited for possessmn of marijuana. Incident Staff: Ingiggng Type: Witnessmg: Anthony Aispuro-Sanchez - Law Enforcement Contact Reporting: Jeffrey Kessel Other Incident Report 78242 (Reference #:78242 Bengm'ng um; 91 Ingiggm 2:99:39] nag; ?g 11mg of Incident Location of Incident Jade RTP 02/16/13 Resource Center Brief Descrigtion:- refused to wake up and take her medication. Incident gaff: Incident Type: Reporting: Britney Olguin - Med Error - Client Refused To Take Medication Sarah McFadden Incident Report 78256 (Reference #:78256 I. l! -l - I Emma?: mg: g, Iimg 9f Ing'lggn; Lgcag?gn 9f Ingiggnt Jade RTP 02/18/13 Off Campus Brief DescriQtion: - left supervisron off of campus. Police were notified. I . I i . Jesus Zamudio - Law Enforcement Contact Dakmrb f? - I unruTnvm Dv-naiu-n: CONFIDENTIALITY NOTE 4 The documents accompanying this felt-copy transmission may contain informalion that is confidential with or lcgally privileged. 'l?hc information is intended only For the use by individual or entity names on this transmission sheet. If you arc not the intended recipient, you are hereby notified that any disclosure, Copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you rereix this [ck-copy in error, please notify us by telephone so that we can arrange for the return of tlic original documents To us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000029 FamiliesE'rs Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Tuesday, February 19, 2013 The iime period of {his? report is from 7'00 mm. (prior of?ce working day; to 7:00 am. (current of?ce working day) gaming; John (Nick) Moriana Incident Report 78257 (Reference #:78257 ln nit of Incl 11mm 3 Tim fIn i Jade RTP 02/18/13 Resource Center left campus without and missed her 7 PM medication. Ingident Staff; Reporting: Angela Lira - Med Error - Missed Dose at Incident Report 78223 (Reference #:78223 Mob?Jig? Unit of Inci nt 2mm Trailblazer DTP 02/15/13 House n- - reported that hit him in the back of the neck. He also reported that- has been tWisting his arm and hurting him every Single day tiring the week, during school transports. Beggrting: Timothy Bowes Other CONFIDENTIALITY NOTE 5 The documents accompanying this tolecopy may contain information that is Confidential rind/or legally The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure copying, distribution, or the taking of any action in reliance on the contents of this l?t?it?t?tiplcti information is strictly prohibited. Ifynn have received this [cit-cop)- in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000030 Fann'ljesFir-st, Inc. 2100 Fifth Street, D2 w?s, CA 95616 24 Hr. CL Report Wednesday, February 20, 2013 The time period of this report is from 7-00 mm. (prior of?ce woikint: day) to 7:00 am. (current of?ce working day) Incident Report 78264 (Reference #:78264 WW Emma: WM Jade RTP 02/19/13 Resource Center left campus without supervision during the 7 AM and 7 PM medication time. Repoging: Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report 78266 (Reference #:78266 Jade RTP 02/19/13 Bedroom made statements of physical abuse from her past. Reporting: Patrick Oleson?Wheeler Other o? - Incident Report 78263 (Reference #:78263 mam Jade RTP 02/15/13 5th Street - The police were called to assist with- on Friday night, when she repeatedly tried to run into traf?c. She was brought back to campus by the police and did safe time in the Quiet Room before returning to the house. nci - Repom'ng: Jared Hungerford - Law Enforcement Contact Msisting: Ashley McLemore 0 - Short-Term Runaway Assisting; Patricia Button Incident Report 78267 (Reference 267 Jade RTP 02/19/13 - Qwet Room informed me about the incidents that occurred while she was out of supervision. Nicole Silva Other Assisting: Kristin Manrique Incident Report 78265 (Reference #:78265 I. ?ll?.ll all]: ?.Il . Jade RTP 02/ 19/13 Resource Center left campus without supervision during the 7 AM medication time. Angela Lira - Med Error - Missed Dose at FamiliesFirst CONFIDENTIALITY NOTE The documents accompanying this transmissmn may contain information that is con?dential and/or legally privileged. The infotmmon is intended only {or the use by the indiVidual or entity names on this transmissxon sheet. If you are not the recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is prohibited. if you have this telecnpy in error. pleas: notify us by telephone immediately so that we can arrange for the return of origin-.11 documents to us at no Cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000031 Fann'lz'eerst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Thursday, February 21, 2013 The time period of this report is from 7:00 am. (prior office working day) to 7:00 am. (current office working day)- Incident Report 78283 (Reference #:78283 Emmn Adventurer RTP 02/20/13 Off Campus - was running and complained of shortness of breath. He then fainted and vomited, he was taken to the Emergency Room. Witnessing: Jared Hungerford - Accident/Injury to Child Sarah McFadden Assisting: John (Nick) Moriana Incident Report 78289 (Reference #:78289 Jade RTP 02/20/13 Bedroom #1 made a statement that her_ had tried to rape her. Andrea Chiles Other Incident Report 78286 (Reference #:78286 Sapphire DTP 02/20/13 Field near Play Structure pushed into and punched staff while attempting to leave supervision, so we inltiated containment. (15 min) 3m; Andrew Enright - Restraint Team Prone Assisting; Jared Hungerford - Suicidal Ideation Standing Assisting; Noel Salazar - Assault/Aggression ?sisting; Ashley McLemore Other Kimberly Rowerdink Incident Report 78298 (Reference #:78298 Voyager RTP 02/20/ 13 House A statement was made. Incidentlm; reporting; Logan Hess Other Kristen Warren Incident Report 78285 (Reference #:78285 CONFIDENTIALITY NOTE 1 The documents accompanying this telecopy transmissmn may contam mtormation that IS confidential and/or legally pnvdeged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient. you are hereby noti?ed that any disclosure, copying, distribution. or the taking of any action in reliance on the contents of this tclecnpied information Is strictly prohibited. If you have recrwed this telempy in error, please notify ?r?altq?g?a?i ?n C-lgl?ot?Iha' 000032 Fann'lieerst, Inc. 2100171711: Street, Davis, CA 95616 24 Hr. CL Report Thursday, February 21, 2013 The time period of this report lS from 7:00 am. (prior of?ce working day) to 7:00 am. (current office working day) BMW Voyager RTP 02/20/13 Bedroom refused to wear his CPAP because his nose was plugged and he said it wouldn't help. Logan Hess Other Incident Report 78284 (Reference #:78284 Walnut Emsmn Trailblazer DTP 02/19/13 Harper Junior High was not at the normal pick-up spot at Harper Junior High when Sergio was there to pick him up. 3mm Steven Knowles 5 - Law Enforcement Contact Mug; Sergio Sanders CONFIDENTIALITY NOTE 2 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient. you are hereby noti?ed that any disclosure. copying, distribution. or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this telecopy in error. please notify us hv telephone immediatel?ii that we can 3min for the return of the or hich ?g,th (.39 -2011 Incident Rggits) 000033 Fann'liesFirst, Inc. 2100 Fifth Street, Dar/1's, CA 95616 24 Hr. CL Report Fnday, February 22, 2013 The timc pcriod of this report is from 7:00 mm. (prior ot'?cc working day) to 7:00 a.mi ottit?c Working dat?l Incident Report 78302 (Reference #:78302 Emmn Adventurer RTP 02/21/13 Resource Center was campus during medication time. Insident?a?. Olguin - Med Error - Missed Dose at FamiliesFirst -) Incident Report 78304 (Reference #:78304 W01 Bantam Widen: Sapphire RTP 02/21/13 Therapy Room made a statement about an incident occurring at a past placement. Amy Mild Other Incident Report 78305 (Reference #:78305 mm Sapphire DTP 02/21/13 - Front of Play Structure threw a nail polish bottle on the ground and a piece to cut her wn'st. Staff immediately put her in a standing restraint. She began to kick staff, so she was placed into a team prone restraint. (75 min) Lisa Robertson - Hospitalization (5150 Hold) Team Prone Kristan Warren Law Enforcement Contact Team Prone Aaron Alston - Restraint Standing Assisting: Marcos Almeida - Accident/Injury to Child Standing Assisting: Jared Hungerford 0 - Assault/Aggression Assisting: Bryce Lumbard Incident Report 78306 (Reference #:78306 Widens Sapphire RTP 02/21/13 Resource Center was off task and in an extended restraint, as a result she missed her 7 PM medication. Repoging; Britney Olguin - Med Error - Missed Dose at FamiliesFirst CONFIDENTIALITY NOTE 1 The documents accompanying this telecopy transmission may contain information than is con?dential and/or legally 'I'hc intormarion is intended only tor the use by thr- individual or entity names on this transmissmn sheet, If you are not the intended recipian you are hereby" notified that :1an disclosure, copying, distribution, or ihc taking of any :Icuon ui rcliancc on the Contents of this information is strictly prohibited, lf you have received this telccopy in error. please notify us by so that we can arrange for the rt-tum of origiiml documents to us at no com to vou. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000034 Fanu'li'csFit-st, Inc. 2100 Fi?h Street, Davis, CA 95616 24 Hr. CL Report Monday, February 25, 2013 The time pcnod of this report is from 7:00 a.m. (prior Ufl-lu.? workmg day} to 7:00 am. (current office working day) Incident Report 78312 (Reference #:78312 2mm Widen: Adventurer RTP 02/22/13 Hallway/Bedroom #4 pushed into staff with force and was evaded and de?ected for ten minutes. He was repeating want to talk to N0el.? Later, without de-escalating, he disrupted the house and pushed into Sule, so he was guided then escorted to the Quiet Room. (1 min) Witnessing; Rachel Fader - Restraint Escort Brian Blanca - Assault/Aggression Sule Anibaba Other Jared Hungerford ?sisting; Marcos Almeida v? Inddent Report 78319 (Reference #:78319 Widens Emma: WW Wooden: Voyager RTP 02/23/13 - House began to hit me with DVDs when I told him I wouldn't take him to sell his DVD player. He became destructive and assaultive with kicks, bite attempts, and whipping with a cord, leading to containment. (14 min) Sule Anibaba - Restraint Team Prone Witnessing: Andrea Chiles - Accident/Injury to Staff Logan Hess - Assault/Aggression Marcos Almeida Timothy Bowes Incident Report 78316 (.Re?erenoe #:78316 WW Bantam WW Monument Ranger RTP 02/23/13 House aggressively pushed into staff multiple times; throwing large laundry forcefully at staff. (20 sec) Bengt-ting: Kelsey Blissett - Restraint Escort Assistim: Efren Sanchez?Delgado - Accident/Injury to Child Assisting: Marcos Almeida - Assault/Aggression Incident Report 78313 (Reference #:78313 WW mm Pioneer DTP 02/22/13 OutSIde of Activity Center --was placed In a team prone after chasing after a peer, assaulting him, and assaulting staff forcefully after attempting proximity control due to- attempt to continuously go after peer, stating "I'm about to beat his (14 min) CONFIDENTIALITY NOTE 1 documents accompanying this tclI-copy transmission may contain information that is con?dential and/or legally privdeged, The information is intended only for the use by the indivxdual or entity names on this transmissmn sheet. If you are not the intended recipient, you ate heteby noti?ed that any disclosure. copying, Or the taking of any acuon In reliance on the contents of this telccopicd information Is strictly prohibited. lfyou have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original ?Fiat 3-201 1 Incident Reports) 000035 Fann'lz'cs?'rst, Inc. 2100 Street, Davis, CA 95616 24 Hr. CL Report Monday, Februqu 2013 The time pcnod of this report is from 7:00 mm. (prior office workng day) to 7'00 a.m. {current of?ce working dayRemus}; Noel Jones - Restraint Team Prone Jared Hungerford - Assault/Aggression Assigns; Kristan Warren Incident Report#: 78325 (Mm #08325) Emmi: Jade RTP 02/24/13 - Bedroom Child gave statements about abuse from past. mm mm Patrick Oleson-Wheeler Other Incident Report 78321 (Reference #:78321 Want Remain Adventurer RTP 02/24/13 Off Campus, Rainbow City Parking WWII: got out of a movmg vehicle, assaulted staff, pushed a peer, and walked into the street, saying he was going to get I a car. e: Rachel Fader - Suicidal ldeation - Assault/Aggression Other Incident Report 78322 (Reference #:78322 Emanm Minimum MW Pioneer RTP 02/24/13 House assaulted staff and targeted a peer. (37 min) Adriana Escobar - Restraint Team Prone Nolan Bradley 0 - Assault/Aggression Standing CONFIDENTIALITY NOTE 2 The documents accompanying this telecopy transmisswn may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure. copying, distribution, or the taking of any action in reliance on the contents of this tclecopicd information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no Cost to you Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000036 Neil Robinson Fanu'liesH'r-st, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report uesdzy, February 26, 201.3 The time period of this report is from 7:00 a.m. (prior of?ce Working day) to 7:00 arm. (current of?ce working day) Incident Report It: 78330 (Reference #:78330 DTP Pioneer quickly escalated after a peer sat at his assigned table and was contained after forcefully punching staff in the ace. 23 mln) 3mm; Noel Jones Assiging: Rosa Retzer John (Nick) Moriana Widen: 02/25/13 - House Remix; Team Prone - Restraint - Assault/Aggression Andrea Guthrie Incident Report 78333 (Reference #:78333 WW Brennan: 1? Voyager DTP 02/25/13 Basketball Court made a statement about staff. Rgpoging; Paris Parker Other Lisa Robertson Incident Report 78332 (Reference #:78332 WW Enigma: Jade RTP 02/25/13 Resource Center was not on campus during the 3 PM medication time frame. - Med Error - Missed Dose at FamiliesFirst Angela Lira Incident Report 78329 (Reference #:78329 panned-inn IlniO Brno-"m Q. Tim- 0? Yul-Ida?. I grab-Sn" anadwf CONFIDENTIALITY NOTE I The documents accompanying this telccopy transmission may contain information that is con?dential and/ or legally The information is intended only for the use by the individual or entity names on this transmission sheet, If you are not the intended reCipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this tclecopicd information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you Thank you PBS Front Line PRA Incident Reports) 000037 Misaki Curtis FannZI'esE'rsz; Inc. 2100 Street, Davis, CA 95616 24 Hr. CL Report Tuesday, Febmmy 26, 2013 The time period of this report is from 7:00 a.m. {prior of?ce working day) to 7:00 am. (current of?ce working day} Adventurer RTP 02/25/13 Front Porch ??gf Desgriggiung- began to spit and assault staff which at that point, we initiated a standing. He began to drop his weight, which at that point we then transitioned into a team prone. (34 min) Reporting: Adrian Mendoza - Restraint Team Prone Aggisting: John (Nick) Moriana - Assault/Aggression Standing - Incident Report 78334 (Reference-#98334 In i trauma mm: In i Voyager DTFI 02/25/13 Basketball Court Bgigf Desgr?lmion; A peer made a statement about @3333; Paris Parker Other CONFIDENTIALITY NOTE 2 The documents accompanying this relecopy transmissmn may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual 0r entity names on this transmission sheet. If you are not The intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. Ifynu have received this. telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to vou. Thank y0u. PBS Front Line PRA Request (2013-2011 Incident Reports) 000038 Fann'liesE'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Thursday, February 28, 2013 The time period of this report is from 7:00 am. {prior of?ce working diy) to 7:00 mm. (current of?ce working day] Courtney Ghilain Incident Report 78366 (Reference #:78366 Widens Bantam Sapphire DTP 02/27/13 Bedroom/Hallway broke a nail polish bottle and began to cut her arm. After staff told her to stop, she continued to be self injurious, so we initiated a standing containment and transitioned to a team prone. (10 min) I.Il5l?, Kristan Warren - Restraint Team Prone Witnessing: Ashley McLemore - Accident/Injury to Child Standing ReQOrting: Luanna Toney Other Assisg?ng; Andrew Enright Bryce Lumbard CONFIDENTIALITY NOTE 1 The documents accompanying this. transmissmn may information that is con?dential and/or legally privxk?gtd. The information is intended only lor the use by the individual or entity names on this transmission slit?t?t. If you are not the intended rempient. you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of [be original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000039 -4- Inc. 2100 Fm}; Street, Davis, CA 95616 24 Hr. CL Report Friday; March 01, 2013 The time lit-nod of This report is from 7:00 am. (print of?ce working day] to 7?00 mm. (current of?ce working day..-.. .. . Incident Report 78377 (Reference #:78377 Program gate Time of Incident Location of Incident Sapphire DTP 02/28/13 Play Structure found glass outside and cut her finger and forearm on the play structure. She left supervision, police was noti?ed but no report or contact was made. She also cut her ?nger on glass while off campus. MM Kimberly Rowerdink - Law Enforcement Contact Assisting; Brooke Plasecki - Accident/Injury to Child Jared Hungerford - Suicidal Ideation Assisting; Courtney Ghilain Other Other . .. .. "He. . Incident Report 78374 (Reference #:78374 . I: II. [1.ll . Adventurer RTP 02/28/13 Resource Center Brief Deggriptionz- refused to take his 7 PM medication. ?agging; Britney Olguin - Med Error - Cilent Refused To Take Medication Incident Report 78375 (Reference #:78375 Re i i ni Program Time I f! . Adventurer RTP 02/28/13 Hallway forcefully kicked and punched Brian and 1. Despite several attempts to evade him, as a result we initiated a standing containment after we could no longer evade because some of his peers were in the area and he continued. (14 minSule Anibaba - Restraint Standing Agisting; Brian Blanco - Assault/Aggression . - . . 4 . . -.. .. 4V Incident Report 78379 (Reference #:78379 3W .Etencam Widens Jade DTP 02/28/13 Parking Lot/5th Street i n: - walked off campus to the police station without permission. - talked to an of?cer and walked back safely. . I i . Marcos Almeida - Law Enforcement Contact Assisting; Jared Hungerford Other CONFIDENTIALITY NOTE 1 The documents accompany-mg ii?llF telecopy transmission may contain information that is cruMduumi and/0r legally privileged. The information is intended only for the use by the indix'iduai or names on this transmissmn sheet. if you are noi the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. if you have received this tciecnpy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000040 Fam'lz'eerst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Ht. CCL Report Monday, March 04, 2013 The time period of this report is from 7 00 am. (print office working day) to 7:00 a.m. (current of?ce workmg day) Incident Report 78407 (Reteoence #:78407 2mm Ranger RTP 03/03/13 Activity Center made statements against staff. Edgar Zamora Other John (Nick) Mariana Incident Report 78406 (Reference #:78406 Wander]: Pioneer RTP 03/03/ 13 - Resource Center There was a medication discrepancy while- was on a home visit. Ashley McLemore - Med Error - Missed Dose at Home Incident Report 78392 (Re?ereuee #178392 Bantam WW Went Voyager DTP 03/01/13 03 House began to wander around the house, but continued when he became assaultive With kicks and body slams in the kitchen. He hurt my right knee when he kicked me in the shin. (18 min) I . I I It. Incl-us?: Isms. 3min: Witnessing; Ashley McLemore - Restraint Team Prone 33mm Logan Hess - Assault/Aggression Team Prone Marcos Almeida Timothy Bowes Kn'stan Warren --) Incident Report 78404 (Reference #:78404 Wedded! 2mm Adventurer RTP 03/03/13 West Parking Lot stated he cut himself with broken glass and chewed/swallowed it. He was transported to the local ER for medical assistance. The doctor initiated a 5150 assessment. Injury to his leg, treated with basic First-Aid. Witnessing: Angela Lira - Hospitalization (5150 Hold) Remrting: John (Nick) Moriana - Accident/Injury to Child Assiging: Adrian Mendoza - Accident/Injury to Child Other Other CONFIDENTIALITY NOTE I The documents accompanying this transmissmn may contam xnformation that is con?dential and/m legally privileged. The informztion is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended rectptent, you are hereby noti?ed that any disclosure, distribution, or the takmg of any action in rchancc on the of this telecopicd mformation IS strictly prohibited. If you have releropy in error, please notify us by telephone immediately so that we can arrange for the return of the ongmal documents to us at no cost to yon. Thank you. PBS Front Line PRA Incident Reports) 000041 Fam?ieer-st, Inc. 2100 Fi?/1 Street, Davis, CA 95616 24 Hr. CL Report Monday, March 04, 2013 TM time period of this report is from 7:00 am. (pnor of?ce working day) to 7:00 mm. (current ot??cc working day) Incident Report 78412 (Reference #:78412 WM Women: Voyager RTP 03/03/13 Front Porch - - alleges that a peer from another house - has been trying to pressure him to be inappropriate with him. mm mm Reporting: Pan's Parker Other Incident Report 78403 (Reference #:78403 In i Emmi: Adventurer RTP 03/03/13 Bedroom #2 made statements about staff. Islam Hassanein Other Adrian Mendoza Incident Report 78408 (Reference #:78408 Wm Emmi: WW Ranger RTP 03/03/13 Activity Center made a statement against staff. momma: Edgar Zamora Other Reporting: John (Nick) Moriana Incident Report 78395 (Reference #:78395 WW 2mm Went . Sapphire RTP 03/01/13 House Bathroom had shards of glass in her hands and was repeatedly slashing at staff. was placed in a standing containment ue to her ongoing assault attempts. (6 min) 33m; Ashley McLemore - Restraint Standing Remm'ng: Marcos Almeida - Assault/Aggression Assisting: Anthony Aispuro-Sanchez Assisting; Courtney Ghilain Incident Report 78393 (Reference #:78393 Dona?lnn amour-.3.? I Time or. anidnn. I ?pg?nn a. Tn'ld-a. CONFIDENTIALITY NOTE 2 The documents accompanying this transmission may contain mformation that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the Contents of this telecopicd information is strictly prohibited. If you have received this tc-lccopy in error, plcasc notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cos: to you Thank you. PBS Front Line PRA Request '(201 3-2011 Incident Reports) 000042 FamiliesFirst, Inc. 2100 Filth Street, Davis, CA 95616 24 Hr. CL Report Monday, March 04, 2013 The time period of this report 15 from 7:00 a.m. (prior office working day) r0 7:00 a.m. (current office working day) Sapphire DTP 03/01/13 - Off Campus, 5th Street - walked off campus this afternoon and picked up a piece of glass which she used to cut herself. Containment was initiated for her safety. (14 min) mum: . Mug; Jared Hungerford - Hospitalization (5150 Hold) Team Prone 3m Michele Bettega - Law Enforcement Contact Standing Assisting; Courtney Ghilain - Restraint - Accident/Injury to Child 5 - Suicidal Ideation 0 - Assault/Aggression Other Incident Report it: 78394 (Reference #:78394 WW Emum Sapphire RTP 03/01/13 Resource Center missed her 7 PM medication. mm mm gem Britney Olguin - Med Error - Missed Dose at FamiliesFirst Incident Report 78401 (Reference #:78401 mm: mm Voyager RTP 03/02/13 House assaulted staff and climbed the roof. After coning off of the roof,- assaulted staff and then off campus. magnesium - Witnessing: Andrea Chiles - Law Enforcement Contact Reporting; Timothy Bowes - Accrdent/Injury to Child Assisting; Jared Hungerford - Accrdent/Injury to Staff Marcos Almeida - Assault/Aggression Aaron Alston Incident Report 78411 (Reference #:78411 Voyager RTP 03/03/13 House managed to leave house supervision and made it off of campus. He was returned by Davis Police. reported that he fell and hit his head. No medical treatment was needed. meson: Christian Villela - Law Enforcement Contact Martin Melgoza - Accident/Injury to Child - Short-Term Runaway Incident Report 78405 (Reference #:78405 Wander]: Lo Pioneer RTP 03/03/13 Front Porch CONFIDENTIALITY NOTE 3 The domments accompanying this telecopy transmission may contain information that is confidmtial and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmissron sheet. If you are not the intended reapient. you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this in error, please notify us by telephone Immediately so that we can arrange for the return of the original documents to us at no cost to vou. Thank PBS Front Line PRA Request {$61 3-2011 Incident Reports) 000043 Inc. 2100 Fifth Enact, Data's, CA 95616 24 Hr. CL Report Monday March 04, 2013 The time period of this report is from 7:00 a.rn. (prior of?ce working day) to 7:00 a.m. (current office working day) A peer alleges that- had been soliciting him for inappropriate sexual behavior. mm In i e' Reporting: Paris Parker Other CONFIDENTIALITY NOTE 4 The documents accompanying this telecopy transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or die taking of any action in reliance on the contents of this telecopied information is strictly prohibited. Ifynu have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original Incident Reports) 000044 Fam?t'esFirs I, Inc. 2100 Fifth Street, Dz W's, CA 95616 24 Hr. CL Report March 05, 2013 The tune period of this report IS from 7:00 a.m. {prior office working day; to 7:00 am. (current oil-ice working day", Incident Report 78420 (Reference #:78420 Winn: Emmi!) WW Eagles NPS 03/04/13 Hallway Wm was directed inside, he escalated and started punching and pushing. We initiated a standing and transitioned to a team prone.- hit his chin and it split open. He was taken to the ER. (10 min) Reporting: Kate Broida - Restraint Team Prone Assisting; Chris Marshall - ACCIdent/Injury to Child Standing Cody Westergaard - Assault/Aggression Oscar Lopez Caitlin Scott Incident Report 78417 (Reference #:78417 Emnm Washed: Sapphire RTP 03/04/13 Resource Center was at the hospital during the 3 PM medication time frame. Therefore, missed her 3 PM medication. Angela Lira - Med Error - Missed Dose at FamiliesFirst CONFIDENTIALITY NOTE The documents atcompanying this telecopy transmission may contain information that is ton?dcntial rind/or legally privileged. The information is intended only tor the use by the individual or entity names on this transmissmn sheet. If you are not the intended recipient. you are hereby noti?ed that any disclosure, copying. distribution, or the taking of any action in reliance on the Contents of this telecopied information is strictly prohibited. If you have received this ielecopy in error. please notify us by telephone immediately so that we can arrange for the return of the original documents to us :it no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000045 Familiest'rst, Inc. 2100 Fifth Street, Dan's, 04 95616 24 Hr. CL Report Wednesday, March 06, 2013 The time period of this report is from 7:00 am. (print office working day; to 7:00 a.m, (current of?ce working day) -) Incident Report 78433 (Reference #:78433 I. ".ln.ll I I. Sapphire DTP 03/05/13 House became upset with Chris, because he would not give her a battery. He told her that he was not comfortable doing that because of how upset she was. She demanded the battery and Chris again refused. She attacked Chris by slapping. (20 min) Reporting: Aaron Alston - Restraint Team Prone Christopher Bryce - Assault/Aggression Standing Andrew Enright Incident Report 78426 (Reference #:78426 2mm Widens Adventurer RTP 03/05/13 School Annex alleged a peer touched him in an inappropriate way. {mm Imelda Davila Other Incident Report 78436 (Reference #:78436 Widen]: Sapphire RTP 03/05/13 Resource Center refused to take her medication. mm Repgrting: Angela Lira - Med Error - Client Refused To Take Medication Incident Report 78437 (Reference #:78437 Went Bantam mm Sapphire RTP 03/05/13 Play Structure/Parking Lot cut herself in her room, then again on the play structure, and eventually pushed staff while attempting to leave campus to harm herself so we initiated containment. (31 mm) mm Witnessing: Misaki Curtis - Hospitalization (5150 Hold) Escart Andrew Enright - Law Enforcement Contact Team Prone Assistim: Christopher Bryce - Restraint Standing Assisting: John (Nick) Moriana - ACCident/Injury to Child Standing Assistim: Erica Retzer - Assault/Aggression Assisting: Nolan Bradley Other . - CONFIDENTIALITY NOTE The documents accompanying this telccopy transmission ma} contain information that is con ?tlential and/or legally privileged. The information is intended only for the use by the indiVidiial or entity names on this transmission sheet. If you are not the intended rcupient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received thlh' telecopv in room please notify us by telephone immediately so that can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000046 Fann'lz'esH'I-sg Inc. 2100 Firth Street, Da W's, CA 95616 24 Hr. CL Report Wednesday; March 06, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 am. (current of?ce working day) Incident Report 78428 (Reference #:78428 Beoerti uni.t_I._e_tof ncid 2mm en Adventurer DTP 03/05/13 Bedroom Bcief Description: - began to assault us multiple times, which at that point we initiated a standing. He dropped his weight, so we transitioned into a team prone. (11 min) Incident Staff: incident Type: ?-estraint Type: Reporting: Adrian Mendoza - Restraint Team Prone Assisting: Aaron Alston - AssaultXAggression Standing Incident Report 78427 (Reference #:78427 Mateo: Ti fInci en Mm a one out Adventurer RTP 03{05f13 School Annex Brig A peer alleged that- touched him in an inappropriately during residential treatment program. Ingident Staff: Reporting: Imelda Davila Other CONFIDENTIALITY NOTE 2 The documents accompanying this telecopy transmission ma},r contain information that is con?dential andXor legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000047 Farm'Iicerst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Monday, March 11, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 a.m. (current of?ce working day) Incident Report 78486 (Reference-#98486 2mm 233W Adventurer RTP 03/10/13 - Resource Center did not take his 7 AM medication while he was on a home visit. modem Ming; Britney Olguin - Med Error - Missed Dose at Home Incident Report 78479 (Reference #:78479 BMW Emnram Walden: Pioneer RTP 03/08/13 Resource Center refused to get up and take his 7 PM medication. . Inddeannm Enchanting. Repg?jng; Britney Olguin - Med Error - Client Refused To Take Medication Incident Report 78481 (Reference #:78481 Winn: Widens Voyager RTP 03/08/13 Living Room threw a controller, began to throw things at staff in the game room, and assault when it was bedtime. He went to his room, but wandered the house, disrupting the house, and assaulting staff; leading to containment. (20 min) witnessing; Martin Melgoza - Restraint Escort Logan Hess - Accident/Injury to Child Team Prone Assisting: Marcos Almeida - Accident/Injury to Staff Standing Assigjng: Timothy Bowes - Assault/Aggression Assigmz Leola Taylor - Incident Report 78489 (Reference #:78489 Adventurer RTP 03/ 10/13 Dollar Tree Parking Lot left campus and was brought back by our campus vehicle. He assaulted staff so we initiated a team prone containment. stated repeatedly that he wanted to go to the hospital and kill himself and that he had been "seeing people." Nolan Bradley - Law Enforcement Contact Team Prone Ming; Islam Hassanein - Restraint John (Nick) Moriana 0 - Assault/Aggression Aerie-Harv Erin: DaHor - CONFIDENTIALITY NOTE 1 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the mdivxdual or entity names on this transmission sheet, If you are not the intended recrpient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have this rclecopy in error, please notify us by telephone immediately so that we can arrange for the return of the onginal documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000048 Fann'lies?'rst, Inc. 2100 Street, Davis, CA 95616 24 Hr. CL Report Monday, March 11, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 am. (current office working day) Keana West Other Rachel Fader Incident Report#: 73490 (Reference #:mso WW Emclm Adventurer RTP 03/ 10/13 Resource Center refused to take his 7 PM medication. madam Incidentlm. Mug; Britney Olguin - Med Error - Client Refused To Take Medication gsisting: John (Nick) Moriana Incident Report 78488 (Reference #:78488 MW Emmi Adventurer RTP 03/10/13 West of 5th Street Wm left campus, stood in the middle of traffic, and ran across the street. There he began to throw rocks at us. Police were as to assist in retuming- to campus. wjohn (Nick) Monana - Law Enforcement Contact Wag; Rachel Fader - Assault/AggressiOn Keana West Other Incident Report #1 78492 (Reference #:78492 WW Bantam Voyager RTP 03/ 10/13 - 03100PM Resource Center returned with more medication than he should have. Incldentlme. 33m Britney Olguin - Med Error - Missed Dose at Home Incident Report 78494 (Reference #:78494 2mm Winn: Jade RTP 03/10/13 Resource Center returned with more medication than she should have. mpg; Britney Olguin - Med Error - Missed Dose at Home Incident Report 78493 (Reference #:78493 WW Emma WM Jade RTP 03/10/13 Off Campus Child left staff supervision off campus and made statements of suicidal ideation. CONFIDENTIALITY NOTE 2 The documents accompanying this telecopy transmisswn may contain information that is con?dential and/ or legally The information is intended only for the use by the individual or entity names on this transmismon sheet. If you are not the intended reapient, you are hereby noti?ed that any disclosure, copying, distribution, or the mking of any action in reliance on the contents of this Lek-copied information is strictly prohibited. If you have received this in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000049 Famb'eSF?'sr, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Monday, March 11, 2013 Tht? time period of this report is from 7:00 an]. [prior of?ce working day) to 7:00 arr). (current of?ce working day) moi-mum e: Regorting: Patrick Oleson?Wheeler - Suicidal Ideation - Short-Term Runaway Other Incident Report 78480 (Reference #:78480 Voyager RTP 03/08/13 House Brief began assaulting staff after being told he couldn't visit another house. He was contained after he continued to assault staff. (10 min) museum mm Witnessing: Kristen Warren - Restraint Team Prone Regorting: Timothy Bowes - Assault/Aggression Standing Assisting: Marcos Almeida Assisting: Logan Hess CONFIDENTIALITY NOTE 3 The documents atft?ompanying this Irriccopy transmissmn may contain information that is con?dential andi'nr legally privileged. The; information is intended only for the use by the individual or entity names on this transmismon sheet. If you are. not the intended recipient you an: hereby noti?ed that any disclosure, copying, diatributiun, or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. lfyou have this in error, please notify' us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. 'i'hnnk you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000050 Fana?ies?'rsr, Inc. 2100 Fifth Saver, Davis, CA 95616 24 Hr. CL Report Tuesday, March 12, 2013 The time period ofthis report is from 7:00 amt (prior of?ce Working day} to "3:00 a.m. {current office working day) - -- ?4 . - row? Incident Report 78505 (Reference #:78505 rtin n' fInci mascara Mme en memos-int Eagles NPS 03/11/13 Off Campus/Downtown Davis After shadowing- for 1 1/2 hours, came and convinced him to come back to FamiliesFirst. Reporting: Kate Broida - Law Enforcement Contact Other ..- Incident Report 78501 (Reference #:78501 mellow 119mm WTime 'den Adventurer DTP 03/11/13 Parking Lot i es ri became aggressive and assaultive towards staff by attempting to punch staff multiple times. (10 min] Iggiggnt Staff; Ingiggnt Type: Restraint Witnessing: Kristin Manrique - Restraint Standing Reporting: Noel Salazar - Assault/Aggression Assisting: Charles Garcia Assisting: Stephen Lendzion Incident Report 78500 (Reference #:78500 I Etescam 933W Mum Adventurer RTP 03/11/13 Resource Center refused to take his 7 AM medication. - M111 e: Reporting: Brenda Vermette - Med Error - Client Refused To Take Medication Assisting: Cristina Mendoza-Sanchez .-, - Incident Report 78503 (Reference #:78503 Renorting Unit of Incident Program Date Time of Incident Locatign of Incident Jade DTP 03/11/13 Off Campus left supervision off campus. Police were notified. Incident Staff: Ingiggnt Tygg: Reporting: Patrick Oieson-Wheeler - Law Enforcement Contact 0 - ShOrt-Term Runaway CONFIDENTIALITY NOTE I The documents accompanyng this telecopv transmission may contain information that is con?dential arid/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the. intended recipient. you are hereby notified that any diSclosurc? copying, distribution, or the takin?i?i of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this telecopy in error: please noti {y us by telephone immediately so that we can arrange For the return (it the original documents to us at no cost [0 you. ?I?hank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000051 Families?'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CCL Report Wednesday, March 13, 2013 The time period of this report is from 7:00 min. (prior oft-ice Working day; It) ?:00 amt vcurrcni of?ce Working day) - .. .-. Incident Report 78514 (Reference #:78514 I. "1th I DIEI. [11' Adventurer RTP 03/12/13 - Adventure Despite multiple attempts,- refused his 7am medications Watt. mugging; Cristina Mendoza-Sanchez - Med Error - Client Refused To Take Medication . ..-. Incident Report 78516 (Reference #:78516 Ranger DTP 03/12/13 Outside Basketball Court minim Child was contained after repeatedly and forcefully punching and pushing me. (12 min) Repomng: John (Nick) Mariana - Restraint Team Prone Oscar Lopez 0 - Accident/injury to Child Standing Claudia Vazquez - Assault/Aggression Incident Report 78520 (Reference #:78520 I. .I El In .II Ranger DTP 03/12/13 2nd bedroom was trying to punch staff. (25 min) Edgar Zamora - Restraint Team Prone assisting: Lanai O'Brian - Assault/Aggression Standing Incident Report 78523 (Reference #:78523 Nut Sapphire RTP 03/12/13 Parking Lot threw a rock at a parked car. It missed the window; she then attempted to pick up the rock and staff separated her and she began to push into staff. (22 min) Adrian Mendoza - Restraint Seated Restraint Christopher Bryce - Assault/Aggression Team Prone ass:sting: Aaron Alston Other - CONFIDENTIALITY NOTE 1 'l'hr- documr-nrs accompanying this transmission may contain information rhar is cnnt?idmtmi and/or legally privileged. The information is intended only for flu: use by the individual or entity names (in this transmission It you are not the intended recipient. you are hereby notified that any disclosure t?npying, distribution, the taking of any action in reliancc on the of this information is strictly prohibited. if you haw this iclccupy in error. please notify us by telephone immediately so that We can arrange for the return of the original documents to us at nn cost to ymi 'i'hank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000052 Fm'lies?'rst, Inc. 2100 FIM Street, Dan's, CA 95616 24 H1: CL Report Wednesday; March 13, 2013 The time period of this report is from 7:00 21.rn. (prior of?ce working day) to 7:00 21.111. (current of?ce working day) Incident Report 78527 (Reference #:78527 Wilmer-tn; uh ram 031W momma; Jade DTP 03/12/13 5th Street Brief Child was contained for forcefully pushing into staff in an attempt to run into oncoming traf?c. (13 min) Incident staff: repoging: Patrick Oleson-Wheeler Law Enforcement Contact Team Prone assisting: John (Nick) Moriana - Restraint assisting: Kristan Warren - Suicidal Ideation 0 - Assault/Aggression CONFIDENTIALITY NOTE 2 The documents accompanying this releropy transmission may contain int?Ormation that is con?dential and/?or legally privileged. 'l'he informatiOn is intended only for the use by the individou or entity names on this transmission sheet. I i? you are not the intended recipient: you are hereby noti?ed that any disclosure, copying, diSItibnnon, or the taking of any action in reliance on the contents of this toiecopied information is strictly prohibited. leou have received this tclecopy in error. please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000053 FamiliesFirs I, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Thursday, March 14, 2013 The time period of this report is from 7:00 am (print ott'icc working day; to 7300 mm. {current ofticc working day) Incident Report 78536 (Reference #:78536 Widen: WEI Jade RTP 03/13/13 Campus/Off Campus left the house supervision in company of two - peers. All clients managed to leave campus. The Davis Police Dept was called and assisted with convincing them to return to campus. All Three clients stayed up awake all night. Martin Melgoza - Law Enforcement Contact Jose Garibay Other Assisting: Antonio Garibay Marcos Almeida .. . .. - Incident Report 78540 (Reference #:78540 Jade RTP 03/13/13 Bedroom Child became irritated with staff and ran off of campus. Adrian Mendoza - Law Enforcement Contact Assisgng: Sergio Sanders Other Incident Report 78542 (Reference #:78542 2mm Jade RTP 03/13/13 Campus/Off Campus left the house supervision in company of two peers. All clients managed to leave campus. The Davis Police Dept was called and assisted with convindng them to return to campus. All Three clients stayed up awake all night. awning; Martin Melgoza - Law Enforcement Contact Jose Garibay Other Antonio Garibay Assisting: Marcos Almeida - Incident Report 78535 (Reference #:78535 all]: Sapphire RTP 03/13/13 3109 stated she was having hallucinations that involved her murdering others this morning. She also reported that she fell and hit her head on her bed this morning while hallucinating. Tar-Ida? Tun.- CONFIDENTIALITY NOTE The documents accompanying this transmissxon may Contain information that is con?dential and/or legally privileged. The information is intended only tor the use by the indiVidual or entity names on this transmisston SllL?Cf. If you are not the intended recipient, you are hereby notified that any copying, distribution. or the taking of any action in reliance on the contents of this telecole information is strictly prohibited. If you have this in ?rm. plats:- notify us by telephone immediately so that can arrange for the return of the unng documents to us :it no cost to you. you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000054 FamiliesFir?st, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Thursday, March 14, 2013 The time period of this report is from 7:00 a.m. (prior working day) to 7:00 ;current office working day) mooning; Genevieve Cames - Suicidal Ideation Judy Jolley Other Incident Report 78537 (Reference #:78537 I. [11' I I Voyager RTP 03/13/12 Voyager A restraint was initiated when- made several attempts to go after a peer. He continuoust punched me in the face and pushed into me as I physically deterred him from daing so. I attempted to evade but he continued to advance towards me. (13 min) MM I_s_im_ncid e: witnessmg: Kamika Sherwood - Restraint Team Prone reporting: Dean Valencia 0 - Assault/Aggression Standing ass?ing: Cody Westergaard Incident Report 78543 (Reference #:78543 89W Emsmn Adventurer RTP 03/13/13 Adventurer became assaultive after stealing food from the kitchen and entering his peers' bedrooms to provoke them. He threw objects and punched staff during the attempt to clear his room, so we had to shut the door. (3 min) Rachel Fader - Restraint Quiet Room Michelle - Assault/Aggression Lem; Brian Blanco Jared Hungerford Incident Report 78539 (Reference #:78539 Walden; Widen: Adventurer RTP 03/ 13/13 Adventure was contained due to assaulting staff past the clear limit set. (9 min) Ming; Chris Marshall - Restraint Escort Eduardo Villalobos - Assault/Aggression Team Prone Adam Rivard Kamika Sherwood Incident Report 78547 (Reference #:78547 We: Emma Wanda: Jade RTP 03/13/13 Bedroom - Child became irritated at being in her room and began to put on shoes. She then left via her window. CONFIDENTIALITY NOTE 2 The documents accompanying [hlb transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the. use by the individual or entity names on this transmission sheet. If you are not tht? intended retipient, you are hereby noti?ed that any disclosure, copying. distribution, or the inking of any acuon in reliance on the contents of this telecopicd information is stricdy prohibited. If you have received this telecopy in error. please notify us by telephone immediately so that we arrange For the return of the original documents to us at no Cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000055 Famlz'eSFirst, Inc. 2100 Fi?h Street, Davis, CA 95616 24 Hr. CL Report Thursday, March 14, 2013 The time period of this report is from $500 3.21:1. (prior of?ce working day) to 7:00 a.rn. (current of?ce working day) Inside??tam. mm e: Reporting: Adrian Mendoza - Law Enforcement Contact Assisting: Sergio Sanders Other Incident Report 78548 (Reference #:78548 greater]: mm LEW Jade RTP 03/13/13 Campus/Off Campus Brief left the house supervision in company of two - peers. All clients managed to leave campus. The Davis Police Dept was called and assisted with convincing them to return to campus. All Three clients stayed up awake all night. aff: Reporting; Martin Melgoza - Law Enforcement Contact Assisting: Jose Garibay Other Assisting: Antonio Garibay Assisting: Marcos Almeida CONFIDENTIALITY NOTE 3 The documents accompanying this telecopy transmission may contain information that is con?dential andy?or legally privileged. The in formation is intended only for the use by the individual or entity names on this transmission sheet. if you are not the intended recipient. you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied in?ammation is strictly prohibited. Ifyou have received this telecopy in error. please noti fy us by telephone immediately so that we can arrange For the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000056 Fanzz'lies?'rst, Inc. 2100 Fi?h Street, D3 W's, CA 95616 24 Hr. CL Report Friday; March 15, 2013 The timr of this rcpon ts from 7:00 a.m. (prior of?ce working day to 7.00 (cum-m oft-ice working day; -) Incident Report 78561 (Reference #:78561 WW Bantam Widen; ?mu? I Adventurer RTP 03/ 14/13 Adventurer House refused his 7am medications. Instdentjsam lug-?m was. Reporting: Brenda Vermett - Med Error - Client Refused To Take Medication _w Incident Report 78564 (Reference #:78564 2mm i Adventurer DTP 03/14/13 and Field - - was playing basketball in the when he exited and ran across the ?eld and hopped over the back fence. He was returned in a company van with Jared and went to the quiet room. mm Witnessing: Marcos Almeida - Law Enforcement Contact mm Brian Blanco - Long-Term Runaway Assisting: Jared Hungerford Sule Anibaba Incident Report it: 78565 (Reference #:78565 . . Adventurer RTP 03/14/13 Resource Center missed his 7pm medication. 1? Insidean Reporting: Britney Olguin - Med Error - Client Refused To Take Medication Incident Report 78568 (Reference #:78568 .Hiln.ll Enzon Wedded: Jade RTP 03/14/13 Jade House refused her 7am medications. new Repoging: Brenda Vermette - Med Error - Client Refused To Take Medication Incident Report 78558 (Reference #:78558 of Incid 2mm WM Adventurer RTP 03/13/13 Adventurer House was throwing hard objects, spitting, and punching staff.- door was shut when he charged at me posturing (1 min). CONFIDENTIALITY NOTE 1 The documents accompanying this telecopy transmission may Contain information that is con?dential and/oi legally privileged. The information is only for the use by the individual or entity names on this transmismon sheet. If you are not the intended recipient, you are hucby noti?ed that any disclosure, copymg, diSlIlbUilUiL or the taking of any In reliance on the contents of this rein-copied information is Strictly prohibited. If you have received illh? in error, please notify us by telephone immediately so that we can arrange for the ?mum of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000057 Inc. 21001717?!) Street; Davis, CA 95616 24 Hr. CCL Report Fridge March 15, 2013 The Little period of this report is from 7:00 an]. (prior oft?1m working day) to 7:00 mm. (current of?ce working day) e: Restraint Ixoe: Reporting; Jared Hungerford - Restraint Quiet Room Assisting: Brian Blanco 0 - Assault/Aggression Incident Report 78569 (Reference #:78569 Eggomng unit of Program gag: Iimg 91 i Adventurer RTP 03/14/13 Trailblazer House Brief Desgn'pgign:- repeatedly punched and spat on me after running into another house without permission. He started provoking peers and pushing into staff. We escorted him out of the living room when we could no longer evade. (4 min) Indium SLIM e: reponing: Sule Anibaba Restraint Escort - Assault/Aggression Quiet Room A ?mnw Incident Report 78571 (Reference #:78571 WW Emcee: Wolverines RTP Campus/Off?Campus Brief At 8:30am,- walked off campus towards the post of?ce. Police were noti?ed by Genevieve. Insideet?a?t witnessing: Leon Jones 5 - Law Enforcement Contact reporting: Maxwell Thomas - Long-Term Runaway assisting: Genevieve Carries assisting: Matthew Bettencourt to CONFIDENTIALITY NOTE The documents .ma?nnpanymg this tclecopy [l??n?miSSl?n may contain information that is con?dential and/or legally privileged. The intermation is intended only for the um: by the mdix'idunl or entity names on this transmissmn sheet. If you are not the intended recipient. you are hereby notified that any disclosure. copyingP distribution, or the taking of :my action in reliance on the contents of this information is strictly prohibited. If you have this in error. please notify us by telephone immediately so that wt: can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000058 Fann'lies?'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Monday, Match 18, 2013 The time pcnod of this report L5 from 700 am. (prior of?ce working day) to 7:00 am. (current of?ce working day) Incident Report 78575 (Reference #:78575 WW amount Wanna: Remnant pioneer DTP 03/15/13 House Felt a need to AWOL or get into a restraint. Began to punch, kick, and bite staff. (9 min) Reporting: Anthony Aispuro-Sanchez - Restraint Escort Assisting: Kyle Garlick - Assault/Aggression Incident Report 78575 (Reference #:78575 MW 1mm Pioneer RTP 03/1 5/1 3 03 ZOOAM HOUSE jumped over the back wall. Insident?a?; gm Cody Westergaard - Law Enforcement Contact Assigigg: Kyle Garlick - Short-Term Runaway Incident Report 73573 (Reference #:78573 2mm mm mm Adventurer RTP 03/15/13 House - was escorted after hitting Matt twice in the head with a video game case. While in the outside Quiet Room, stated he swallowed one of two small pieces of metal. Chris Marshall - Restraint Escort Assisting; Matthew Bettencourt - Assault/Aggression Other Incident Report 78574 (Reference #:78574 WW [mum Widens Wooden: Adventurer RTP 03/ 15/ 13 House continued to forcefully push into staff. (25 min) 3mm; Cody Westergaard - Restraint Team Prone Assisting; Adam Rivard - Assault/Aggression Genevieve Carnes Kamika Sherwood Incident Report 78572 (Reference #:78572 BMW Emma: Widens Jade DTP 03/14/13 5th Street CONFIDENTIALITY NOTE 1 The documents accompanying this transmisswn may contain information that is con?dential and/ or legally priwlcged. 'lhe information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopicd information is prohibited. If you have received this win-cow in Please notify ?fii??'id??iit awaits) 000059 TO US at no COSY t0 YOU. Families?'rst, Inc. 2100 Street, Davis, CA 95616 24 Hr. CL Report Monday, March 18, 2013 The time period of this report is from 7:00 mm. (pnor office working day) to 7:00 am. (current of?ce working day) it: became escalated when processing an eariier incident and ran off campus, so the police were noti?ed. She sat on center divider of 5th Street and eventually returned to campus. 1mm MM semi-ting; Kn?stin Manrique - Law Enforcement Contact Assisting; Jared Hungerford Other momma vases muses-r). . Emsmn Ranger RTP 03/17/13 Front Parking Lot began to wander campus and wanted to go into the vehicles. He began to walk off campus and eventually came bac . mung; Adrian Mendoza - Law Enforcement Contact Edgar Zamora Other - 1- i Voyager RTP 03/16/13 House kissed Logan's wrist when dared by a peer. This was followed by 2 hours of screaming and assaults (punches, kicks, throwing objects, spitting), leading to a closed door restraint. (11 min) Britney Olguin - Restraint Quiet Room gem Logan Hess 0 - Assault/Aggressmn awning; Marcos Almeida Other Brian Blanca m; Chades Garcia Incident 78583 ?mousse; - Wigwam! Emnm WW Pioneer RTP 03/17/13 Resource Center missed his 7 AM medication. 3m Britney Olguin - Med Error - Client Refused To Take Medication Incident Report 73578 (Mm #:78578) - .. 2mm: Pioneer RTP 03/16/13 - House ?uid hut-Haunte- O-n kin-O a me mow-h emulla' nneurr-aee?nl Head nhuriral "Salaam nn c033 indnaf' CONFIDENTIALITY NOTE 2 The documents accompanying this telecopy transmissron may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmiss?iun sheet. If you are not the intended recrpient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this witcom in ?for, Please 0006' us (zone-bow mum- Ruwlts) documents to us at no cost to you Thank you. Families?'rsz; Inc. 2100 Street, Dal/119, CA 95616 24 Hr. CCL Report Monday, March 18, 2013 The time period of this report is from 7:00 1111;. (prior office working day) to 7:00 am. (current office Working day) (13 min) Lngidgug Staff; Insiggnt Type: Restrginj; Type: Regorting: Anthony Aispuro-Sanchez - Restraint Escort Assisting: Andrea Chiles - Assault/Aggression CONFIDENTIALITY NOTE 3 The documents accompanying this telecopy transmission may contain information that is con?dential and/or legally privileged. The. information is intended only for the use by the individual or entity names on this transmission sheet, If you are not the intended recipient. you are hereby notified that any disclosure Copying. distribution. or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited lfyou have received this telecopy in error. please notify us by telephone immediately so that we can arrange for the return of the original ??tting 3-201 1 Incident Reports) 000061 Fann'liesFirst, Inc. 2100 Street, Davis, CA 95616 24 Hr. CL Report Tuesday, March 19, 2013 The time period of this report is from 7:00 am. (prior of?ce Working day} to 7:00 (current ofticc working day) Incident Report 78597 (Reference #178597 ?n n' mm Pioneer RTP 03/18/13 House ?n'ef Desgjgiog; wanted to AWOL off of campus, attempted to jump the wall and climb the roof.- kicked staff several times and threw ig rocks at staff. (2 min) 3mm; Adriana Escobar - Restraint Standing Adrian Mendoza - Assault/Aggression Incident Report 78598 (Reference #:78598 Voyager RTP 03/1'8/13 Hallway/Bedroom #1 A peer -) witnessed? with his hand down his pants, touching his groinReporting: Jacob Babcock - Sexualized Behavior Incident Report 78604 (Reference #:78604 2mm Jade RTP 03/18/1-3 Campus Entrance argued with a peer and became escalated saying she didn?t want to be in the house and yelling at me. As I tried to ver a de-escalate her, she left my supervision to the front of campus. (13 min) I . I I SI Incl-dc?; Ixng- Type: Witnessing; Patricia Button - Hospitalization (5150 Hold) Team Prone Witnessing: Oscar Lopez - Restraint Team Prone Witnessing: Adam Rivard - Accident/Injury to Child Standing Witnessing: Adrian Mendoza - Suicidal Ideation Remrting: Reynoso ijillo Other Assisting: Eduardo Villalobos Other Assisting: Genevieve Carnes Kyle Garlick Incident Report 78601 (Reference #:78601 i In ?oater! Wig?Am of Inciden We: Sapphire DTP 03/18/13 House repeatedly punched staff in the head, so we initiated centainment. (1 min) Incidentm mm Reporting: Andrew Enright - Restraint Team Prone Assisting: Aaron Alston - Assault/Aggression Standing Assisting; John (Nick) Moriana Other Erica Retzer CONFIDENTIALITY NOTE The documents~ accompanying this transmission may contain information that is confidential legally privileged. The information is intended only For the use by the individual or entity names On this transmission If you are not the intended recipienn you are hereby noti?ed that any disclosure, copying, distribution, or the taking of my action in reliance on the contents of this information is strictly prohibited. If you have received this in error. plt?asc notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000062 Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Wednesday, March 20, 2013 The time period of this report is from 7:00 um. (Print of?ce Working day) to 7:00 a.m. office working day) Incident Report 78621 (Reference #:78621 -ll Jade DTP 03/19/13 House was contained for aggressively and forcefully charging, shoving, pushing, and grabbing staff. (17 min) In i rr- Regulating; Witnessing: Nicole Silva - Restraint Team Prone Reporting: Patrick OIeson-Wheeler - Accident/Injury to Child Standing Assisting: Jesus Zamudio - Assault/Aggression Other -- - - Incident Report 78615 (Reference #:78615 nl anagram I: Ti I cl We]: Trailblazer DTP 03/19/13 Activity Center accidentally electrocuted himself by leaning on the Activity Center wall and breaking off an electric fixture. He was treate at Sutter Hospital. ?itnessing; Sergio Sanders - Accident/Injury to Child Witnessing: John (Nick) Moriana Reporting: Matthew Brown Steven Knowles Assisting: Brenda Vermette Incident Report 78610 (Reference #:78610 Adventurer DTP 03/19/13 Bedroom #4/Sutter E.R. Br cri io experienced a seizure and all was called to assist. He was admitted to Sutter Memorial in Sacramento at around 8:15 PM this evening. witnessing; Noel Salazar - Accident/Injury to Child Michelle Glicksman Other Witnessing: Eduardo Villalobos Remrting: Islam Hassanein Assisting: Zachariah Fromm John (Nick) Moriana Judy Jollev Incident Report 78613 (Reference #:78613 Bending Unit 0.: I. nsi'dent. Plenum ti In i Ranger DTP 03/19/13 - Cantrill Dr., Davis ?nan- mun-w. . Erin? ?nerra?inn- he Inauo r-unnru?cinn and karat-no annrarriuo ulin and 941.: nnliro h" bipbinn CONFIDENTIALITY NOTE The documents accompanying this tclucopy transmission may contain information that is confidential rind/oi legally privileged. The information is intended only for the use by the indiVidual or entity names on this transmissmn sheet, If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this in please- notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. 'lhank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000063 Famz'ljesFii-st, Inc. 2100 Street, Davis, CA 95616 24 Hr. CL Report Wednesday, March 20, 2013 The time period of this report is from 7:00 tm. (prior of?ce working day} to 7:00 a.m. {current of?ce working day) and hitting. (16 min) Witnessing; Renee Palombi - Law Enforcement Contact Team Prone Mm; Claudia Vazquez - Restraint Standing Assisg'ng: John (Nick) Mariana - Accident/Injury to Staff Assisg'ng: Kamika Shemood - Assault/Aggression Other Incident Report 78614 (Reference #:78614 I. .l HI In .II Ranger DTP 03/19/13 Parking Lot became assaultlve when we deterred him from attempting to leave supervision. (7 mln) Reporting: Claudia Vazquez - Restraint Escort Assisting: Robert Dehn 0 - Assault/Aggression Quiet Room - Incident Report 78617 (Reference #:78617 Voyager DTP 03/19/13 Hallway was aggressively approaching a peer?s - doorway while shouting at the peer inside, so Paris and I initiated a restraint. (38 min) Jacob Babcock - Restraint Team Prone Paris Parker 0 - Assault/Aggression Standing Misaki Curtis Aaron Alston Nolan Bradley Incident Report 78611 (Reference #:78611 amendment Bantam Wanna: Adventurer RTP 03/19/13 Hallway After did not get the snack that he demanded, he started spitting, kicking, and punching staff. As a result, we escorted - a er we could no longer evade. (10 min) Adrian Mendoza - Restraint Escort gem Noel Salazar - Assault/Aggression Sule Anibaba Incident Report 78612 (Reference #:78612 WM anagram Wot Adventurer RTP 03/19/13 Hallway - After- got upset over not getting the toy he requested, he started throwin his shoes, spitting, and forcefully punching staff. We attempted to evade several times, but we initiated an acort afteri continued to walk towards staff. (5 min) CONFIDENTIALITY NOTE 2 The documents accompanying this transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. ll you are not the intended reCipient, you are hereby noti?ed that any disclosure. copying, distribution, or the taking oi any :lCI?ltm in reliance on the Contents of this tcleeopied information is stricrly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cosr to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000064 FaImZiestI-st, Inc. 2100 Street, Davis, CA 95616 24 Hr. CL Report Wednesday, March 20, 2013 The time period of this tepon is from 7:00 a.mv (prior of?ce working day} to 7:00 am. (current of?ce working day} Matt: minim; Re Witnessing: Adrian Mendoza - Restraint Escort Reporting: Sule Anibaba 0 - Assault/Aggression Reporting: Noel Salazar CONFIDENTIALITY NOTE 3 The documents accompanying this lelecopy transmission may contain information that is confidential and/or legally privileged. The in formation is intended Only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are herebyr noti?ed that any disclosure, copying, distribution, 01' the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. if you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. 'I'hank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000065 Farmlz'cs?rst, Inc. 2100 Street, Davis, CA 95616 24 Ht. CL Report Thursday, March 21, 2013 The tum: period of this report is from 7:00 amt (prior of?ce working day) to 7:00 a.m. .jcutrent of?ce working day) Lisa Robertson Incident Report 78626 (Reference #:78626 Widen: anagram Locations?nsidem Ranger DTP 03/20/13 Parking Lot/Goodyear left campus and managed to ignite a vehicle off campus from a tire garage, due to the fact that the keys were in the ignition. Police retumed- to campus. - continued with non-compliance and assaulted; standing initiated. (13 min) Ingident Staff: Restraint Txgg: Witnessing: Robert Dehn - Law Enforcement Contact Standing Efren Sanchez-Delgado 0 - Assault/Aggression Assisting: John (Nick) Moriana Other Other Andrea Guthrie Incident Report 78627 (Reference #:78627 termini Jade RTP 03/20/13 Resource Center was off campus at court and she missed her 3:00 PM medications. Marcos Almelda - Med Error - Missed Dose at FamiliesFirst Reporting: Claudia Vazquez Michelle Glicksman Incident Report 78622 (Reference #:78622 Adventurer DTP 03/20/13 Campus Gym/5th St. (Off Campus) When he became jealous of a peer's toy, - left the gym, walked off campus, was driven back by the police, and was mildly assaulu've in the Quiet Room. Reporting: Rachel Fader - Law Enforcement Contact Assisting: Marcos Almelda Assault/Aggression Assisting; John (Nick) Moriana Short-Term Runaway CONFIDENTIALITY NOTE The documents this transmission may contain information that is con?dential and/or legally privileged. The information IS intended only for the uSe by the individual or entity names on this transmisswn sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure. copying, distribution, or the taking of an}r action in reliance on the contents of this telecopied information is strictly prohibited. If you have this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us :it no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000066 Farmlies?'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Friday, March 22, 2013 The time period of this report is from "7:00 a.m. (prior of?ce working day; to 7:00 a.m. oft-ice working day) Coronda Carter Incident Report 78642 (Reference #:78642 Trailblazer DTP 03/21/13 Bedroom #3 - made a statement that involved suicidal ideation before barricading himself in his room. Eventually processed with staff. Matthew Brown - Suicidal Ideation Assisting; Whitney Shettler Assisting; Sarah McFadden Assisting: Marcos Almeida Lisa Robertson Incident Report 78640 (Reference #:78340 mm mm mm Ranger D'l House kept punching me and kicking me even after I attempted to evade, he would follow me. (11 min) Lanai O'Brian - Law Enforcement Contact Team Prone gm Efren Sanchez-Delgado - Restraint Standing Kelsey Blissett - Assault/Aggression Other -) Incident Report 78639 (Reference #:78639 WW Emcee: Women: Ranger DTP 03/21/13 Side Porch was forcefully pushing into staff and spitting on staff before attempting to run towards the front of pl campus. Per an, he was escorted to the Quiet Room. He continued to attempt to assault staff, causing the door to close. (10 min . I 5' Ins-mm; 1mg. 1mg; Witnessing; Kelsey Blissett - Restraint Escort Lanai O'Brian - Assault/Aggression Quiet Room ?sisg'ng: Efren Sanchez-Delgado Other CONFIDENTIALITY NOTE I The documents :iu'ompiinvmg this wit-copy transmissmn may contain information that is confidential and/"or legally prwticgcd. The information is intended only for the use by the individual or entity names on this transmissmn sheet. If you 'th? not the you ate noti?ed that any disclosure, copying, distribution. or the inking of any ucnon uI itlianu- on thL' contents of this information is strictly prohibited. If you have this in error. please notify us by immediately so that We can arrangc for the tct?um ot the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000067 FamII'esE'rst, Inc. 2100 Fifth Street, D2 vis, CA 95616 24 Hr. CL Report Friday, March 22, 2013 The time period of this report is from 7:00 am. (prior ollicc working day; to 7:00 am. (current ot'ticc working day) Incident Report 78637 (Reference #:78637 Ranger DTP 03/21/13 Front Parking Lot made verbal threats to harm his bio-mother and pursued her when she disengaged. He made attempts to assault er and attempts to prevent her from leaving the facility. Law enforcement was contacted after- broke the back window of her vehicle. mam; Leon Jones 5 - Law Enforcement Contact Renaming; Lisa Robertson 0 - Assault/Aggression Assisting; Robert Dehn Logan Hess Assisting: Marcos Almeida Incident Report 78638 (Reference #:78638 Ranger RTP 03/21/13 House became very aggressive; threw multiple items at staff and peers and destroyed the house. (2 min) Reporting; Kelsey Blissett - Restraint Quiet Room Aisling; Robert Dehn - Assault/Aggression 555mm Lanai O'Brian Other Michelle Incident Report 78632 (Reference #:78632 Adventurer DTP 03/21/13 Activity Center Misaki Curtis - got upset about March Madness prizes, assaulted staff multiple times, and stated that he wanted to "die and go to heaven. 33m; Rachel Fader - Suicidal Ideation missing; Aaron Alston - Assault/Aggression Helen Kim mixing; Marcos Almeida - Incident Report 78641 (Reference #:78641 a I. .II I .ll Voyager RTP 03/21/13 House minim At 3:20 left staff supervision. Police were noti?ed and brought- back at 5:05 AM. CONFIDENTIALITY NOTE 2 The documents accompanying this telecopy transmissmn may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission 511661. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. Ifyou have received this wit-copy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000068 Fann'lies?lrs Inc. 2100 Fifth Street, Dana's; CA 95616 24 Hr. CL Report Fnda y, March 22, 2013 The time period of [l?llb report 15 from 7:00 am. {prior of?ce working day) to 7:00 a.m. [current oft-1C6 working day) Incident Staff: Incident Tyne; Regorting: Jeffrey Poynter - Law Enforcement Contact 0 - Short-Term Runaway CONFIDENTIALITY NOTE 3 The documents accompanying this teleeopy transmission may contain information that is confidential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. Ifyou have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us in no cunt to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000069 Families?'rs I, Inc. 2100 Fifth Sacct, Davis, CA 95616 24 Hr. CL Report Monday, March 25, 2013 The time period of this report is from 7 00 a.m. [prior office working day) to 7:00 a.m. (current office working day) Michelle Glicksman Incident Report 78674 (Reference #:78674 Adventurer RTP 03/24/13 Resource Center missed his 12 PM medication while on a day visit. 3mm; Angela Lira - Med Error - Missed Dose at Neil Robinson Incident Report 78680 (Reference #:78680 BMW Emnm Widen: Pioneer RTP 03/24/13 Resource Center After several attempts,- still refused his 12 PM medication. imam Regg?ing: Angela Lira - Med Error - Client Refused To Take Medication Mlsaki Curtis Incident Report 78667 (Reference #178667 Voyager RTP 03/23/13 House I witnessed- manipulating his genitals at a high rate of speed with his hands down his shorts. '5 door was fully open when this happened. David Stewart Other Logan Hess 3mg; Timothy Bowes Neil Robinson Incident Report 78655 (Reference #:78655 CONFIDENTIALITY NOTE 1 The documents accompanying this transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmissmn sheet. if you are not till: intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this tciecnpicd information is strictly prohibited. if you have received this in error, please notify us by telcplionc immediately so that we can arrange for the tctum of original PM Relq'lieslt 3(2'01 3-201 1 Incident Reports) 000070 FamiliesE't-s Inc. 2100 Fifth Street, Dan's, CA 95616 24 Hr. CL Report Monday, March 25, 2013 The time period of this report is from 7:00 a.m. (prior of?ce working day) to 7:00 a.m. (current of?ce working day) 2mm Pioneer RTP 03/22/13 Dinning Room A peer told- that he was going to make out with him. Amy Mathers Other Coronda Carter Incident Report 78661 (Reference #:78661 WW Emile-m Trailblazer DTP 03/22/13 Bedroom #3 - was upset in his room and barricaded himself against his closed door, then stated he had a rope and was going to tie a noose and hang himself from the metal bar in his cubbie. modem Repomng; Whitney Shet?er - Suicidal ldeation Remr?gg; Marcos Almeida Michelle Glicksman Incident Report 78679 (Reference #:78679 Adventurer RTP 03/24/ 13 - Bedroom #3/Pole Line Rd walked off campus with Adrian and I following him, and was returned to campus by Davis Police. Islam Hassanein - Law Enforcement Contact ?sistim; Adrian Mendoza Other Incident Report 78650 (Reference #9865!) Adventurer DTP 03/22/13 House walked out of his room and assaultive staff in the hallway of Adventurer House. (44 min) Watt: mm Reporting: Charles Garcia - Restraint Escort Assisting: Cody Westergaard - Assault/Aggression Standing Quiet Room Incident Report 70551 (Reference #98651 CONFIDENTIALITY NOTE 2 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the indivtdual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. If you have received this in error, please notify us by telephone immediately so that we can arrange for the return ofthc original u. Th . Requ?'?tyf??m 3-2011 Incident Reports) 000071 Families?'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Monday, March 25, 2013 The time period of this report is from 7:00 a.m. (prior of?ce working day) to 7:00 a.m. (current of?ce working day) Want Emmun Wanna: Adventurer DTP 03/22/13 Front of Campus ran out of the house, assaulted staff and made statements about previous abuse. Repoging: Charles Garcia 0 - Assault/Aggression Mug; Marcos Almeida Other Brian Blanco Incident Report 78675 (Reference #:78675 Adventurer RTP 03/24/13 House ri was upset about not being able to go on an outing and attempted to leave my supervision, and then made statements. mm mm Rachel Fader Other 5- Suicidal Ideation Andrea Guthrie Incident Report 78683 (Reference #:78683 Jade RTP 03/24/13 Resource Center made a statement regarding past abuse. John (Nick) Mariana Other Courtney Ghilain Incident Report it: 78672 (Reference #:78672 MW Bantam We: Sapphire RTP 03/23/13 Resource Center After 3 unsuccessful attempts, - refused her 7 PM medicationsReporting; Brenda Vermette - Med Error - Client Refused To Take Medication Assisting: Whitney Shettler CONFIDENTIALITY NOTE 3 The documents accompanying this transmission may contain information that is con?dential and/or leg-ally The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution. or the taking of any action in reliance on the contents of this telecopied information is Strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the ongmal documents to us at no cost to vou. Thank PBS Front Line PRA Request 3-2011 Incident Reports) 000072 FanzilicsEfrst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Monday, March 25, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 am. (current of?ce working day) Incident Report 78673 (Reference #:76673 WW 2mm Sapphire RTP 03/23/13 Side Porch stated that girls in the house are making fun of her to the point that want to kill myself." mm mm Christopher Bryce Other Witnessing; Aaron Alston Witnessing; Charles Garcia Leola Taylor Jonathan Stone Marcos Almeida Misaki Curtis Incident Report 76663 (Reference #:78663 Sapphire RTP 03/22/ 13 Basketball Court stated that her father struck her sister. Reporting; John (Nick) Mariana Other Misaki Curtis Incident Report 78670 (Menace #98670 Want Voyager RTP 03/23/13 House grief I escorted- out of the house when he was ?ghting with another peer. I attempted a closed door restraint in the Quiet Room, but it was unsuccessful. (4 min) mm; Timothy Bowes - Restraint Esc0rt Marcos Almeida - Assault/Aggression Quiet Room David Stewart Anthony Aispuro-Sanchez Incident Report 78668 (Reference #:78666 Danny-Han Ila].- Ten-Ida?. Brewer-m 11m. AC 'ou-ldoni I torso-Inn CONFIDENTIALITY NOTE 4 The documents accompanying this telecopy transmissmn may contain information that IS con?dential and/0r legally privileged. The information is intended only for the use by the individual or entity names on this transmisston sheet. If you are not the intended rcopient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of tclecopicd information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to vou Thank PBS Front Line PRA Request 3613-2011 Incident Reports) 000073 FamiliesFirst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Monday, March 25, 2013 The time period of this report is from 7:00 a.m. (pnor office working day]- to 7:00 am. (current of?ce working day) Voyager RTP 03/23/13 Bedroom #3 was destroying a radio while in his room, upset about consequences. He took a sharp shard and put it near my eye, and became extremely assaultive when I deflected it away; leading to containment. (26 min) Andrea Chiles - Restraint Escort gagging; Logan Hess - Accident/Injury to Child Team Prone Timothy Bowes 0 - Accident/Injury to Staff Matthew Brown 0 - Assault/Aggression Neil Robinson Incident Report 78656 (Reference #:78656 WW Pioneer RTP 03/22/13 Dinning Room made a statement to a peer that they were going to make out. 10mm Amy Mathers Other Incident Report 78658 (Reference #:78658 Wagner}: Emulm Pioneer RTP 03/22/13 - House - began charging towards peer with assaultive behaviOrs and throwing metal sink strainers/cups/dish water soap. (8 min) Mags-$9; Andrea Chiles - Restraint Escort gm Anthony Aispuro-Sanchez - Assault/Aggression Standing Felicia Thomas Andrea Guthrie Incident Report 78649 (Reference #:78648 WW Bmstom W01 Wolverines NPS 03/22/13 Quiet Room #1 - was upset over her options, having to give up her MP3 player which she was not on level to have at school. She stated, Fuc you all, I hope 1 die. I'm gonna scratch myself until I die.? and proceeded to scratch her leit arm with a broken pen. \Mit-nareinn- loan 1nn?r - Ciuiridal lr?oa?hn CONFIDENTIALITY NOTE 5 The documents accompanying this relecopy may contain information that IS con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended reapient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this tclecnpied information is prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to ?00 Than . PBS Front Line PRA equest y(51013-2011 Incident Reports) 000074 Families?rst, Inc. 2100153211 Street; Davis; CA 95616 24 Hr. CL Report Manda); March 25, 2013 The time period of this report is from 7:00 a.rn. (prior of?ce working day) to 7:00 arm. (current of?ce working day) Stephen Lee Other Asgisg?ng: Coronda Carter Assisting: Kamika Sherwood CONFIDENTIALITY NOTE 6 The documents accompanying this telecopy transmission may contain irifonnation that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission Sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediater so that we can arrange for the return of the original documents to us at no cost to no. Than . PBS Front Line PRA equestliozu013-2011 Incident Reports) 000075 FamZI'csE'rst, Inc. 2100 Filth Street, D2 w?s, CA 95616 24 Hr. CL Report Tuesday, March 26, 2013 The time period of this report 15 from 7:00 an]. {prior oft?ice working day) to ?kill! a.m. {Current oft?ice working . . Incident Report 78692 (Reference #:78692 Adventurer RTP 03/25/13 Backyard/Fence was attempting to take space appropriately at the side porch as per his behavioral plan. Shortly after, he started clirn ing on the fence nearby. As a result, I verbally prompted him to stop, however he jumped over the backyard wall. I ff: Reporting: Sule Anibaba - Law Enforcement Contact 0 - Short-Term Runaway . . Incident Report 78702 (Reference #:78702 A. I Bantam &Tim Adventurer DTP 03/21/13 Activity Center ran into the Art room, crying and holding his head. Incident Staff: mm Reporting: Lisa Little - Accident/Injury to Child CONFIDENTIALITY NOTE 1 Thi- documents accompanying this ielecopy transmission may contain information that is con?dential (Ind/or legally privileged. The information is intended only for the use liy the individual or entity names on this transmissnon sheet. if? you are not the intended recipient you are hereby notified that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this [ch-copied informatit?m is strictly prohibited. If you have received this tale-copy in error, please notify us by telepl'ione immediately so that we can arrange for the return of the original documents to us no cost to you. ?l?hank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000076 Fanzilies?'rs I, Inc. 2100 Sa'eet, Davis, CA 95616 24 Hr. CL Report Wednesday, March 27, 2013 The timr: period of this report is from 7 001m. {prim of?ce working day," to 7:00 1mg ot??cc working day) Lisa Robertson Incident Report 78706 (Reference #:78706 2mm Ranger RTP 03/26/13 House W- lunged at staff, kicking. (41 min) Insists?1L!? rummage: gem Edgar Zamora - Restraint Team Prone Assisting; Lanai O'Brian - Assault/Aggression Standing Assisting: John (Nick) Moriana Assisting; Aaron Alston Assisting: Angela Lira Michelle Glicksman Incident Report 78713 (Reference #:78713 Widens Adventurer DTP 03/26/13 Bedroom #3 made vague statements hinting his past abuse. John (Nick) Mariana Other Andrea Guthrie Incident Report 78708 (Reference #:78708 - . Jade RTP 03/26/13 - 2nd Street was contained for attempting to run into ongoing traf?c and again for assault. She also made suicidal threats. Reggm?ng: Patrick Wheeler - Law Enforcement Contact Team Prone Assigjgg: Bryce Lumbard - Restraint Team Prone - Accident/Injury to Child Standing 0 - Accudent/Injury to Staff - Suicidal Ideation 0 Assault/Aggression Other CONFIDENTIALITY NOTE 1 The document: auompanying this transmission may contain information that is con?dential and/or lcgally privileged The information is intended only for the use by the Indivxdual or cntity names on this transmission sheet. If you are not the mtundcd recipient, you are hereby noti?ed that any disclosure, copying. distribution, or the taking of any action in reliance on the Contents of this information is strictly prohibited. If you have this talc-copy crror. plcasc notify us by telephone immediately so that We can arrange for the return of tht? original documents to us at no to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000077 Fann'lies?'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Wednesday, Match 27, 2013 The time period of this report 15 from 7:00 AID. [prior other working day} to 7:00 zi.m. (current of?ce working day] Courtney Ghilain Incident Report 78707 (Reference #:78707 .l I nl II. I I. Sapphire RTP 03/26/13 House began looking for objects to but with. She went into the bathroom and took the light bulb cover off and used it to break a ight bulb. Staff immediately initiated a standing restraint. (3 min) Aaron Alston - Restraint Seated Restraint Assisting: Andrew Enright 0 - Assault/Aggression Standing Assisting: John (Nick) Moriana CONFIDENTIALITY NOTE 2 The documents accompanying this telecopy transmission may contain information that is con?dential and/or legally.- privilegcd. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended rcc1picnt. you are hereby noti?ed that any disclosure, copying, distribution. or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. If you have received this telecopy in error. please notify us by telephone immediately so that we can arrange for the remm of the original documents to us at no cost to mu. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000078 FamiliesErst, Inc. 2100 Fifth Street, Dan's, CA 95616 24 Hr. CL Report Thursday, March 28, 2013 The time period of this report is from 7.00 11.171 (prior of?cc- working day) to 7:00 a.m. {current of?ce working day) Michelle Glicksman Lisa Robertson Incident Report 78718 (Reference #:78718 Mum Adventurer RTP 03/27/13 Field began to assault staff, which at that point we initiated a standing. He then began to struggle out, so we transitioned into a team prone. (18 min) gem Adrian Mendoza Restraint Team Prone Assisting: Kyle Gadick Assault/Aggression Standing Assisting; Zachariah Fromm Lisa Robertson Incident Report 78721 (Reference #:78721 Ranger DTP 03/27/13 Back to School lunged at staff, wildly punching. (20 min) Reporting; Edgar Zamora - Restraint Team Prone Assisting; Oscar Lopez 0 - Assault/Aggression Standing Incident Report 78719 (Reference #:78719 .I . I I Ranger Outsnde of Campus DTP 03/27/13 was running around campus and when he had the opportunity, he assaulted me by punching my chest. Therefore a standing restraint was initiated. (33 min) John (Nick) Moriana - Restraint Seated Restraint Efren Sanchez-Delgado - Assault/Aggression Team Prone Assisting; - Dehn Other Team Prone Standing Quiet Room Incident Report 78720 (Reference #:78720 Donor-Heu- llniO- Hf ?l?nridono- I ?ma n0 Int-id?. ara?nn Thr?l??n.? CONFIDENTIALITY NOTE 1 ?l'hc documents accompanying' this may contain information that Is confidential and/"or legally privileged. The information IS intended only for the use by the mdmdual or rntiry namcs on this transmissmn Slch?l. If you are nor the intended rt-apic-nt, you arc nori?ed that any disclosure, copying, distribution, or taking of any action in reliance on the Contents of this telecopied information is strictly prohibited. If you have received this [eh-Copy in error. plcasa notify us by immcdiarch' so that WC can arrange for the return of the original documents to us at no cost [0 you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000079 Fann'lies?'ts I, Inc. 21001717211 Street, Davis, CA 95616 24 Hr. CL Report Thursday, March 28, 2013 The time period of this report is from 7'00 am. (prior oft?ice working day; to 7:00 a.m. (current office working day) Ranger RTP 03/27/13 House In order to help to kee ourselves safe and reduce hostility within the house of other peers participating in crisis, we had to escort in the Quiet Room upon assaulting staff. (20 min) Repomng: Efren Sanchez-Delgado - Restraint Quiet Room Assiglng: Edgar Zamora - Assault/Aggression Lisa Robertson Incident Report 78722 (Reference #:78722 03/27/13 Outside of Pioneer House Ranger RTP lunged at Claudia, trying to punch her. (31 min) gem Edgar Zamora - Restraint Team Prone John (Nick) Moriana - Assault/Aggression Standing Claudia Vazquez CONFIDENTIALITY NOTE 2 The documents accompanying this telecopy transmission may contain information that is con?dential and/or legally priVilcged. The information is unended only for the use by the mdiV'idual or entity names on this trausnilssum sheet, If you are not the intended recipient. you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on contents of this information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no Cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000080 Lisa Robertson Fam'll'eSFIrs t, Inc. 2100 Fi?b Street, D3 W's, CA 95616 24 Hr. CL Report Friday, March 29, 2013 The time period of this report is from 7:00 am. (prior of?ce wnrking day) to 7:00 a.rn. (current oft-ice working day) Incident Report 78730 (Reference #:78730 In Program Ranger DTP 03/21/13 was contained. (14 min) Incident Staff: luggent Tree: Restraint - Assault/Aggression Reporting: Marcos Aimeida Assisting: Lanai O'Brian Assisting: Kyle Garlick Assisting: Dean Valencia CONFIDENTIALITY NOTE i Parking Lot Rg?rgin; Tyge: Standing 1 The documents accompanying this tt?lerupy transmission may tnnmin information that Is confidential and/0r legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet: If you are not the intended recipient, you hereby noti?ed that any disclosure, copying, distrihulicm, or the taking of any action in reliance on the contents of this telecopied informatinn is strictly prohibited. If ynu have received this telecnpy in (strut, please notify us by telephone immediately that we can arrange for the return (it the original documents to us at no cost It} you. 'l'hank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000081 Fanu'IJ'esE'rs t, Inc. 2100 Street, Dan's, CA 95616 24 Hr. CL Report Monday, April 01, 2013 The period of this rcpurt is from '00 am. (prior uf?u day: in (Ill (um-m attic: working dav'. Incident Report 78748 (Reference #:78748 2mm Ranger RTP 03/31/13 Resource Center .. - -..-..- e- left on a day visit with his family off of campus and forgot to take 12 PM medication. mm mm Remains]: Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report 78740 (Reference #:78740 Pioneer RTP 03/30/13 Resource Center missed his noon medications. M?id nt Staff: Brenda Vermette - Med Error - Missed Dose at FamiliesFirst Incident Report 78739 (Reference #:78739 I . . I I Pioneer RTP 03/30/ 13 Resource Center missed his 3 PM medication. Insidentlme. Brenda Vermette - Med Error - Missed Dose at FamiliesFirst Incident Report 78745 (Reference #:78745 Wellington: Emanm Widen: Wastes-int Jade RTP 03/30/13 House made a statement about staff. Reporting: Johnny Tillis Other -) Incident Report 78738 (Reference #:78738 WW Emmi: WM Sapphire RTP 03/26/13 08.45PM Outside left supervusnon, made multiple cuts wuth glass, was held in a standing till police arrived. Taken to Sutter ER and 5150 hold. We released and returned to campus that night. Titration.- Tahiti-M Tun-I Ono?s-sin. Tun.- CONFIDENTIALITY NOTE 'l'hc atcumpzinying this transmissmn may contain information that is con?dential and/m Mull): privle-gcd. The information is intended uniy fur the use by the or entity names (in this transmissmn If mu are not the intended recipient, you an- noti?ed that any disclosure, copying, distribution. or the taking of any reliance on the contents of this tclcuipicd is strictly prohibited. Ifynu have [cu-wed this ICIL in error. please notify us by telephone immediately that we can arrange for the return nt? the nnguml documents in us .it nu rust to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000082 Fatm'lies?kst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Monday, April 01, 2013 The time period of this repon is from 7:00 am. (prior office Working day) to 700 a.m. {current of?ce working day) Kimberly Rowerdink - Hospitalization (5150 Hold) Standing Assiging: John (Nick) Moriana - Law Enforcement Contact Noel Salazar - Restraint - Accident/Injury to Child Other Other Incident Report 78744 (Reference #:78744 I I Sapphire RTP 03/30/13 House left campus without permission. She picked up a piece of broken glass off the ground and cut her arm. She was immediately placed in a standing restraint. The police were noti?ed and the ambulance took- to the Emergency Room. (2 min) Reporting: Aaron Alston - Law Enforcement Contact Standing Assigng: Marcos Almeida - Restraint - Accident/Injury to Child Other Incident Report 78750 (Reference #:78750 WNW 2mm Sapphire RTP 03/31/13 Bedroom #3 was walking around campus with staff in close supervision saying, wanna pull my staples out." She walked into the house to her room and began pulling out the staples. She was physically deterred, then placed in a standing restraint. (26 mm) Andrew Enright - Restraint Team Prone Banging; Christopher Bryce - Assault/Aggression Standing Steven Knowles Other Assisting; Rosa RetZer Incident Report 78736 (Reference #:78736 WW 2mm Trailblazer RTP 03/29/13 Bedroom #2 was escalated in his room and making suicidal statements about grabbing a kitchen knife. He became assaultive an grabbed and pushed staff when deterred from going to the kitchen. Mug; Matthew Brown - Suicidal Ideation Keana West 0 - Assault/Aggression Assisting; Marcos Almeida CONFIDENTIALITY NOTE 2 The documents accompanying this transmission may contain information that is con?dential and/or legally prinleged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure. copying, distribution, or the taking of any action in rcliancc on the Contents of this tclecopietl information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000083 FaIm'II'esE'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Tuesday, April 02, 201.3 The Ilmt? period of this report is from 7:00 am. (prior of?ce working dayj to "7:00 2.m (current office working day) Andrea Guthrie Incident Report 78763 (Reference #:78763 2mm Jade RTP 04/01/13 Activity Center informed me that she feels uncomfortable with a peer telling her that said peer is bisexual. mum Insidenune; Mug; John (Nick) Mariana Other Julia Braun Incident Report it: 78755 (Reference #:78755 Pioneer RTP 03/24/13 10309AM HOUSE was kicking and punching staff. We evaded as he continued. We put hands on him and placed him in containment. (30 min 3mm}; Adriana Escobar - Restraint Team Prone Assisting; Anthony Aispuro-Sanchez - Assault/Aggression Standing Andrea Guthrie Incident Report 78764 (Reference #:78764 Wen: Jade RTP 04/01/13 Activity Center A peer stated that she was uncomfortable with- telling her that she is bisexual. John (Nick) Mariana Other Lisa Robertson Incident Report 78757 (Reference #:78757 Donne-0530 IIHIO Tao-3d? Oman.? I. Tim. Tun-51love. hf.?nn CONFIDENTIALITY NOTE 1 The accompanying this transmismon may contain information that is con?dential and/or legally The information is intended only for the use by the individual or entity names on this transmission sheet If you arc not the intended recipient, you are hereby notified that any disclosure, copying, dismbution, or thy mung of any action in rclunu- on contents of this telecopicd information is strictly prohibited. If you have this In error, please notify us by telephone immediately so that we can arrange for return of original m) Request (Q01 3-201 1 Incident Reports) 000084 Fatm'liesFirst, Inc. 2100 Fifth Sat-ct, Davis, CA 95616 24 Hr. CL Report Tuesday, April 02, 2013 The nme period of this repon ts from 7.00 1m. (prior of?ce Working day) to 7:00 a.rn. (current of?ce workmg day) Ranger DTP 04/01/13 douse was pushing forcefully into staff. (24 min) Edgar Zamora - Restraint Team Prone Assisting; Claudia Vazquez - Assault/Aggression Standing Assisting; Robert Dehn Incident Report 78758 (antennae #:78758 Want Lo?C?at?m?Q?dew Ranger RTP 04/01/13 Slallw became assaultive and attempted to stab us with a fork. (28 min) Wm; Erica Retzer - Restraint Team Prone Mug; Claudia Vazquez 0 - Assault/Aggression Standing Edgar Zamora Incident Report 1875? (Reference #178756 W190: Emma: Ranger RTP 04/01/13 House was being extremely dangerous by hitting, kicking, and thrownng objects at staff. (11 min) messing; Brett Atwood - Restraint Escort Nicholas Rhodes 0 - Assault/Aggression Wall?Assisted Genevieve Carnes Quuet Room CONFIDENTIALITY NOTE 2 The documents accompanying this telempy transmissiOn may contain informanon that is con?dential rind/or Izgzally privileged. The information IS intended only for the use by the individual or com} names on [no Imus] .xlu-rl ll you are not the intended recipient, you are hereby noti?ed that any disclosure. copying, dismhunmi. ?th53 of any acuon in tehancc on the Contents of tins telecopied information 15 strictly prohibited 1: )Im luvt' tut-Wed :lm tdccopy error. please notify us by telephone immediately so that we can arrange for the return of the origtml dFBS?F?I?o'h?tsEl?g {201 3-201 1 Incident Reports) 000085 FamJYJ'eerst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Wednesday, April 03, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 a.m. (current office working day) Michelle Glicksman Andrea Guthrie Incident Report 78768 (Reference #:78768 Adventurer DTP - began to aggressively push into staff which at that point, we initiated a standing. He began to try to struggle out, which at at point we transitioned into a team prone. (12 min) 04/02/13 Side Porch Reporting; Adrian Mendoza - Restraint Team Prone Assisting: Sule Anibaba - Assault/Aggression Standing Aaron Alston Assisting: John (Nick) Moriana Misaki Curtis Incident Report 78776 (Reference #:78776 Emuun Jade RTP 04/02/13 Bleachers near Resource Center Wm-informed me that- had told her that she touches people in her sleep. John (Nick) Moriana Other Incident Report 78771 (Reference #:78771 Andrea Guthrie Voyager DTP 04/02/13 Pole Line and 5th Street was Upset he did not have privileges and walked out of the house and off of campus, while Kristin and I shadowed him. er 20 minutes, he walked back to the house. Kristin Manrique - Law Enfortement Contact Kristan Warren Other 3mm Jacob Babcock CONFIDENTIALITY NOTE 1 The documents accompanying this telccopy transmission may contain information that is con?dential and/or legally The information is intended only for the use by the individual or entity names on this transrnisswn sheet. If you are nor the intended reCipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of my action in reliance on the contents of this telecopicd information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original d??g F68 "E?q'll?gt %13-2011 Incident Reports) Familz'esFir-st, Inc. 2100171321: Sweet, Davis, CA 95616 24 Hr. CL Report Wednesday, April 03, 2013 The time period of this report is from 7:00 am. [prior office working day) to 7:00 a.m. (current of?ce working day) Julia Braun Incident Report 78777 (gator-anon #:78777 Jade RTP 04/02/13 - 08: 10PM W- Ie? supervision, running. Police were noti?ed. She returned to campus on her own. Off Campus 5 - Law Enforcement Contact mixing; Patrick Oleson-Wheeler - Short-Term Runaway gm Nolan Bradley Assisting: Whitney Shettler Assisting: Adrian Mendoza Incident Report 78767 (Reference #:78767 WW Pioneer DTP 04/02/13 Outside be an to run around campus and as staff attempted to verbally de-escalate him, he began to push into staff. I evaded and as continued, he was placed into a standing. (31 min) Bryce Lombard - Restraint Team Prone Ming; Oscar Lopez 0 - Assault/Aggression Standing gagging; Felicia Thomas CONFIDENTIALITY NOTE 2 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally The information is intended only for the use by the indivrdual or entity names on this transmission sheet. If you are not the intended you are hereby noti?ed that any disclosure, copying. distribution, or the taking of any action in reliance on the of this information 15 strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original 5' Th cm; Incident Reports) 000087 Fm?lr?esFirst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Ht. CL Report Thursday, April 04, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 chrrent office working day) Incident Report 78788 (Reference #:78788 WW Emnm Wilcox Sapphire RTP 04/03/13 House stated that she was hungry because she had purged her lunch and dinner. minus; 3mm Andrew Enright Other Aaron Alston - Incident Report 78786 (Reference #:78786 ammonia: 2mm Wonder-t Voyager RTP 04/03/13 - Therapy Room came back from Therapy and showed me a cut that occurred during his sessmn. Reporting: Misaki Curtis - Accident/Injury to Child Assisting: John (Nick) Moriana Incident Report 78789 (Reference #:78789 WW 2mm Jade RTP 04/03/13 Doctors Appointment (Off Campus) made a statement on a doctors appointment about sexual abuse. She stated that a peer attempted to touch her in a sexual manner at her previous group home. Caitlin Scott Other Incident Report 78784 (Reference #:78784 Wm Emma: Ranger RTP 04/03/13 Outside Parking Lot After wandering around campus and attempting to get inside locked/unlocked vehicles,- was assaultive after he was given the direction to go to the Quiet Room. He punched Adrian, therefore we escorted him to the Quiet Room. (8 min) 1mm Losidentlm ain Witnessing: Claudia Vazquez - Restraint Escort Rgpg?ing; Efren Sanchez-Delgado - Assault/Aggression Quiet Room Adrian Mendoza Other CONFIDENTIALITY NOTE The documents accompanying this transmission may contain information that is con?dential and/0r legally priVilegcd Tilt: mformation is intended only for the use by the individual or entity names on this mnsmissmn sheet. If YOU are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distnbution, or the tilting of any action in reliance on the contents of this tclecopicd is strictly prohibited. if you have this telecopy in error, please notify us by telephone immediately so that WC can arrange for the return of the original Relq'lleslt M1 3-201 1 Incident Reports) 000088 Farm'lies?'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report TI: utsday, April 04, 2013 The time period of this report is from 7:00 am. (prior office working day} to 7:00 arm. (current of?ce workmg day) Incident Report 78785 (Reference #:78785 Voyager RTP 04/03/ 13 House was continuously pushing and hitting staff after we had evaded and switched out. - was continuing to assault; a restraint was then initiated. (5 min) Bryce Lumbard - Restraint Team Prone 3mm; Dean Valencia - Assault/Aggression Standing David Stewart 55mg; Maxwell Thomas Incident Report 78790 (Reference #:78790 In min W01 We: Voyager RTP 04/03/13 Side Porch was attempting to help a peer who was in crisis. - then threatened to punch me and kill himself. (8 min) Kamika Sherwood - Restraint Team Prone Assisting: Brett Atwood - Suicidal Ideatlon Standing Assisting; Maxwell Thomas - Assault/Aggression Incident Report 78787 (Reference #:73737 WW 2mm Voyager RTP 04/03/13 07:01 PM Kitchen W- attempted to crawl over into a room while verbally threatening staff. Logan and I stopped- and as he began to hit Logan with his fist, we placed him in a standing restraint. (4 min) Rachel Fader - Restraint Standing gem Dawd Stewart 0 - Assault/Aggression Logan H655 CONFIDENTIALITY NOTE 2 The documents accompanying this transmission may contain information that is con?dential and/or legally privileged. The information is intended only tor the use by the indiVidual or entity names on this transmissmn sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information IS strictly prohibited. Ifynu have received this Iclccopy in error, please notify us by telephone immediately so that we can arrange for the return of the original Wilt Raiin 1201 3-201 1 Incident Reports) 000089 FamiliesE'rst, Inc. 2100 Fifth Street, w's, CA 95616 24 Hr. CL Report Fa'da y, April 05, 2013 The time period of this report is from 7:00 a m. (prior of?ce Working day) to 7:00 am. oi'?cc working day) Incident Report 78798 (Reference #:78798 I. .II . I I. .l Pioneer RTP 04/04/13 Davns attempted to leave supervi5ion by gonng through the back door. 1mm ReQOrting: Anthony Aispuro-Sanchez - Law Enforcement Contact Assisting: Marcos Almeida Other -) Incident Report 78805 (Reference #:78805 2mm lm Sapphire RTP 04/04/13 Bathroom #1 Myself and Aaron heard gagging noises, as though someone was puking while. was usmg the restroom. Witnessmg: Aaron Alston Other Luanna Toney Incident Report 78799 (Reference #:78799 Re 0 In i 2mm mm Ranger RTP 04/04/13 House shown unsafe behavior by assaulting staff (36 mm) in Tm: Witnessing: KamikaSherwood - Restraint Team Prone Melissa Van Sambeek - Assault/Aggressuon Standing Assisting; Eduardo Villalobos Incident Report 78800 (Reference #:78800 Ranger DTP 04/04/13 - Front Parking Lot of Campus Brief Degg?p?gn; Due to history of unsafe behavnor while in vehicles and for being assaultive, - was placed in an escart. This turned into a team prone for continuing assaults.- continued unsafe assaultive behavior, resulting in 2nd 3rd team prones. (36 min) Regorting: Lanai O'Bnan - Restraint Escort Aer-crinn- Volt-aw Queen? - Accoiilf/Annroccinn Ctr-n" CONFIDENTIALITY NOTE 1 The accompanying this tL-lccopy transmission may contain information that IS con?dential and/or li-gally privileged. The information is Intended only {0r use by thc~ indindunl or names on this transmission sheet. If you are not the rcripicnt? you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents oftliis information is strictly prohibited. lfyou have ri-ct-iw-d this telecopy ui error. please notify us by telephonr immediately so that we can arrangi- for the: return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000090 Fam'lr'esE'rst, Inc. 2100 Street, Davis, CA 95616 24 Hr. CL Report Frida y, April 05, 2013 The time period of this report is from 7,00 am. (prior of?ce Working clay) to 7:00 a.m. (current of?ce working day) Assisting; Marcos Almeida Escort Andrea Chiles Team Prone Team Prone Team Prone Incident Report 78804 (Reference #:78804 Sapphire DTP 04/04/13 In Front of Play Structure ri - was attempting to harm herself by pulling the staples out of her arm, that were not supposed to yet be removed. (31 min) Mn id 0' seam Witnessmg: Brett Atwood Restraint Team Prone Reporting: Aaron Alston - Acadent/Injury to Child standing Assasting: Eduardo Villalobos Other Standing Assisting: Kyle Garlick Assisting: Erin Milligan Assisting: Caitlin Scott Assisting: Marcos Almeida Incident Report 78797 (Reference #:78797 Adventurer RTP 04/04/13 Resource Center returned with incorrect amounts of his medications after a home visut. Caitlin Scott - Med Error - Missed Dose at Home Incident Report 78802 (Reference #:78802 nggm'ng Quit 9f Incident [Eggmm Date Ilme of Incident Location 91 Ing'ggm Voyager RTP 04/04/13 House left campus through his bedroom WlndOW. Police were notified and he returned to campus. InsidenLSJa?E: mumps; Witnessing: Brett Atwood - Law Enforcement Contact Repomng; Dean Valencia - Short-Term Runaway Leon Jones Assisting; Matthew Bettencourt CONFIDENTIALITY NOTE 2 The document: .Iccompanying this lelecopy transmission may contain information that is con?dmtial and/or privrleged. The information is intended only for the use by the individual or entity names on this transmission sheet If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this tilt-copied information is strictly prohibited. If you have received this tt-lcropy in error. pleasr notify us by telephone immediately so that we can arrange for the return of the original documents to us :it no cost to you Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000091 FamiliesE'z-st, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CCL Report Frida y, Aptil 0.5; 2013 The time period of this report is from 7:00 a.m. (prior oft-ice working day; to 7:00 a.m. (current of?ce working day) Incident Report 78801 (Reference #:78801 Trailblazer RTP 04/04/13 Sapphire (bedroom peer,- made a statement that he touched her in a sexual manner Without her permissmn. Lu anna Toney Other Whitney Shettler Incident Report 78806 (Reference #:78806 WW 2mm W3 Sapphire RTP 04/04/13 Bedroom #3 stated another peer- had sexually touched her without her and after she said llno.? Reporting: Luanna Toney Other Aggig?ng: Whitney Shettler CONFIDENTIALITY NOTE 3 The documents accompanying this telecopy transmission may contain information that is confidential and/or legally prmleged. The information is intended only {or the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying~ distribution, or the taking of any action in reliance on the contents of this telecopit-tl information is strictly prohibited. ?you have received this telecopy in error, please notify Us by telephone immediately so that We can arrange for the return of the original documents to us at no cost to you. 'l'hank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000092 FamiliesE'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Monday, April 08, 2013 The tune period of this report is from 7:00 am. (prior office Working day} to 7:00 am. {current working day) Incident Report 78837 (Reference #:78837 Winn: Bantam Wu: Ranger RTP 04/07/13 Side Porch of Sapphire House was pushing into staff. (23 min) 33993139; Edgar Zamora - Restraint Team Prone Claudia Vazquez - Assault/Aggression Standing Inddent Report 78834 (Reference #:78834 Emma: musician: Pioneer RTP 04/07/13 House awoled off campus. We noti?ed the police. He came back with scratches that required two Band- Aids. Adriana Escobar - Law Enforcement Contact Steven Knowles 0 - ACCIdent/Injury to Child - Short-Term Runaway Incident Report 78832 (Reference #:78832 0 In Emma Widens Pioneer RTP 04/07/13 - 3rd Bedroom shown me a drawing that he said his roommate drew; picture of a naked woman, Men; Repoging: Nolan Bradley Other Incident Report 78823 (Reference #:78823 I MW Voyager RTP 04/06/13 Bedroom Wm I walked by- room and saw him in his bed with his hand down his pants. Christian Villela Other Reporting: Jason Wade CONFIDENTIALITY NOTE The documents accompanying this uansmissnon may contain information that is con?dential and/0r legally The information is intended only for the use by the individual or entity names on this transmissmn sheet. If YOU are not the intended rectpient, you are hereby non?ed that any disclosure. copying, distribution, or the taking of any action reliance on the contents of this telecopicd information is strictly prohibited. If you have received this in error, please notify us by telephone immediately so that we can arrange {Or the renim of the original hineCFRA 3-201 1 Incident Reports) 000093 Fann'liesFirst, Inc. 2100 Fifth Street, Dan's, CA 95616 24 Hr. CL Report Monday, April 08, 2013 The time period of this report is from 7:00 am. (prior of?ce working day} to 7:00 am. (current of?ce working day) Incident Report 78818 (Reference #:78819 Emsnm Sapphire RTP 04/05/13 Field stated that her throat had been bleeding from forcing herself to throw up. Cristina Mendoza-Sanchez - Accident/Injury to Child mm Hillary North Other Re?ning; Caitlin Scott Incident Report it: 78840 (Reference #:78840 13:91th Went Sapphire RTP 04/07/13 5th Street was walking through the front parking lot with her pea and walked off campus. Davis Police Department were contacted. She returned on her own after about 40 minutes. Angela Lira - Law Enforcement Contact min; Patrick Oleson-Wheeler - Short-Term Runaway Islam Hassanein --) Incident Report 78838 (Reference #178838 Emir-m Widens Wooden: Voyager RTP 04/07/13 5th Street, Pole Line Rd, Backyard rode his bike off of campus without permission and was brought back by Davis Police Department. Witnessing: John (Nick) Moriana - Law Enforcement Contact Witnessing; Erica Retzer - Short-Term Runaway Reporting: Jacob Babcock Incident Report 78812 (Reference #:78812 I. all]: Adventurer DTP 04/05/13 Quiet Room assaulted staff by aggressiver kicking and hitting staff and throwing his shoes at staff. (8 min) Witnessing; Adriana Escobar - Restraint Team Prone Felicia Thomas - Assault/Aggression Assisting: Anthony Aispuro-Sanchez CONFIDENTIALITY NOTE 2 documents accompanying this telecopy transmissmn may contain information that is con?dential and or legally The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in on the contents of this information is strictly prohibited. If you have received this in error, please notify us by telephone immediately so that we can arrange for the return of the original ?mm E?i?ie?m 3-201 1 Incident Reports) 000094 Fam'licerst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Monday, April 08, 2013 The time period of this report is from 7:00 am. (prior of?ce Working day) to 7:00 amt (current of?ce working day) Incident Report 78813 (Reference #:78813 Widen: 2mm Wooden: Ranger DTP 04/05/13 - Outside shattered a glass door, ran around campus, and assaulted staff. Therefore, he was escorted to the Quiet Room. Due to his ?ghting nature and resistance, closing the door was not achieved and a standing to a team prone was placed. (29 min) mg; Marcos Almeida - Restraint Escort My; Efren Sanchez-Delgado - Assault/Aggression Team Prone Assisting; Robert Dehn Other Standing Incident Report 78814 (Reference #:78814) a I. .II [mill I I. Ranger DTP 04/05/13 - 04: 15PM Porch stated that he received an injury a few days ago when a fork pierced his chest during a containment. He reported that the injury was starting to ache now. Resource Center staff was noti?ed and offered First-Aid to child. Efren Sanchez-Delgado - Accident/Injury to Child Wing; Lisa Robertson Other Incident Report 78825 (Reference #:78825 WW Emma Wooden: Adventurer RTP 04/07/13 Resource Center After several separate attempts, - refused his 12 PM medication. modem 105mm mg; Angela Lira - Med Error - Client Refused To Take Medication Incident Report 78831 (Reference #:78831 WW grizng WM Adventurer RTP 04/07/13 House managed to stay out of house chaos until the house settled down, then he began a high?pitched yelling, laughing, re Sing to follow directions, and running out of the house. Insidcm Rachel Fader Other Adrian Mendoza CONFIDENTIALITY NOTE 3 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended you are noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this in error, please norify us by telephone immediately so that we can arrange for the return of the original Linecm 3-201 1 Incident Reports) 000095 Familiesli'irst, Inc. 2100 Street, Davis, CA 95616 24 Hr. CL Report Monday, April 08, 2013 The time pcnod of this report is from 7:00 a.m. (prior of?ce Working day) to 7:00 am. (current office working day) Incident Report 78820 (Reference-M78820 mm Ranger RTP 04/06/13 - House 'Hawas guided to the Quiet Room after assaulting staff and being Inappropriate to female staff. When elbowed sta we nsitioned to an escort to the Quiet Room. (56 min) Marcos Almeida - Restraint Escort gem Efren Sanchez-Delgado - Assault/Aggression Quiet Room Kelsey Blissett Quiet Room Quiet Room Quiet Room Incident Report 78821 (Reference #:78821 WW 2mm Widens Ranger RTP 04/06/13 House W- refused his 3 PM medication. 331mg; Brenda Vermette - Med Error - Client Refused To Take Medication Incident Report 78836 (Reference #:78836 W03 2mm Wooden: Ranger RTP 04/07/13 - Off Campus walked off of campus and was brought back by me Davis Police Department. Angela Lira - Law Enforcement Contact 3mm; Islam Hassanein 0 - Short-Term Runaway Incident Report 78822 (Reference #:78822 Emerem WW Went Ranger RTP 04/06/ 13 House was pushing forcefully into staff. (34 min) Edgar Zamora - Restraint Escort Assisting; Efren Sanchez-Delgado 0 - Assault/Aggression Standing Quret Room Quiet Room Incident Report 78839 (Reference #:78839 WW ?nest-m Wooden: Wooden: Sapphire RTP 04/07/13 - House CONFIDENTIALITY NOTE 4 The documents accompanying this teleropy transmissron may contain information that is confidential anti/or legally The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this tclecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original ?m ?r??ii ??qhh?ns Incident Reports) 000096 Fann'licsE'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Monday, April 08, 2013 The time period of this report 15 from 7:00 am. (prior of?ce working day) to 7:00 am. (current office working day) stated that her visit went poorly, because her mother kept bringing up her safety issues and visions. Also, that he father was touching and poking her chest while they were playing. modem Andrew Enright Other Incident?Report 78841 (Reference #:78841 MW Erratum Wt Sapphire RTP 04/07/13 5th street was walking through the front parking lot with her peer and walked off campus. Davis Police Department were contacted. She returned on her own approximately 50 minutes. Angela Lira - Law Enforcement Contact 33min; Islam Hassanein - Short-Term Runaway Patrick Oleson-Wheeler Incident Report 78842 (Reference #:78842 .I I In Sapphire RTP 04/07/13 5th Street I was emotionally escalated and walked off of campus. She returned on her own after about 30 minutes. Davis Police Department was noti?ed. 1W witnessing; John (Nick) Moriana - Law Enforcement Contact 3m Islam Hassanein - Short-Term Runaway Incident Report 78819 (Reference #:78819 WW Emma Widen: Widen: Sapphire DTP 04/05/13 Play StructUre/Front of Admin was pushing into staff in an attempt to leave campus. After multiple prompts, we initiated a standing containment en transitioned to a team prone due to struggling. (17 min) mg; Luanna Toney - Restraint Team Prone Assisting; Oscar Lopez 0 - Assault/Aggression Standing Assisg?ng: Marcos Almeida Other Courtney Ghilain Incident Report 78824 (Reference #:78824 Email: Wander]: Sapphire RTP 04/06/13 Front of Campus attempted to run into the street. I tried to physically deter her from the street, but she tried to push through me. We then placed a standing restraint. min) CONFIDENTIALITY NOTE 5 The documents accompanying this transmission may contain Information that is con?dential md/ or legally pm'ileged The information is intended only for the use by the Individual or entity names on this transmissmn sheet. If you are not the intended reCIpient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have this [cit-copy in error, plcasc notify us by telephone Immediately so that we can arrange for the return of the original documents to us at no cost to you Thank vou. PBS Front Line PRA Request '(201 3-2011 Incident Reports) 000097 Fam'lz'csErst, Inc. 2100 Street, Davis, CA 95616 24 Hr. CL Report Monday, April 08, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 am. (current of?ce working day) 3m; Aaron Alston - Restraint Standing Matthew Brown 0 - Assault/Aggression min; Johnny Other Assam; Logan Hess Other Incident Report at: 78843 (Reference #:78843 Sapphire RTP 04/07/13 House stated that her grandmother spoke to her about family issues, which she was told not to do by clinical, and that she would not be doing anything clinical said to do anymore. midsummer Ming; Andrew Enright Other Incident Report it: 78809 (Reference #:78809 WW Emma: WM Widens Adventurer RTP 04/05/13 House was in the hallway assaulting staff by punching, kicking, and spitting; so he was escorted to the Quiet Room. (1 min) arm-1m Rem; Charles Garcia - Restraint Escort 5551mm; Sule Anibaba - Assault/Aggression Quiet Room Incident Report 78830 (Reference #:78830 Beating Unit of mom 2mm Adventurer RTP 04/07/13 Resource Center was not refilled in time for him to receive his 3 PM medication. 1mm mm Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report #2 78833 (Reference #:78834 1 mm Pioneer RTP 04/07/13 Bedroom #3 roommate shown me a picture of naked woman that he said - had drew. Nolan Bradley Other CONFIDENTIALITY NOTE 6 The documents accompanying this teiecopy transmission may contain information that is con?dential and/or legally The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended temple-m, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopicd information IS strictly prohibited. If you have received this telecopy in error, piease notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000098 If II.) I Inc. 7 2100 Street, Davis, CA 95616 24111: CCL Report -- . 3r. Tuesday, April 09, 2013 timc pt?rlt)d of this report is from 700 am (print of?ce working day} to 7:00 am. {current of?ce working day) -) Incldent Report 78870 (Reference #:78870 MW _eg__Pr ram tlon got Jade DTP 04/08/13 Bedroom had a bad phone call with her social worker and gave statements about the phone call and of suicidal ideation. m; Patrick Oleson-Wheeler - Suicidal Ideation Other Incident Report #:78865 (Reference #:78865 Ranger DTP 04/08/13 - House was trying to punch staff. (61 mm) Edgar Zamora - Restraint Team Prone Assisting; Claudia Vazquez - Assault/Aggression Team Prone Assisting; Robert Dehn Standing Assisting; Bryce Lumbard Standing Incident Report 78861 (Rererehce #:78861 Wight 2mm Adventurer DTP 04/08/13 Back of School began to throw hard objects at staff. Police were called, which at that point walked with staff to the Quiet Room. He arged the door, which I then closed the door. I opened it again and attempted talk to him when he charged again. (32 min) Repoging: Adrian Mendoza - Law Enforcement Contact Quiet Room mm; John (Nick) Moriana - Restraint Quiet Room Assisting; Stephen Lendzion - Assault/Aggression Incident Report #:78869 (Reference #:78869 Ranger RTP 04/08/13 Outside of House was placed in a standing for punching staff. (9 min) Indicating; 33mm Edgar Zamora - Restraint AeeIcHnn- 1Ahn fMir-Ir\ Mariana - CONFIDENTIALITY NOTE 1 The documents accompanying this tclecopy transmission may contain information that is con?dential and/ or legally The information 15 intended only {or the use by the individual or entity namcs on this transmissmn sheet. If you arc not recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000099 Fam'liesFJ'z-s t, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Tuesday, April 09, 2013 'l'he time period of this report is from 7:00 em. {pnor of?ce working day) to am (current of?ce working day) Steven Knowles Other Incident Report. 78868 (Reference #:78868? Ranger RTP 04/08/13 House stated that his roommate had exposed his underwear to him. Edgar Zamora Other I-ncidentReport 78863 (Reference #:78863 WM Emma: Went Ranger DTP 04/08/13 House was trying to punch staff. (13 min) Ming; Edgar Zamora - Restraint Team Prone Claudia Vazquez - Assault/Aggression Standing Assisting: Kristen Warren Incident Report 78804 (Reference-#98864 Emma: new Ranger DTP 04/08/13 Front Parking Lot attempted to AWOL, so we initiated containment. (20 min) mug; Claudia Vazquez - Restraint Escort John (Nick) Moriana Other Standing Stephen Lendzion Angela Lira - Incident Report 78867 (Reference #:78867 Ranger DTP 04/08/13 Front Yard became extremely assaultive and was pushing forcefuin into us, so we initiated containment. (28 min) Witnessing: Bryce Lumbard - Restraint Team Prone Oonnr?nn- Nauru: \la?l?ll?? - CONFIDENTIALITY NOTE 2 The documents accompanying this tclecopy transmissmn may contain information that is con?denth and/(u legally privileged The information is mtended only for the use by the individual or entity names on this transmission sheet. If you are not the intended rempicnt, you are hereby notified that any disclosure, copying, distribution, or the taking of any action in reliance on the Contents of this icltcopicd information is strictly prohibited. lfyou have this in error, please notify us by immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000100 FamiliesFirst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Tuesdays April 09, 2013 The time period of this report is from 7:00 a.m. (poor office working day) to 7.00 a m. (current of?ce working day) Edgar Zamora (Reference #:78858.) V. i 2mm Widens Wooden: Sapphire DTP 04/07/13 Parking Lot in Front of Campus was attempting to leave campus in a distressed state and began pushing into staff. (12 min) Claudia Vazquez - Restraint Standing Christopher Bryce - SuiCIdal Ideatlon John (Nick) Mariana 0 - Assault/Aggression Other Other Incident Regan 78859. (Reference #08859). Emnm Sapphire DTP 04/07/13 Parking Lot In Front of Campus attempted to leave campus in a distressed state and swung at staff with closed ?sts. (13 min) momma Christopher Bryce - Restraint Team Prone John (Nick) Moriana - Suicidal Ideation Standing 55m Steven Knowles 0 - Assault/Aggression Assisgng: Jesus Zamudlo Other Other Incident Reporthiif: 70860 WW Emmi: Wen: Sapphire DTP 04/07/13 Grass near Outside Quiet Room attempted to leave campus by pushing into staff and yelling *l'here is no way you can stop me form hurting myself!" (70 min) Christopher Bryce - Restraint Team Prone John (Nick) Moriana - Suxcidal Ideation Team Prone Steven Knowles 0 - Assault/Aggression Standing Keana West Other Standing Other CONFIDENTIALITY NOTE 3 The documents accompanying this telecopy transmissmn may contain information that is confidential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this tclecopied information is strictly prohibited. Ifyou have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you, PBS Front Line PRA Request (2013-2011 Incident Reports) 000101 Fam'licsE'rst, Inc. 2100 Street, Davis, CA 95616 24 Hr. CL Report Wednesday, April 10, 2013 The time period of this report is from 7:00 a.rn. (prior office working day) to 7:00 a.m (current office working day) Incident Report 78883 (Reference #:78883 3W 2mm Wu: Winn: Ranger RTP 04/09/13 School Quiet Room W?had left campus and was brought back by police of?cers. Back on campus,- was contained after repeatedly an orce lly pushing of?cer Herman and forcefully pulling me towards the ground by my shirt. (5 min) momma: Jennifer Hungerford - Law Enforcement Contact Quiet Room gagging; John (Nick) Moriana - Restraint Assig?ng: Lisa Robertson 0 - Assault/Aggression Incident Report 78887 (Reference #:78887 a I. El II. .l Voyager RTP 04/09/13 Shower #1 opened shower #1 to clean it. A peer was showering in there. He immediately shut the door. Witnessing; Erica Retzer Other Wm; Kristan Warren Incident Report 78888 (Reference #:78888 WW Barium Wu: Voyager RTP 04/09/13 - Shower #1 was in the shower when a peer opened the door to do his chore. maximums; Erica Retzer Other Wm; Kristan Warren Incident Report 78894 (Reference #:78894 WW Emmi: WM Widens Jade DTP 04/09/13 Trailblazer Front Porch made a statement about staff. Incident Stag; lunchtime: Sergio Sanders Other CONFIDENTIALITY NOTE I The documents accompanying this transmissmn may contain information that is con?dential and/"or legally The information is only for the use by the indivrdual or entity names on this transmissmn sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure. copying, distribution. or the taking of any ?man In (chance (in the contents of this telempicd information is strictly prohibitcd. If you have this telecopy in error. please notify us by telephone immediately so that We can arrange for return of the original documents to us at no cost to 'ou. Thank you PBS Front Line PRA equest? (201 3-2011 Incident Reports) 000102 Familt'eer-st, Inc. 2100 Fi?h Street, Davis, CA 95616 24 Hr. CCL Report Wednesday, April 10, 2013 time period of this report is from 7:00 am. [prior office working day) to 7:00 a.m. {current of?ce working day) Incident Report 78886 (Reference #:78886 Voyager RTP 04/09/13 - Field, Bldg, 5th Street walked out of the house without permission and entered the program building through an unlocked door. Upon exiting the program building,- joined peers at the front of campus and left campus, eventually returning with the police. mm - Witnessing: Kristen Warren - Law Enforcement Contact Erica Retzer - Short-Term Runaway Witnessing; John (Nick) Mariana mm; Jennifer Hungerford Lisa Robertson gem Jacob Babcock Incident Report 78892 (Reference #:78892 Went Eastern Widens Sapphire RTP 04/09/13 - Bedroom #2 Chris was walking to bedroom #2 to ask to turn down her music. When he entered her doorway, he witnessed standing on top of her bed in her underwear osmg her window. Reporting: Christopher Bryce Other Asslging: Adriana Escobar Inddent'Report 78877 (Reference #:78877 8W Bantam Winn: Widens Trailblazer DTP 04/08/13 House - mentioned 6 incidents that happened during his week long visit at home in Sonorna. These incidents heavily affecte his mood upon returning to campus. Reporting: Sergio Sanders Other -- Incident Report 78893 (Reference #:78893 . . I I . I I Jade DTP 04/09/13 Off Campus said she was going to run into traf?c to get hit by a car following a dramatic incident in group. We escorted her out of tra and initiated a standing when she pushed staff; attempting to run back into traf?c. (17 min) CONFIDENTIALITY NOTE 2 The documents accompanying this telecopy transmission may contain information that is confidential and/or legally The information is intended only for the use by the individual or entity names on this transmissmn sheet. If you are not the intended recapicnt, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. lfynu have this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000103 Fanu'liesE'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Ht. CL Report Wednesday, April 10, 2013 The time period of this report is from 7:00 a.m. (prior of?ce working day) to 7:00 amt (current office working day) Bryce Lumbard - Restraint Escort gem Nicole Silva - Suicidal Ideation Standing Andrew Enright - Assault/Aggression Other Incident Report 78880 (Reference #:78880 all]: Ranger DTP 04/09/13 Non-Public school was being aggresswe towards staff and in an unsafe environment. Per his plan, he was escarted to the Quiet Room. (1 min) Witnessing: Kristan Warren - Restraint Escart Lanai O'Brien 0 - Assault/Aggression Aaron Alston Assisting: Steven Knowles Incident Report 78881 (Reference #:78881 mm mm Ranger RTP 04/09/13 Front Parking Lot/House Porch was attempting to leave campus and was assaultive. Per his plan, he was restrained. Later,- was assaultlve towar police, causing the police to escort him. (27 min) John (Nick) Moriana - Law Enforcement Contact Escort gem Lanai O'Brian Restraint Team Prone Assisting: Sergio Sanders - Assault/Aggression Standing Other Quiet Room o? Incident Report 78891 (Reference #:78891 Sapphire RTP 04/09/13 -- 5th Street ran into traf?c, attempting to get hit by a car, so I ran into the street and deterred her from running back into oaf?c. Once another staff came to assust, we escorted- to the outside Quiet Room. (2 min) Courtney Ghilain - Law Enforcement Contact Escort Andrew Enright - Restraint Standing Assisting: John (Nick) Mariana Other Incident Report 78879 (Reference #:78879 CONFIDENTIALITY NOTE 3 The documents accompanying this telecopy transmission may contain mformation that is confidential and/ or legally prmleged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are herebyr noti?ed that any disclosure, copying, distribution, or the taking of my action in reliance on the Contents of this telecnpied information is strictly prohibited. If you have this telecopy in error. please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to vou. Than '1 . PBS Front Line PRA Request (2013-2011 Incident Reports) 000104 Farm'ljesFirst, Inc. 2100 Street, Davis, C4 95616 24 Hr. CL Report Wednesday, April 10, 2013 The time period of this report is ?rom 7:00 tun. (prior of?ce working day) to 7:00 mm. (current of?ce working day) Adventurer RTP 04/09/13 Hallway/Quiet Room repeatedly touched his peers and staff despite staff verbally prompting and evading him. - was escorted out of the ha way after he continued to touch his peers and staff inappropriately. (2 min) Remus]; Sule Anibaba - Restraint Escort Assisting; Islam Hassanein - Assault/Aggression Quiet Room Incident Report at: 78889 (heteren'ce #:78889 Ind Voyager walked off of campus and was brought back by the police. 04/09/13 Off Campus ?itnegsigg: Kristan Warren - Law Enforcement Contact Witnessing; Jacob Baboock 0 Short-Term Runaway John (Nick) Moriana mm Erica Retzer CONFIDENTIALITY NOTE The documents accompanying this telecopy transmissmn may contain information that is con?dential and/ or legally privtlegcd. The information is intended only for the use by the individual or entity names on this transmissmn sheet. If you are not the intended rec1pient, you are hereby noti?ed that any disclosure, copying, distnbunon, or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. It'you have received this in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000105 FamilicsE'r-st, Inc. 2100 Street, Davis, CA 95616 24 Hr. CL Report Thursday, April 11, 2013 The time period of this report is from 7:00 am. (pnor of?ce working day) to 7:00 am. (current office working day) Incident Report 78915 (Reference #:78915 WW anagram Walden: Wooden: Ranger DTP 04/10/13 Adventurer Front Yard was contained for pushing forcefully into us. (25 min) Instantly?; Renee Palombi - Restraint Escort Claudia Vazquez - Assault/Aggression Team Prone Caitlin Scott Standing Quiet Room Incident Report 78918 (Reference #:78918 Ranger DTP 04/10/13 House A peer stated that- exposed himself to said peer. m; Edgar Zamora Other Incident Report 78920 (Reference #:78920 uh Wanna: Voyager DTP 04/ 10/13 - 5th street walked out of the house without permission and walked off campus. He stated that wanted to go to Juvenile Hall and kil imself. He walked back with staff. Kristan Warren 0 - Short-Term Runaway Other Incident Report 78921 (Reference #:78921 i Barnum Women: 0 on 1 Voyager DTP 04/10/13 Bedroom #4 was putting a piece of metal in the power socket and began to assault Kristan and I with farceful punches and attempts to bite. We called for assistance and Initiated a supine restraint. (35 min) Witnessing; Marcos Almeida - Restraint Team Prone Logan Hess - Suicidal Ideation Assisting: Kristan Warren 0 - Assault/Aggression Assisg'm: John (Nick) Moriana Other CONFIDENTIALITY NOTE I The documents accompanying this transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have rccuvcd (his telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you PBS Front Line PRA Request (2013-2011 Incident Reports) 000106 FamiliesFir-st, Inc. 2100 Fifi]: Street, Davis, CA 95616 24 Ht. CL Report Thursday, April 11, 2013 The time period of this report is from 7:00 a.m. (prior of?ce working day) to 7:00 a.m. (current office working day) Incident Report it: 78922 (Reference #:78922 2mm Widen: 1mm Voyager DTP 04/10/13 - 5th Street (Just off Campus) ran out of the house and off cam us onto 5th Street. I deterred him and Noel and I contained him when he punched me. avis police responded and took to the hospital for assessment. (16 min) Adrian Mendoza Hospitalization (5150 Hold) Team Prone Witnessing: Kristan Warren - Law Enforcement Contact Standing Logan Hess - Restraint Noel Jones 5 - Suicidal Ideation - Assault/Aggression Other Other Incident Report 78923 (Reference #:78923 2mm Voyager RTP 04/10/13 Resource Center was taken to the hospital by Davis Police and - was not on campus during 7 PM medication time frame. Wag; Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report 78911 (Reference #:78911 2mm Ranger DTP 04/10/13 House was pushing forcefully, trying to bite staff, and punching staff. (44 min) Ming; Edgar Zamora - Restraint Escort Assigning; Bryce Lumbard - Assault/Aggression Team Prone gaming; Marcos Almeida Standing Quiet Room Incident Report 78912 (Reference #:78912 2mm Ranger RTP 04/10/13 Resource Center mm; After several separate attempts, - refused his 3 PM medication. Wart. Incidentlm Begging; Angela Lira - Med Error - Client Refused To Take Medication Incident Report 78913 (Reference #:78913 a . . I I 2mm Ranger DTP 04/10/13 - Outside of Resource Center was contained after repeatedly and forcefully hitting and trying to run into me with a lowered shoulder. (20 min) CONFIDENTIALITY NOTE 2 The documents accompanying this telecopy transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. if you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000107 FamiliesE'rst, Inc. 2100 Fifth Street, Data's, CA 95616 24 Hr. CL Report Thursday, April 11, 2013 The time period of this report is from 700 am (prior ()l-l-lct? working day) to 7:00 am. (current of?ce working day) Kristan Warren - Restraint Team Prone Ming; John (Nick) Moriana - Accident/Injury to Child Standing Ashley McLemOre - Assault/Aggression Other Incident Report 78928 (Reference #:78928 Widens Bantam Washing Sapphire DTP 04/10/13 Bedroom #2 stated that she wanted to die and go to the hospital and she proceeded to tie a cord around her neck in attempt to choke herself. Want - mm Andrew Enright - Suicidal Ideation Assisting: Ashley McLemore Other Incident Report 78919 (Reference #:78919 2mm Went Wm Trailblazer RTP 04/10/13 - House became upset after a call with his mom and he said that he had previously thought about killing himself. Keana West Other Incident Report 78917 (Reference #:78917 Email: Went Ranger DTP 04/10/13 House stated that his peer exposed himself to him. msidantlm Rgpg?lng: Edgar Zamora Other Incident Report 78931 (Reference #:78931 WW 2mm WW Jade RTP 04/10/13 - Field super?cially cut herself with glass she said a peer helped her obtain. CONFIDENTIALITY NOTE 3 The documents accompanying this telecopy transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmissmn sheet If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying. distribution, or the taking of any action in reliance on the contents of this tclecopicd information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to vou. Thank you PBS Front Line PRA Incident Reports) 000108 FamiliesE'rst, Inc. 2100 1am Street, Davis, CA 95616 24 Hr. CL Report Thursday, April 11, 2013 The pcnod of this report is from 7:00 mm. (prior of?ce working day) to 7:00 a.m. (current office working day) Remr?ting: John (Nick) Moriana - Accident/Injury to Child Other Other Incident Report it: 78903 (Reference #:78903 Wu! Bunnie WW Wanda: Adventurer DTP 04/09/13 Field/Front of Campus became upset with the limitations his doctor enforced and ran to the front of campus. He made statements about wanting to run into traffic and walked onto the asphalt. Witnessing: Jennifer Hungerford Other Witnessing; John (Nick) Mariana Other Rewing; Islam Hassanein Assisting; Noel Salazar Assisting: Michelle Glicksman Incident Report 78908 (Reference #:78908 WW Eminent Widens Ranger DTP 04/10/13 House/Davis Community/Dog Park ri - - ran away from campus and was returned to campus by police of?cers. - was assaultive towards police officers, who placed him inside the Quiet Room; closing the door on him. (7 min) Efren Sanchez-Delgado - Law Enforcement Contact Quiet Room Usa Robertson - Restraint - Assault/Aggression Other Incident Report 78909 (Reference #:78909 Email) Widens Ranger RTP 04/10/13 Resource Center left campus without supervision during the 3 PM medication time frame. mm mm Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report 78910 (Reference-#08910 WW 2mm Ranger DTP 04/ 10/13 House/Police Station/Com mu nity walked away from campus, avoiding staff and continuously running from staff. Police assisted by bringing him back to campus, he released- inside the Quiet Room and closed the door. (13 min) CONFIDENTIALITY NOTE 4 The documents accompanying this transmission may contain information that IS con?dential and/0r legally The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the Intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000109 FamiliesFimt, Inc. 2100 Fifi]: Sac-ct, Davis, CA 95616 24 Hr. CL Report Thursday, April 11, 2013 The time period of this report is from 7:00 a.m. (prior of?ce Working day) to 7:00 am (current of?ce working day) Lisa Robertson 5 - Law Enforcement Contact Quuet Room Beaming; Efren Sanchez-Delgado - Restraint Assisting; John (Nick) Mariana - Assault/Aggression Other Incident Report 78916 (Reference #178916 Widen: 2mm Walden: Walden: Ranger DTP 04/10/13 House from the front of campus to the school Quiet Room, due to physical aggression towards staff and encouraging peers on campus to "riot." (45 min) ?imessmg; Efren Sanchez-Delgado - Restraint Escort 33mg; Robert Dehn - Assault/Aggressuon Quiet Room Assisu?ng: Claudia Vazquez ?sistigg; Marcos Almeida Incident Report at: 78926 (Reference #:78926 WM Emmn Widen: LEW Sapphire RTP 04/10/13 - Front of Campus, Parking Lot - - aggresswely pushed into staff repeatedly in attempt to leave supervision and to run into oncoming traf?c. (1 min) mm mm mmessing: Jose Garibay - Restraint Escort Witnessing: Leola Taylor 0 - Assault/Aggression Reporting: Patricia Button Other Assisting; Eduardo Villalobos Assisting; Hilary Sleuter Incident Report 78927 (Reference #:78927 . . I I Etnntam nix: I?m! 9! Insumt Sapphire RTP 04/ 10/13 - 5th Street ran into traf?c, attempting to get hit by a car, so we initiated an escort containment and held her in a standing containment once off of the street. Davis PD transported her to Sutter for assessment. (5 min) Mug; Andrew Enright - Hospitalization (5150 Hold) Escort Marcos Almeida - Law Enforcement Contact Standing - Restraint CONFIDENTIALITY NOTE 5 The documents accompanying this telecopy transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the indivxdual or entity names on this sheet. If you are not the intended recipient. you are hereby noti?ed that any disclosure, copying, distribution. or the taking of any acuon in reliance on the contents of this telecopicd information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for this return of the original documents to us :it no cost to 'ou Thank you PBS Front Line PRA equest (2013-2011 Incident Reports) 000110 FanH'IJ'cerst, Inc. 2100 Fifth Sacet, Dan's, CA 95616 24 Hr. CCL Report Thursday, April 11, 2013 The um: period of this report is from 7:00 am. (prior of?ce Working day) to 7:00 a.m. (current of?ce working day) Incident Report 78930 (Reference #:78930 WW 2mm Wedded: Sapphire RTP 04/10/13 Field A peer stated - gave said peer a piece of glass with which she cut herself with. John (Nick) Morlana Other Incident Report 78907 (Reference #:78007) Brenna: Widens Adventurer RTP 04/10/13 Front of Campus was assaultlve by hitting staff repeatedly with a 3'3" wide stick. We evaded and as- contlnued hitting us, we initiated a containment. (15 mln) Marcos Almeida - Restraint Team Prone 3319mm; Islam Hassanein - Assault/Aggression Logan Hess Other John (Nick) Mon?ana Kristen Warren Incident Report 78924 (Reference #:78924 MW Bantam Wt WM Voyager DTP 04/ 10/ 13 Field had just come back from leaving campus without and was trying to escalate other struggling peers. He arged me, pushing forcefully; leading to containment. (8 min) Witngsing: Jennifer Hungerford - Restraint Escort Wimessing; Noel Jones 0 - Assault/Aggression Standing Beaming; Logan Hess John (Nick) Moriana CONFIDENTIALITY NOTE 6 The documents accompanying this transmission may contain information that is con?dential and/ or legally The information is only for the use by the individual or entity names on this transmissnm sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in rclinnCc on contents of this information is strictly prohibited. If you have received this in error. please notify us by telephone immediately so that we can arrange for the: return of the original documents to us at no cost to you Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000111 Familicerst, Inc. 2100 Fifi]: Street, Davis, CA 95616 24 Hr. CL Report Frida y, April 12, 2013 The Unit period of this report is from 7:00 a.m. [prior office working day) to 7:00 2.m. {current of?ce working day) Incident Report 78941 (Reference #178941 Emcarn Ranger RTP 04/11/13 Resource Center refused his 12 PM medications. Several attempts were made and appropriate noti?cations were made. Renaming; Julie Vice - Med Error - Client Refused To Take Medication Mug; Kyle Garlick -- Incident Report 78943 (Reference #:78943 WW Emnm Voyager DTP 04/11/13 Activity Center/Field/House was not following directions as soon as he made it to Activity, and began to wander campus. In the house, he told Marcos and I that he was hearing voices and aggressively punched, kicked, pinched, scratched, and threaten to kill himself. (8 min) Brooke Piasecki - Restraint Team Prone Misaki Curtis 0 Accident/Injury to Child Standing Logan Hess 0 - Accident/Injury to Staff Bryce Lumbard 0 - Assault/Aggression Assisting; Marcos Almeida Other Incident Report 78945 (Reference #:78945 William 2:93am WM Jade RTP 04/11/13 Resource Center refused her 7 AM medications. Several attempts were made and appropriate noti?cation were made. 331931119; Julie Vice - Med Error - Client Refused To Take Medication Erin Milligan Incident Report 78942 (Reference #:78942 Wind: Emum Washed: Ranger DTP 04/11/13 - Porch/Parking Lot was placed on suicide watch for unsafe behaviors. He was assaultive towards staff and attempted to leave supervision, causing an escort to the Quiet Room. The door closed because he was violently trying to leave. (12 min) anId-nl- com- inc-500-000- Tuno- Daefraluo- Tun.- CONFIDENTIALITY NOTE 1 documents accompanying this transmission may contain information that is con?dential and/or legally privileged The information is intended only for the use by the indivndual or entity names on this transmissron sheet. lf you are not the intended you are hereby noti?ed that any disclosure. copying, disuibution, or the taking of :my action in reliance on the contents of this information is strictly prohibited. If you have received this talc-copy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank PBS Front Line PRA Request (5"013-2011 Incident Reports) 000112 Fann'lt'es?'rst, Inc. 2100 Filth Street, Dan's, CA 95616 24 Hr. CL Report Friday, Apn'lIZ, 2013 The of this report is from 7:00 a.m. (prior office working day) to 7:00 am. (current of?ce working day) Kelsey Blissett - Restraint Escort Lanai O'Brian - Assault/Aggression Quiet Room Efren Sanchez-Delgado Other Assisting; Robert Dehn Incident Report 78944 (Reference #98944 Emanm Voyager RTP 04/11/13 Resource Center After several attempts separately, - still refused his 7 PM medication. mm m; Andrea Chiles - Med Error - Client Refused To Take Medication Incident Report 78948 (Reference #:78948 Widens Emmn Woman: Sapphire DTP 04/11/13 NPS Library Staff statement about staff. min; Eduardo Villalobos Other Stephen Lee CONFIDENTIALITY NOTE 2 The documents accompanymg this telecopy transmissmn may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, y0u are hereby noti?ed that any disclosure, copying, distribution, or the taking of any acnion in reliance on the contents of this telecnpicd information is prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000113 Fam'lieerst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CCL Report Monday, 111711715, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 a.m. (current other working day) Incident Report it: 78954 (Reference #:78954 Went Adventurer DTP 04/12/13 Side Porch/Trailblazer House attempted to climb the roof several times, despite staff verbally prompting and physically deterring him. started pushing into us and attempt to bite me. As a result, we initiated a containment. (10 min) gem Sule Anibaba - Restraint Team Prone Marcos Almeida - Assault/Aggression Other Incident Report 78970 (Reference #:78970 89W 20W i Adventurer RTP 04/14/ 13 Resource Center returned with an incorrect amount of medication after a home visit. modem Rggoging: Brenda Vermette - Med Error - Missed Dose at Home Incident Report 78971 (Reference #:78971') I. ".ln.ll all? [I?ll Adventurer RTP 04/ 14/13 House/Safeway ri m- was upset and slammed a door and punched a window. He left campus and returned with the Davis Police Department. He complained of his right pinky hurting. mum 3mm Islam Hassanein - Law Enforcement Contact Assisting; Adriana Escobar - AccidenUInjury to Child - Assault/Aggression - Short-Term Runaway Incident Report 78952 (Reference #:78952 In Location a Incident Pioneer DTP 04/09/13 Hallway was placed into a standing after punching and kicking staff. Staff evaded and as- continued, he was placed into a standing. (2 min) Oscar Lopez - Restraint Standing Assisgng: Nolan Bradley 0 - Assault/Aggression CONFIDENTIALITY NOTE 1 The documents accompanying this transmissum may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on [111$ transmission sheet. If you are not the intended recipient. you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any 11([100 reliance on the contents of this teiecopicd information is strictly prohibited. If you have reccivcd this telecopy in error. please notify us by telephone immediately so that we can arrange for the return of the original . i . Li?ii?? B?iiA" E'qii??g Won-2011 Incident Reports) 000114 Farm'IiesE'rst, Inc. 2100 Fifi!) Street, Davis, CA 95616 24 Hr. CL Report Monday, April 15, 2013 The time period of this report is from 7:00 a.m. (prior of?ce Working day) to 7:00 am. (current office working day) Incident Report 78978 (Reference #:78978 Email). Voyager RTP 04/14/13 Living Room tried to grab a chair to throw at us, so we initiated a standing restraint per his needs and services plan, due to aggressuve avior. (14 min) witn?sing; Jacob Babcock - Restraint Team Prone Repogng; Erica Retzer - Assault/Aggression Standing Assl?ng; Erlc Benoit Assisting; John (Nick) Moriana Incident Report 78964 (Reference #178964 WW 2mm Sapphire RTP 04/12/13 Activity Center stated that she wanted to sit in the street. She punched the wall in the bathroom of the Activity Center. - John (Nick) Moriana - Accident/Injury to Child Other Incident Report 78969 (Reference #:78969 2mm Sapphire RTP 04/13/13 Resource Center Wm After multiple separate attempts, - refused her 7 AM medication. modem meantime. Reporting; Andrea Chiles - Med Error - Client Refused To Take Medication Incident Report 78980 (Reference #:78980 2mm WW Sapphire RTP 04/14/13 Resource Center returned with the incorrect amount of medication after a home visit. 3min; Brenda Vermette - Med Error - Missed Dose at Home Incident Report it: 78957 (Reference #:78957 mm mm Widens Voyager RTP 04/12/13 House told me that he shown his girlfriend his penis at public school. CONFIDENTIALITY NOTE 2 The documents accompanying this transmissmn may contain information that Is con?dential and/or legally privrleged. The information is intended only for the use by the individual or entity names on this sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the takrng of any action in reliance on the contents of this telecopicd infomntion is strictly prohibited. If you have this in error. please notify us by immediately so that we can arrange for the return of thr- original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000115 Farnilz'esFirst, Inc. 2100 Street, Davis, CA 95616 24 Hr. CL Report Monday, April 15, 2013 The time pt?flnd otthis report l5 from 7:00 am. (prior of?ce working day) to 7:00 am. (current of?ce working day) Reporting; Maxwell Thomas Other Incident Report 78972 (Reference #:78972 Emnum Widens Pioneer RTP 04/ 14/13 - Father's Home called Pioneer House and reported that the police were called to_ residence. His and were arguing, ran away and called_. Nolan Bradley Other Misaki Curtis Oscar Lopez Incident Report 78984 (Reference #:78984 Jade RTP 04/14/13 House gave statements/threats of homicidal and suicidal ideation. Patrick Oleson-Wheeler - Suicidal Ideation Other Incident Report ?it: 78966 (Reference #:78966 Ranger RTP 04/13/13 0425mm House Eng: got frustrated at staff who was helping him fold his clothes. He assaulted Lanai by throwing projectiles and pushing into her, therefore emergency interventions were utilized. min) mm Incidentlm Remain; 1mg; Anthony Aispuro-Sanchez - Restraint Team Prone Efren Sanchez?Delgado - Assault/Aggression Assisting; Lanai O'Brian Other Incident Report 78975 (Reference #:78975 Waco: Emerita: Woman: Ranger RTP 04/14/13 Field became assaultive by hitting me forcefully, so I resorted to holding his hands ?rmly. (1 min) Int-Edna.- Ina-id?s. Tun-I Dante-33M Tuna- CONFIDENTIALITY NOTE 3 The documents accompanying this transmission may contain information that is con?dential and/or legally The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution. or the taking of any action in reliance on the contents of this telecopied utformation is strictly prohibited. lfynu have received this in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000116 Familicerst, Inc. 2100 Fifi}: Smear, Davis, CA 95616 24 Hr. CL Report Monday, April 15, 2013 The time period of this report is from 7:00 a.m. (prior of?ce working day) to 7:00 gun. (current of?ce working day) Claudia Vazquez - Restraint Standing 0 - Assault/Aggression Incident Report 78985 (Re?erence #:78985 'n In 3mm a Jade RTP 04/14/13 House gave statements of what happened during an AWOL. Remrting: Patrick Oleson-Wheeler Other Incident Report 78986 (Reference #:78986 Emma Jade RTP 04/14/13 Around Campus was contained for assault to staff after being self injurious with glass. (27 minWitnessing; Ashley McLemore - Law Enforcement Contact Seated Restraint 33m Patrick Oleson-Wheeler - Restraint Team Prone Steven Knowles 5 - Suicidal Ideation Standing Erica Retzer 8 - Assault/Aggression ther Incident Report 78973 (Reference #:78973 gamma: 2mm Widen: Ranger RTP 04/ 14/13 House was trying to punch staff. (9 min) Repomng: Edgar Zamora - Restraint Escort Assisting: Efren Sanchez-Delgado - Assault/Aggression Quiet Room Incident Report 78965 (Reference #:78965 Sapphire RTP 04/12/13 - Side Porch grabbed a hold of a scissors and attempted to stab herself several times on her left arm. (2 minRepoging: Sule Anibaba - Restraint Escort Assigg?ng: Marcos Almeida Other CONFIDENTIALITY NOTE 4 The documents accompanying this transmission may contain information that is con?dcntial and/or legall) privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that. any disclosme, copying, distribution, or the taking of any action reliance on the contents of this information is strictly prohibited. If you have received this in error, please notify us by telephone immediately so that we can arrange for the return of the original . 3-2011 Incident Reports) 000117 Fam'lies?'rst, Inc. 2100 Fi?b Street, Dan's, CA 95616 24 Hr. CL Report Monday, April 15, 2013 The timc period of this report is from 7:00 a.m (prior of?ce working day) to 7:00 a.m. (current of?ce working day) Incident Report 78962 (Reference #:78962 Emnnm WM We: Sapphire DTP 04/12/13 House left campus and harmed herself. mum 3399mm; Marcos Almeida - Law Enforcement Contact Other Other Incident Report 78963 (Reterenoe #:78963 WW 2mm Sapphire RTP 04/12/13 Resource Center During 7 PM medication time frame,- missed her medication due to her being at the hospital. Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 78968 (Reference #:78968 Sapphire RTP 04/13/13 Front of Campus -- attempted to run into the street, I deterred her from running into the street. She tried to push passed me. so Marcos and I initiated a standing restraint. (8 min) Aaron Alston - Restraint Standing Marcos Almeida - Accident/Injury to Child Other Incident Report 78981 (Reference #:78981 Woollen: Went Sapphire RTP 04/14/13 South Sidewalk of 5th Street - was contained per her current treatment plan regarding leaving supervisron and forcefully hitting me. (8 min) John (Nick) Moriana Restraint Escort Assisting: Ashley McLemore 0 - Assault/Aggression Standing Other Incident Report 78988 (Reference #:78988 Adventurer DTP 04/11/13 House, 5th Street ran off of campus without supervision. The police were notified.- returned on his own. CONFIDENTIALITY NOTE 5 The documents accompanying this telecopy transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure. copying, distribution, or the taking of any action in rcliancr on the contents of this information is strictly prohibited If you have (his in error, please notify us by telephone immediately so that we can arrange for the return of the original dlchugienrs to us at no cost to nu Thank vou Front Line PRA equest (2013-2011 Incident Reports) 000118 FamiliesFirst, Inc. 2100 Han Street, Dz no, CA 95616 24 Hr. CL Report Monday, April 15, 2013 The time period of this report is from 7:00 a.m. (prior of?ce Working day) to 7:00 a.m. (current of?ce working day) Wag; Sule Anibaba - Law Enforcement Contact Remrtigg: Marcos Almeida Other Incident Report 78960 (Reference #178960 Voyager DTP 04/12/13 - Off Campus began to wander the house when it was time to shower and then he left supervision. This led to a Quiet Room restraint after the police brought him back. (5 min) mm; Misaki Curtis 5 - Law Enforcement Contact Quiet Room Witnessing: Eric Benoit - Restraint Logan Hess - Accudent/Injury to Child Reporting: Kn?stan Warren 0 - Assault/Aggression Repom' g; Marcos Almeida Other Noel Salazar Other Oscar Lopez John (Nick) Moriana Incident Report 78967 (Reference #:78967 WW Brennan: Wedded: Voyager RTP 04/13/13 House Winn; After dinner,- began to wander the house and got a broom to swing around, almost hitting two of his peers. He attempted to leave supervision and assaulted staff with forceful punches and kicks, leading to a restraint. (33 min) Insidenum Rostrum Witnessing: Felicia Thomas - Restraint Team Prone Witnessing; Marcos Almeida - Accident/Injury to Child Standing Logan Hess - Assault/Aggression Asgig?ng: Eric Benoit Other Assisting; Charles Garcia Assisting; Matthew Brown Incident Report at: 78979 (Reference #:78979 WW Bantam Voyager RTP 04/ 14/13 Off Campus left campus out of his bedroom window and was picked up by Davis Police.- was medically cleared by UC Davis Medical Center and returned to campus. Wimessigg; Erica Retzer - Law Enforcement Contact John (Nick) Moriana - Accident/Injury to Child gaming; Jacob Babcock - Short-Term Runaway Incident Report #2 78958 (Reference #:78958 CONFIDENTIALITY NOTE 6 The documents accompanying this telecopy transmission may contain information that is confidential and/ or legally priVileged The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipian you are hereby noti?ed that any disclosure, copying. distribution, or the taking of any action in reliance on the of this telecopied information is strictly prohibited. If you have received this tclecopy in error, please notify us by telephone Immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank vou. PBS Front Line PRA Request '(2013-2011 Incident Reports) 000119 Fam'licerst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Monday, April 15, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 arm. (current of?ce working day) Voyager DTP 04/12/13 House left su rvision when asked to take a shower. After many verbal threats to harm staff off of campus, the police came to help back to the Quiet Room. Kristen Warren - Law Enforcement Contact 3mm Logan Hess - Assault/Aggression Marcos Almeida Other Oscar Lopez CONFIDENTIALITY NOTE 7 The documents accompanying this transmissmn may contain Information that is con?dential and/or legally information is only tor the use by the Individual or entity names on this transmissmn If you are not the Intended reapimt. you an: hereby noti?ed that any disclosure; copying, distribution, or the taking of any action in on the contents of this information is strictly prohibited. If you havr received this in error. please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no Cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000120 Fam'lies?'rst, Inc. 2100 Fifth Street, Dan's, CA 95616 24 Hr. CL Report Wednesday, Apa'117, 2013 'l'hc timc pcnod of this report is from 7:00 am. (print of?ce working day) to 7:00 a.m. (current of?ce working day) Incident Report 79021 (Reference #:79021 WW Emacam Wanna: Trailblazer DTP 04/16/13 Activity Center came up to me and said a peer hit him in the genitals when he was running. Lisa Uttle Other Assisting: Matthew Brown Incident Report 79018 (Reference #:79018 WW Emma minimum Ranger DTP 04/16/13 Campus Bri cri was placed in a standing for pushing into staff. (13 min) 33mm Edgar Zamora - Restraint Standing Kristan Warren 0 - Assault/Aggression Assisting: John (Nick) Moriana Incident Report 79019 (Reference #:79019 Emnm Ranger RTP 04/16/13 Bedroom #2 was repeatedly punching his window. (22 min) Edgar Zamora - Restraint Team Prone A_ss_i?nng; Adrian Mendoza 0 - Assault/Aggression Standing Incident Report 79022 (Reference #:79022 Unit Ing??ent Etmtim nag; Hm: at Incident nga?gn 9f Insidgng Trailblazer DTP 04/16/13 - 05312PM Activity Center was running laps in the Activity Center. A peer said- hit him in his genitals- con?rmed this to staff and said it was an accident. Rgpg?ing: Lisa Little Other Matthew Brown Incident Report 79027 (Reference #:79027 CONFIDENTIALITY NOTE 1 The documents accompanying this teiecopy transmissxon may contain information that Is con?dential antl/ or legally The information is intended only for [ht use by the individual or entity names on this transmissxon sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distnbunon, or the taking of any action in reliant: on the contents of this telecopird information is prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000121 Fam?icerst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Wednesday, April 17, 2013 The time period of this report is from 7:00 a.m. (prior of?ce working day) to 700 a.m. (current office working day) Beast-m Weldon: Sapphire RTP 04/16/13 Resource Center refused to take her 7 AM dose of medication. Severalattempts were made. Appropriate people were nod?ed. 33m; Julie Vice - Med Error - Client Refused To Take Medication Wm; Eduardo Villalobos Incident Report a: 79020 (menus #:79020 WW Emmn Wooden: Monument. Ranger RTP 04/16/13 - House was placed in an escort for repeatedly punching and biting me. (2 min) Kate Broida - Restraint Escort gem; Melissa Van Sambeek - Assault/Aggression 555mm; Nicholas Rhodes Incident Report 79016 (Reference #179016 WW Adventurer DTP 04/16/13 Hallway began to assault staff which at that point, we initiated containment. (14 min) 3mm Noel Salazar - Restraint Team Prone Assisting; Adn?an Mendoza - Assault/Aggressmn Standing Incident Report 79017 (Reference #:79017 Adventurer RTP 04/16/13 Resource Center refused his 7 AM dose of medication. Several attempts were made and appropriate staff were notified. Julie Vice - Med Error - Client Refused To Take Medication Curtis Richardson Incident Report 79026 (Reference #:79026 MW Emma: Wooden: Voyager DTP 04/ 16/13 Hallway lei-C Hoar-?neinn- -rliAn?r mount 'n tell. a (kn-"av and In? Ha. hnurn ian-wuw HQrmifrihn AM. ha van-rand om Hus CONFIDENTIALITY NOTE 2 The documents accompanying this tclecopy transmissron may contain information that is con?dential and/or legally The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this telccopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Hunk you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000122 Farmlz'es?rsr, Inc. 2100531211 Street; Davis, CA 95616 24 Hr. CL Report Wednesday, Apn] 17; 2013 The time period of this report is from 7:00 am. l{prior oft-ice working day) to 7:00 if?. (current til-{ICC working day) house, he began to punch, kick, and forcefully ram into staff; trying to get down the hallway where his peers were. He was contained. (84 min) Incident Staff: MM Restraint nag: Witnessing: Misaki Curtis - Restraint Team Prone Witnessing: Bryce Lombard - Assault/Aggression Team Prone Reporting: Kristan Warren Assisting: Erica Retzer Assisting: John (Nick) Moriana Incident Report 79025 (Reference #:79025 11035111 9 mm; Trailblazer RTP 04/15/13 Hallway grief Description:- repeatedly put a knife up to staff and then to staff's neck as if to stab him. (15 min) I Reporting: Sergio Sanders - Restraint Standing Assisting: Steven Knowles 0 - Assault/Aggression Incident Report 79023 (Reference #:79023 ra mum: Trailblazer DTP 04/16f13 Porch Brief We initiated a containment on- to prevent serious injury to staff. (67 min) Witnessing: Noel Salazar - Restraint Team Prone Witnessing: Misaki Curtis 0 - Accident/Injury to Child Standing Witnessing: Reynoso Trujillo - Assault/Aggression Reporting: Steven Knowles assisting: Sergio Sanders Assisting: Adrian Mendoza Incident Report 79024 (Reference #:79024 3912mm ELQSIEIIJ. Wooden: Trailblazer RTP 04/16/13 House Brief Description:- refused his 7 AM medication. Several attempts were made and appropriate people were noti?ed. nt in Reporting: iulie Vice Med Error - Client Refused To Take Medication Assisting: Hilary Sleuter CONFIDENTIALITY NOTE 3 The documents this telecopy trilnSmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmissmn sheet. If you are not the intended recipient. you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this telecopy in error. please notify us by telephone immediately so that we can arrange For the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000123 Fam'lies?'rst, Inc. 2100 Fi?b Street, D2 W's, CA 95616 24 Hr. CL Report Thursday, April 18, 2013 The tune prtiod of this report is from 7:00 am. (prior of?ce Working day) to 7:00 a.m. (current ot'ticc working day) Incident Report 79047 (Reference #:79047 Emnm Ranger DTP 04/17/13 By Outside Quiet Room was running around campus, encouraging his peers to get "off task," despite staff prompting him to stop. Staff initiated a containment after he continued to encourage his peers and attempting to go break up an ongoing containment. min) Remus; Sule Anibaba - Restmint Escort Stephen Lendzion - Assault/Aggression Team Prone Incident Report 79058 (Reference #:79058 Pioneer RTP 04/17/13 Bedroom I walked in and saw- touching a peer's penis over his clothes. Reporting; Kate Broida - Sexualized Behavior Incident Report 79042 (Reference #:79042 WWI. 2mm a Voyager DTP 04/17/13 - Hallway continued to kick me, so we initiated a seated containment due to- dropping weight to his bottom immediately, per is needs and services plan due to assaultive behavior. (22 min) Marcos Almeida - Restraint Seated Restraint Wag; Misaki Curtis 0 - Assault/Aggression Reporting: Erica Retzer Kristan Warren - Incident Report 79048 (Reterence #:79048 2:91am Madden: Sapphire RTP 04/17/13 Resource Center refused her 7 AM dose of medication for the third day in a row. Several attempts were made and appropriate people notified. maximum Rgporb?ng; Julie Vice - Med Error - Client Refused To Take Medication Assisting: Brett Atwood CONFIDENTIALITY NOTE The documents accompanying this transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the mdivxdual or entity names on this slicrt ll you are not the intended reCipicnt, you are hetcb)r noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the Contents of this information is strictly prohibited. If you have this in crrox, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000124 Famz'liesE'rst, Inc. 2100 Fi?/1 Street, Davis, CA 95616 24 Hr. CL Report Thursday, April 18, 2013 The time pcriod of this report is from 7:00 am. (prior of?ce working day) to 7:00 a.m. (current of?ce working day) Incident Report at: 79049 (Reference #59049 MW 2mm Sapphire RTP 04/17/13 Front of Campus attempted to run into the street. Sergio and i attempted to physically deter her from the street. She continued to push us, so we initiated a standing restraint. She continued to struggle and was placed in a team prone. (73 min) Insidentlmez Witnessing; Islam Hassanein - Restraint Team Prone Marcos Aimeida - Accident/Injury to Child Team Prone mg; Aaron Alston - Assault/Aggression Standing mum (Nick) Mariana Other Standing gaming; Sergio Sanders Stephen Lendzion Assisting; Adrian Mendoza I. Jade RTP 04/ 17/13 Resource Center After several separate attempts, - still refused her 7 PM medication. Angela ura - Med Error - Client Refused To Take Medication .mn?msz v. A -- - ~v Emsram WW Jade RTP 04/17/13 Resource Center refused her 7 AM dose of medication. Several attempts were made and the appropriate people were notified. Wm; Julie Vice - Med Error - Client Refused To Take Medication Patricia Button Incident Report it: 79050 (Reference #99050 WM Emnm Sapphire RTP 04/ 17/13 Resource Center missed her noon medications, because she was at public school. mm Brenda Verrnette - Med Error - Missed Dose at FamiliesFirst CONFIDENTIALITY NOTE 2 The documents accompanying this tranSmissmn may contain information that is con?dential and/or legally privdeged. The infon'nation is intended only for the use by the individual or entity names on this transmissron sheet if you are not the intended you are hereby noti?ed that any disclosure. copying, distribution, or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. If you have received this telecopy in error, please noti us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank vou. PBS Front Line PRA Request '(2013-2011 Incident Reports) 000125 Famill'eerst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Thursday, April 18, 2013 The timc period of this report is from 7:00 am. (prior of?ce Working day) to 7.00 a.m. (current of?ce working day) Incident Report it: 79044 (Reference #:79044 2mm Ranger DTP 04/17/13 House was kicking staff forcefully. (18 min) 3m; Edgar Zamora - Restraint Team Prone 555131119; Marcos Almelda - Assault/AggressiOn Incident Report 7904s (Reference #9905 WW Brennan: Ranger DTP 04/17/13 Basketball Court convinced two other peers to run out of the house with him to create chaos on campus. He was assaultive toward sta at got in his way by throwing punches; therefore we placed him in a standing containment. (16 min) gaming; Efren Sanchez-Delgado - Restraint Team Prone W- Dehn - Assault/Aggression Standing Incident Report 79046 (Reference #:79046 2mm WEI Ranger DTP 04/17/13 - Lower Parking Lot was pretending or trying to fall asleep while in containment. Staff released and he began to assault staff again an we re-captured. {13 min) Dehn Restraint Team Prone Efren Sanchez-Delgado - Assault/Aggression Oscar Lopez Angela Lira Incident Report 79038 (Reference #:79038 WW 2mm Adventurer RTP 04/17/ 13 Living Room began to break the window screen and attempted to break the TV. We Initiated a standing then escorted him outside where we remained in a standing and released. Once released, he assaulted staff so we initiated containment. (40 min) Adrian Mendoza - Restraint Escort Steven Knowles 0 - Assault/Aggression Escort Team Prone Standing Standing Standing -) CONFIDENTIALITY NOTE 3 The documents accompanying this transmission may contain information that is con?dential and/or legally The information is intended only for the use by the individual or entity names on this transmissmn sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopted information is strictly prohibited. If you have received (hm [ck-copy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000126 Fam?ics?'rst, Inc. 2100 Street, Dave's, CA 95616 24 Hr. CL Report Tbursdag April 18, 2013 The time period of this report is from 7:00 am. (prior of?ce Working day) to 7:00 am. (current of?ce working day) Incident Report 79051 (Reference #:79051 -) Sapphire RTP 04/17/13 - House grief Desg?ngion:- stated she was hearing voices and wanted to kill herself by running into traf?c. Reporting: Andrew Enright Other Other Incident Report it: 79037 (Reference #99037 of In id Bantam MD in! of I MW Adventurer DTP 04/17/13 Behind School/School Quiet Room r' - repeatedly hit and punched staff, so a containment was initiated. - also displayed sexual behavior during this incident. He charged at the Quiet Room door multiple times and was in three Quiet Room containments. (15 min) mummies; Witnessing: Marcos Almeida Restraint Seated Restraint Witnessing: Efren Sanchez-Delgado - Sexuaiized Behavior Team Prone Regorting: Islam Hassanein - Assault/Aggression Quiet Room ?sisting: Adrian Mendoza Quiet Room Assisting: Michelle Glicksman Quiet Room Assisting: Kristan Warren Incident Report 79041 (Reference #:79041 Beggm'ng unit of Incident page Iime at ?gment WM Voyager DTP 04/17/13 House i began to wander the house and made several attempts to leave supervision. He became assaultive with kicks, punches, and attempts to cut with sharp metal, and made attempts and threats to hurt himself. (48 min) Incident?ta??s mm more. Witnessing: Misaki Curtis - Restraint Team Prone Witnessing: Erica Retzer Accident/Injury to Child Team Prone Regorting: Logan Hess - Assault/Aggression Regorting: Jacob Babcock Other Assisting: Marcos Almeida Other Assisting: Kristan Warren Other Assisting: Andrew Enright Assisting: Noel Salazar Incident Report 79039 (Reference #:79039 genom'ng unit 215 Incident Dag; Time of Iggiggm of Insiggng Voyager RTP 04/17/13 Hallway was contained after repeatedly and forcefully pushing us. (19 min) CONFIDENTIALITY NOTE 4 The documents accompanying this transmiSSIon may contain information that is con?dential and/or legally pnv?eged. The information is intended only for the use by the individual or entity names on this: transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. Ifyou have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000127 Inc. 2100 Fifth Street, Dan's, CA 95616 24 Hr. CCL Report Thursda? Apr1718, 2013 The time period of this report 15 from 7:00 3.111. [prior of?ce working day) to "3:00 a.rn. (current of?ce working day) Ingjgent staff; gaging]; 112g; ngg; Repomng: John (Nick) Moriana - Restraint Team Prone Assisting: Erica Retzer - Assault/Aggression Standing Incident Report 79043 (Reference #:79043 __osta_Pr Women; MW Voyager DTP 04/17/13 Front Parking Lot grief Description; - was repeatedly aggressive to staff by threatening, posturing, and pushing, so restraint was initiated. (10 minBeam Reporting: Kristin Manrique Restraint Escort Assisting: Oscar Lopez 0 Team Prone Incident Report 79057 (Reference #:79057 'n Un' of nc' nt Date Time 91 gncident Location of Incident Pioneer RTP O4l17/13 Bedroom I walked in and saw a peer touching -penis over his clothing. In 'den ff: Mime: Reporting: Kate Broida Other CONFIDENTIALITY NOTE 5 The documents accompanyng this telecopy transmission may contain information that is con?dential and/or legally privileged The information is intended only for the use by the indiwdual or entity names on this transmission sheet. If you are not the Intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this relecopiod information is strictly prohibited. If you have received this telecopy in error? please notify us by telephone immediateiy So that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000128 FanzilicsFirst, Inc. 2100 Fifi]: Street, Davis, CA 95616 24 Hr. CL Report Fade}; April 19, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 am. (current office working day) Incident Report 79070 (Reference #:79070 gm; of nag: Iim: Qt Insidgnt ngagign of Incident Ranger DTP 04/18/13 MultI-purpose Room turned severely escalated once he kicked the Quret Room door closed. I held the door closed Since he kept cussmg an making threats to hurt me and AWOL. (43 min) Marcos Almelda - Restraint Room Reparting: Efren Sanchez-Delgado 0 - Assault/AggreSSIon Quret Room Incident Report 79073 (Reference #:79073 WW Begum was ime Wooden; Sapphire DTP 04/18/13 Front of Campus attempted to leave campus. I attempted to deter her, but she continuously attempted to push passed staff. Anthony came to assust me and we initiated a standing restraint. After continuously kicking staff, we transntioned into a team prone. (12 min) Reporting; Aaron Alston - Restraint Team Prone Assisting: Bryce Lumbard - Assault/Aggresswn Standing Anthony Arspu ro-Sanchez Other Incident Report 79074 (Reference #:79074 in I Emu Went Sapphire RTP 04/18/13 - Behind Program i n: was attempting to leave campus. Efren and I attempted to deter, but she began to kick us and attempting to push ough us, so we escorted her to the Quiet Room. (2 min) Aaron Alston - Restralnt Esc0rt Assisgng: Efren Sanchez-Delgado - Assault/Aggre55ion Incident Report 79072 (Reference #:79072 In Emma: Went Sapphire RTP 04/18/13 07.28AM Resource Center refused her 7 AM dose of medication for the fourth day in a row. Several attempts were made and appropriate people were noti?edReporting: Julie Vice - Med Error - Client Refused To Take Medication Assisting: Davnd Waites CONFIDENTIALITY NOTE The documents accompanying this transmissmn may contain information that is con?dential and/or legally privileged. The information is intended only {or the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, Copying, disti'ibution? or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000129 Familicerst, Inc. 2100 Fifi]: Street, 03 yrs, CA 95616 24 Hr. CL Report Friday, A pm] 19, 2013 The time period of this report IS from 7:00 am. (prior of?ce workmg day} to 7:00 am. (current of?ce working day) Incident Report 79079 (Reference #:79079 . . Jade RTP 04/18/13 - Resource Center Brief - refused to take her 7 AM medication. Several attempts were made and the appropriate staff were noti?ed. mum e: Julie VICE - Med Error - Client Refused To Take Medication Erin Milligan Incident Report 79076 (Reference #:79076 We 0 in Emmi: Mfme of Wooden: Sapphire DTP 04/18/13 Hallway It was reported by a peer that- touches said peer. modem maximums; Reporting; Angela Lira Other Incident Report 79080 (Reference #:79080 _.o_q_LPr MD Time of I i Jade RTP 04/18/13 - 5th Street left superVISIon, assaulted staff, and attempted self injurious behavror. (12 min) Incident Staff: Resgaint Type: Reporting Benout - Law Enforcement Contact Escort Ass:sting? Johnny - Restraint Team Prone - Assault/Aggressmn Standing Other Incident Report 79078 (Reference #:79078 P4931321 Tim In Sapphire RTP 04/18/13 Resource Center refused to take her 7 PM medications. Caitlin Scott - Med Error - Client Refused To Take Medication Assusting: Andrea Chiles CONFIDENTIALITY NOTE 2 The documents accompanying this telecopy may contain information that Is confidential and/or legally privileged. The information is intended only for the use by the indindual or entity names on this transmissmn sheet. If you are not the intended recipient, you are hereby noti?ed that my disclosure, copying, distribution, or the taking of any action in reliance on the contents of this irlempit-d information 15 Strictly prohibited. If you have received this tclecopy in error. please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000130 Fann'lieerst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Fn'da y, April 19, 2013 The time period of this report is from 7:00 a.m. (prior of?ce Working day) to 7:00 a.m. (current of?ce working day) Incident Report 79068 (Reference #:79068 Emmi: Widens Adventurer RTP 04/18/13 House Wm repeated] rovoked his peer despite staff prompting and physically deterring him from physically engaging. ta escorted to the Qmet Room a er he tried to charge at his peer. (5 min) Repomng? Sule Anibaba - Restraint Escart Marcos Almeida 0 - Assault/Aggression Qutet Room Incident Report 79071 (Reference #:79071 Voyager DTP 04/18/13 OutSIde of Actiwty Center began to be physically aggresswe toward staff, which we closed the Qunet Room door. We opened the door when he continued to charge at us. (11 min) we: Remainmpe; Reporting: Adrian Mendoza - Restraint Quuet Room A55isting: Lisa Little 0 - Assault/Aggressuon Quiet Room Incident Report 79075 (Reference #:79075 Reporting gnig gf Incident 0935 Time of of Incident Sapphire DTP 04/18/13 Hallway was asked by a peer it another peer touches her Incident Stag; Incident Type: Reporting; Angela Lira Other CONFIDENTIALITY NOTE 3 The documents accompanying this tclecopy transmissmn may contain information that is con?dential and 'or legally privileged. The information is intended (ml)r for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us :it no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000131 Familics?'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Wednesday, April 24, 2013 The time period of this report 15 from 7:00 a.m. (prior of?ce working day) to 7:00 a.m. {current of?ce working day) Incident Report 79144 (Reference #:79144 I. H. Elln Jade RTP 04/23/13 Resource Center was not on campus to receive her medication at 3 PM and 7 PM. Angela Lira - Med Error - Missed Dose at FamiliesFirst - Incident Report 79134 (Reference #:79134 BMW mam Trailblazer RTP 04/23/13 Resource Center returned with more medication than he was suppose to. Angela Lira - Med Error - Missed Dose at Home Incident Report 79-124 (Reference #:79124 Mum Adventurer RTP 04/23/13 Living Room forcefully and repeatedly pushed into staff, despite staff verbally prompting and evading. (11 min) Sule Anibaba - Restraint Escart Adrian Mendoza 0 - Assault/Aggression Standing Matthew Brown Incident Report 79139 (Reference #:79139 Voyager RTP 04/23/13 Play Structure A peer reported that- threatens to ?ash his penis to him. Other Incident Report 79123 (Reference #:79123 CONFIDENTIALITY NOTE 1 The documents accompanying this telecopy transmissmn may contain information that is con?dential and/ or legally privileged. The information is intended only for usc by the individual or entity names on this transmission sheet. If you are not the intended recrpient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action ui reliance on the contents of this tclecopicd information is strictly prohibited. If you have this in error, please notify us by telephone u'nmcdiately so that wc can arrange {Or the rctum of the original documents to us at no cost to you. 'l'hunk you PBS Front Line PRA Request' (2013-2011 Incident Reports) 000132 FaIm'II'esFirst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Wednesday, April 24, 2013 The time pcnod of this rrpon is from 7:00 am, (prior of?ce working day) r0 7:00 a.rn. (current of?ce working dayPioneer RTP 04/ 18/13 Activity Center was contained for attempting to bite staff hands. (7 min) gem; Anthony Aispuro-Sanchez - Restraint Team Prone Johnny Tillis - Assault/Aggression Other Incident Report 79136 (Reference #:79136 WW 2mm Voyager RTP 04/23/13 - Play Structure Winn; A peer reported that- ?ashed his penis at him, when walking out of the bathroom on Friday morning. Reporting: Kristan Warren Other Incident Report 79135 (Reference #:79135 Winn: Emnm Widen: Voyager RTP 04/23/13 Play Structure reported a peer -) ?ashed his penis at him, when walking out of the bathroom on Friday morning. Wag; Kristan Warren Other Incident Report 79131 (Relevance-#09131 MW 2mm i Ranger DTP 04/23/13 Side Porch was throwing large rocks at Claudia and trying to kick staff. He also bit me on the hand. (49 min) minimising; mm Mug; Edgar Zamora - Restraint Team Prone Assisting; Lanai O?Bri'an 0 - Assault/Aggression Team Prone Aim Claudia Vazquez Standing John (Nick) Moriana Standing Kristan Warren -) CONFIDENTIALITY NOTE 2 The documents accompanying this telecopy transmission may contain information that IS con?dential and/ or legally privileged. 'Ihc information is intended only for the use by the indiVidual or entity names on this transmission sheet. If you are not the intended reapient, you are hereby noti?ed that any disclosure. copying. distribution, or the inking of any aCtion in reliance on the Contents of this information is strictly prohibited. If you have received this iclccopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000133 FamZI'esE'rs Inc. 2100 Fifth Street, D3 W's, CA 95616 24 Hr. CL Report Wednesday, Apr1'124, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 3.11]. (current of?ce working day) Incident Report 79138 (Reference #:79138 . .l Erggtam Eat: a Iimg at mgiggnt gigagign g1 Ingiggn; Voyager RTP 04/23/13 Play Structure reported that a peer -) keeps threatening to ?ash his penis while telling- that he know wants to see it. Reporting: Kristan Warren Other Incident Report 79142 (Reference #:79142 nit 9f Lngident Program Timg gf Incidgng of Incident Jade RTP 04/23/13 Front Bathroom 8 i attempted to charge at staff and postured with an extension cord before wrapping it around her neck. Staff attempted to physically deter her from wrapping it amund her neck. She attempted to bite staff and punched staff in the face. (19 min) Witnessing: Heather Flood Restraint Seated Restraint Reporting: Patricia Button I - Assault/Aggression Team Prone Assisting: Erin Milligan Other Assisting: Kyle Garlick Assisting: Brett Atwood Incident Report 79132 (Reference #:79132 In i ent 35m page Iime of Incident Logg?gn of Ranger DTP 04/23/13 Lehigh Dr./Front Parking Lot attempted to leave supervision to Lehigh Drive, where Davis Police Department caught him and transported him back to campus. - refused to go to the Quiet Room and became assaultive by kicking staff and was placed in a team prone. (11 min) 1mm 'nt Reporting: Nolan Bradley - Law Enforcement Contact Team Prone assisting: Aaron Alston - Restraint Assisting: Oscar Lopez 0 Assault/Aggression Assisting: Noel Jones Other . Incident Report 79133 (Reference #:79133 In ent Program Date Time of Incident Location of Incident Ranger DTP 04/23/13 Outside Quiet Room was pushing forcefully into staff. (12 min) ci Bantam Reporting: Edgar Zamora - Restraint Escort Assisting: Aaron Alston - Assault/Aggression Quiet Room Assisting: Oscar Lopez CONFIDENTIALITY NOTE 3 The documents accompanying this telecopy transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you an: hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is stoctly prohibited. lfynu have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the engine] documents to us at no cost to on. Thank yo PBS Front Line PRA equest (29013-2011 Incident Reports) 000134 FamiliesE'rst, Inc. 2100 Street, Davis, CA 95616 24 Hr. CL Report Wednesday, April 24, 2013 The time pcnod ot'this report is from 7:00 am. (prior of?ce working day} to 7:00 a.m. {current ot?ce working day) Incident Report 79143 (Reference #:79143 Jade DTP 04/23/13 Street/Quiet Room left campus and refused to return with staff. Police retumed her to campus and she ended in containment for pus ing rough staff. (15 min) mm Michelle - Law Enforcement Contact Team Prone Kristan Warren - Restraint Quiet Room Matthew Brown 0 - Accident/Injury to Child Aim; Bryce Lumbard 0 - Assault/Aggression Assisting; Angela Lira - Short-Tenn Runaway Incident Report 79126 (Rafa-no. #:79126 Went Adventurer RTP 04/23/ 13 Front Porch made a statement about staff. Islam Hassanein Other Assisting; Sule Anibaba i Incident Report 79127 (Reference #00127 WW 2mm Weldon: Wm: pioneer DTP 04/23/13 Outside House Old Sapphire House - continued to make attempts for large wood beams to hit us with and continued to forcefully push into us, passed his - ar imit; so we initiated a team prone restraint due to his current aggressive behavior. (11 min) Nolan Bradley - Restraint Team Prone Wag; Rosa Retzer - Assault/Aggression 5551mm; Kristan Warren Other mm; Stephen Lendzion Indian Report 79128 Wamnm WW Emile-In Pioneer RTP (34/23/13 07:00?" Back Of House was hitting the window and when we set a clear limit, he became violent and pushed into staff. (17 min) Turkic-o0 Tm- 9min. M- CONFIDENTIALITY NOTE 4 The documents accompanying this transmismon may contain information that is confidential and/or legally The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution. or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000135 Fanlilies?'rst, Inc. 2100 H311 Street, Davis, CA 95616 24 Hr. CL Report Wednesday, Apr? 24, 2013 The time period ofthis report is from 77:00 21.111 (prior of?ce working day) 7:00 (current of?ce working day) Regorting: Adriana Escobar - Restraint Team Prone Asgisting: Edgar Zamora - Accident/Injury to Child Standing Agsisting: Bryce Lumbard 0 - Assault/Aggression CONFIDENTIALITY NOTE 5 The documents accompanying this telecopy transmission may contain information that Is: con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmissmn sheet. If you are not the intended recipient? you are hereby noti?ed that any disclosure copying, distributiom ur the taking of any action in reliaIICe on the contents of this wit-copied information is strictly prohibited. If you have received this telecnp}; in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no to you. ?I?hank your PBS Front Line PRA Request (2013-2011 Incident Reports) 000136 Farm'II'esE'I-st, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Thursday, Apa'125, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 a.m. (current office working day) Incident Report 79148 (Reference #:79148 We: Emscam Wands-int Ranger DTP 04/23/13 Side Porch was running around campus when he began to throw hard objects at staff. We evaded and charged at us and began to push forcefully. - attempted to so we deterred him. He continued to push forcefully. (12 mln) Oscar Lopez - Restraint Standing John (Nick) Moriana 0 - Assault/Aggression - Incident Report in: 791% (Reference #:79156 MW ra Voyager DTP 04/24/13 House - - stated that his- exposed himself to- in the hallway. - said that it was- who exposed himself. Reporting: Logan Hess Other Incident Report 79160- (Reference #9916!) Emma: Sapphire DTP 04/24/13 Living Room Emmi-was assaulting staff by pushing and hitting. (27 min) Nolan Bradley - Restraint Escort Stephen Lendzion - Assault/Aggression Team Prone 5m Christopher Bryce Standing gigging; Andrew Enright Standing Ashley McLemone Incident Report 79152 (Reference #:79152 Wu! 2mm Pioneer RTP 04/24/13 Bedroom #4 was accused of putting his hands down his roommates pants. Amy Mathers Other CONFIDENTIALITY NOTE The documents accompanying this telecopy transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the indiVidual or entity names on this transmission sheet. If you are not the intended recipient. you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you havc received this tclecopy in error, please notify us by telephone immediately so that we can arrange for the rctum of the original #331 5:338 Incident Reports) 000137 Farm'II'eerst, Inc. 2100 Fifth Smer, Davis, CA 95616 24 Hr. CL Report Thursday, Apri125, 2013 Th: timr pcnod of this report is from 7:00 a.m. (prior of?ce working day} to 7:00 ant {current ottice working day) Incident Report 79162 (Reference #179162 MW 2mm Jade RTP 04/24/13 Appointment (In car) stated that a peer sexually touched her on her buttocks. Mug; Caitlin Scott Other Incident Report it: 79153 (Reference #179153 Emnm Pioneer RTP 04/24/13 Bedroom #4 stated that his roommate put his hands down his pants. Amy Mathers Other Incident Report 79159 (Reference #:79159 anm Sapphire RTP 04/24/13 Appointment (in car) peer reperted that- touched her in an inappropriate and sexual manner. . Caitlin Scott Other Incident Report 79150 (Reference #:79150 Wanna: 2mm Widen: Adventurer DTP 04/24/13 Bedroom stated that I locked him in his room. mm Wm; Adn?an Mendoza Other 5551mm; Brian Blanco CONFIDENTIALITY NOTE 2 The documents accompanying this telecopy may contain information that is con?dential and/or legally privilL-gcd. The information is intended only for the use by the individual or entity names on this transmissron sheet. If you are not the recipient, you are noti?ed that any disclosure, copying, distribution, or tht' taking of any action in reliance on the contents of this is strictly prohibited. If you have [l?CCth'd this in error, please norify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000138 Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Thursday, Apr]? 25, 2013 The time period of this report is from 7:00 am. (prior of?ce Working day} to 700 a.rn. (current oil?ice working day) Incident Report 79149 (Reference #:79149 Email: Ranger DTP 04/23/13 Parking Lot pushed into staff forcefully. We evaded and set his clear limit to stop pushing into staff.- continued and was ace into a standing containment. (10 min) Begging; Oscar Lopez - Restraint Team Prone Assisting; Aaron Alston - Assault/Aggression Standing Incident Report 79161 (Reference #:79161 WW 2mm Sapphire RTP 04/24/13 Quiet Room was attempting to break a light bulb in her bra. Given her history of self injurious behavior with broken light bulbs, We eterred her from doing so. At which point, she began to punch staff, so we initiated containment. (15 min) John (Nick) Moriana - Restraint Team Prone witnessing; Ashley McLemore 0 - Accident/Injury to Child Renaming; Andrew Enright - Assault/Aggression Marcos Almeida Other Christopher Bryce Incident Report 79151 (Reference #:79151 2mm Adventurer DTP 04/24/13 - School Classroom began to assault and spit at us, which at that point we evaded. He continued to assault us, which at that point we initiated a standing. He began to try to struggle out which at that point we transitioned into a team prone. (12 min) Adrian Mendoza - Restraint Team Prone Oscar Lopez 0 - Assault/Aggression Standing John (Nick) Moriana Incident Report 79158 (Reference #:79158 Voyager DTP 04/24/13 House/Parking Lot - left the house multiple times, going to the parking lot, leaving campus, and wandering campus. No himeal? uulfh are and hat-II in mamas-c now-h nnlino n?ir'or ho?nra veneer-ala?nn neg-gukinn co,? and CONFIDENTIALITY NOTE 3 The documents accompanying this telecopy transmission may contain information that is con?dential and/or legally The information is Intended only for the use by the Individual or entity names on this sheet. If you are not the Intended recipient. you are hereby noti?ed that any disclosure, copying. distribution, or the taking of any action in reliance on the contents of this telecopicd information Is prohibited. If you have received this Iclccopy in error, please notify us by telephone so that we can arrange for the rctum of ongmal documents to us at no cost to 'ou. Thank PBS Front Line PRA equestya?01 3-2011 Incident Reports) 000139 Fann?lics?'rst, Inc. 2100 Fr'?b Street, Dan's, CA 95616 24 Hr. CCL Report Thursday, April 25, 201.3 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 am. (current of?ce working day) contained. (22 min) Noel Salazar - Law Enforcement Contact Team Prone Kristan Warren - Restraint Standing ?imgssing: John (Nick) Moriana 0 - Accident/Inqu to Child witnessing: Johnny Tillis - Accident/Injury to Staff Reggrting: Logan Hess 0 - Assault/Aggression Marcos Alrneida Other Andrea Chiles Jennifer Hungerford Incident Report 79155 (Reference #:79155 Went Emsmn Voyager DTP 04/24/13 House said that- exposed himself to-in the hallway- said that it was- that exposed himself to Logan Hess Other CONFIDENTIALITY NOTE 4 The documents accompanying this telecopy may contain information that IS con?dential and/or legally prmleged. The informanon is intended only for the use by the indmdual or entity names on this transmission sheet. if you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the Contents of this telecopied information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the of the original documents to us at no cost to you. 'Ihank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000140 Fanu'lics?'rst, Inc. 2100 Fifth Safer, Dan's, C4 95616 24 Hr. CL Report Monday, April 29, 2013 The timc period of this report is from 7'00 am. (pnor of?ce Working day) to 7:00 a.m. (current ot?cc working day) Incident Report 79195 (Reterence #:79195 Bantam Winn: Jade RTP 04/26/13 Front Parking Lot - was feeling frustrated and ran out of supervision of the house, leaving staff supervision. When staff attempted to physica eter her from leaving, she assaulted by punching staff with a closed ?st. (13 min) 3mm; Patricia Button - Restraint Standing Assisting: Curtis Richardson 0 - Assault/Aggression Incident Report 7929 (Reference #:79229 anagram Jade RTP 04/28/13 Off Campus left staff supervision. Davis Police had to be contacted. Reporting: Jose Garibay - Law Enforcement Contact 0 - Short-Tenn Runaway Incident Report 79187 (Reference #:79187 Ranger DTP 04/26/13 House - was inside the Quiet Room with the door open atter haying been wandering and how-ling in attempt to get other peers off task. He punched the Quiet Room shut and so I held It closed, feanng that he might come outside and punch me as well. (11 min) witnessing; Jennifer Hungerford - Restraint Quiet Room Kenning; Efren Sanchez-Delgado - Assault/Aggression Kelsey Biissett Incident Report 79202 (Reference #:79202 I. n! In .II . . Ranger RTP 04/27/13 Campus was pushing into staff forcefully. (7 min) Edgar Zamora - Restraint Team Prone Efren Sanchez-Delgado - Assault/Aggression Standing 0? CONFIDENTIALITY NOTE 1 The documents accompanying this transmission may contain information that is con?dential and/or legally pnvilcged. The information IS intended only for the use by the mdiwdual or entity names on this transmission sheet. If you are not the intended moment, you are hereby noti?ed that any disclosure. copying, distribution, or the taking of any acnon in reliance on the contents of this tdccopicd information is strictly prohibited. If you have received this relccupy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to - u. Thank vou. PBS Front Line PRA Incident Reports) 000141 Fam?z'es?'rst, Inc. 2100 Fi?b Davis, CA 95616 24 Hr. CL Report Monday, Apti129, 2013 The time period of this report is from 7:00 am, (prior office working day) to 7:00 a.m. (current of?ce working day) Incident Report it: 79234 (Reference #:79234 BMW Musicians Bantam Sapphire RTP 04/28/13 - House mm was hitting, kicking, stomping on feet, and scratching after being asked to stop and having clear limits to stop. (16 min Beaming; Leola Taylor - Restraint Escort Jonathan Stone 0 - Assault/Aggression Standing Quiet Room Incident Report 79190 (Reference #:79190 WW Ecosnm MW Minimum Voyager DTP 04/26/13 House made numerous attempts to provoke and engage with an already escalated peer. This led to multiple assaults to staff and throwing missiles, so we evaded out and used a closed door restraint. (1 min) W311: mums: Messing; Misaki Curtis - Restraint Quiet Room Kristan Warren 0 - Assault/Aggression Logan HESS Ernest Perkins mg; Andrea Chlles Incident Report 79220 (Reference #179220 33W 21:93am Sapphire RTP 04/28/13 5th Street and her peer walked off campus. Reporting: Micheie Bettega - Law Enforcement Contact Assisting: Kristin Manrique Other Incident Report 79221 (Reference #:79221 Sapphire RTP 04/28/13 09: 15PM Backyard W5 We placed - In a standing containment for smashing a chair into the living room window. (14 min) Leon Jones - Restraint Escort Brown 0 - Assault/Aggression Standing 39mm Mic Bettega Standing Matthew Bettencourt Incident Report 79222 (Reierence #:79222 CONFIDENTIALITY NOTE 2 The documents accompanying this tciccopy transmission may contain information that is con?dential and/ or legally an?ingCd. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient. you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000142 FamilicsE'rst, Inc. 2100 Fifth 5am, Davis, CA 95616 24 Ht. CL Report Monday, April 29, 2013 The time period of this repon is from 7:00 a.m. (prior of?ce working day) to 7:00 a.m. (current of?ce working day) Sapphire RTP 04/28/13 Livmg Room was contained after repeatedly and forcefully pushing and hitting us. (10 min) John (Nick) Moriana - Restraint Escort Jose Garibay - Assault/Aggression Team Prone Standing Incident Report 79191 (Reference #:79191 Voyager DTP 04/26/13 - Front of Campus was harassed by a citizen. John (Nick) Moriana - Problematic Interaction with Citzen - Law Enforcement Contact Incident Report 79198 (Reference #:79198 Wanna: Einstein of Pioneer RTP 04/27/13 03: 52PM House began to aggressively throw plastic items from the kitchen at staff. (4 min) Wanting; Anthony Aispuro-Sanchez - Restraint Escort 0 - Assault/Aggression Standing Incident Report 79192 (Reference #:79192 WW Emnm Voyager DTP 04/26/13 - House walked out of his room and grabbed a chair in the hallway that he used to beat against the wall. He closed himself in his peer's room and repeatedly assaulted staff when we entered, leading to a restraint. (12 min) Reporting: Logan Hess - Restraint Escort - Assault/Aggression Standing Incident Report 79215 (Reference #:79215 BMW Voyager RTP 04/28/13 Front of House telac nu PHD I?m-Ind hit-Finn and errat'I-hinn mu lone- :nd hiO-O-inn mu hand en tug iniHafgr? 1 (inning -?empted to punch me in the face, so we initiated a standing per his needs and services plan due t-n hahauinr CONFIDENTIALITY NOTE 3 The documents accompanying this telccopy transmission may contain information that is con?dential and/or legally privileged The information is intended only for the use by the indivrdual or entity names on this sheet. If you are not the intended recipient. you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any acnon in reliance on the contents of this information is strictly prohibited. If you have received this telecopy in error, pleasc notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to on. Thank 0 PBS Front Line PRA 3-2011 Incident Reports) 000143 Fanzilies?'rst, Inc. 2100 Fifth Street, Dan's, CA 95616 24 Hr. CL Report Monday, April 29, 201.3 The period of this report Is from 7:00 am. (prior of?ce working day) to 7:00 am. (current of?ce working day) (60 min) Reporting: Erica Retzer - Restraint Team Prone Assisting: Nolan Bradley 0 - Assault/Aggression Standing Assisting: Eric Benoit Other Standing Assisting: Michele Bettega Incident Report 79214 (Reference #:79214 WW Emmi Wot Pioneer RTP 04/28/13 Resource Center Staff informed me that- did not receive his - at 3 PM. Reporting: Angela Lira - Med Error - Missed Dose at Home Incident Report 79227 (Reference #:79227 mum Sapphire RTP 04/28/13 Bedroom #5 violently pushed into staff and assaulted Antonio, Eric, and I with closed ?rst punches after her clear limit on assaultive behaviors had been set. (21 min) Adrian Mendoza - Restraint Team Prone Erica Retzer - Assault/Aggi'ession 3min; Matthew Brown Michele Bettega Eric Benoit Antonio Garlbay Matthew Bettencourt IncidentRepon 79-197 (Reference #:79197 Wilma! of Adventurer RTP 04/27/13 Public followed a peer off of campus and out of supervision. Eric Benoit - Law Enforcement Contact Assisting; Marcos Almeida Other Incident Report 79210 (Reference #:79210 2mm MW Adventurer RTP 04/28/13 Field CONFIDENTIALITY NOTE 4 The documents accompanying this telccopy may contain information that Is con?dential and/or legally pnv?cged. The information Is intended only {or the use by the individual or entity names on this transmissmn sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. If yOu have received this in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000144 Fam?ics?'rsr; Inc. .2100 Fifth Street; Data's, CA 95616 24 Hr. CL Report Monday, April 29, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 a.rn. {current of?ce working day) r' began to fall and push on staff, which at that point we initiated an escort. We remained in a standing after he refused to walk. Once he was ready, we escorted him to the Quiet Room. (11 min) Staff: nci int e: Reporting: Adrian Mendoza - Restraint Escort Assisting: Eric Benoit Assault/Aggression Escort Standing Incident Report 79209 (Reference #:79209 a Un? ent mm Location at Incident Adventurer RTP 04/28/13 Basketball Court said his life was not worth living anymore and that he planned to hang himself at some point in the near future. Reporting: Rachel Fader - Suicidal Ideation - Incident Report 79200 (Reference #:79200 Ranger RTP 04/27/13 Resource Center Alter several attempts,- repeatedly refused his 7 PM medication. Incident staff: Incident Ix-pg; Reporting: Andrea Chiles - Med Error Client Refused To Take Medication Incident Report 79201 (Reference #:79201 Ranger RTP 04/27/13 Post Of?ce walked to the post of?ce without permission and I called the police. In 'd . Begging; Edgar Zamora - Law Enforcement Contact Other Incident Report 79194 (Reference #:79194 Jade DTP 04/26/13 Front of Campus ?tief Descri?ign:- was contained by law enforcement at the front of campus. She was placed in the Quiet Room by law enforcement. She asked to go to the bathroom on the way to the bathroom, she ran off campus and out of supervision. locum 1mm Reporting: Lisa Little 5 Law Enforcement Contact Assisting: Andrea Guthrie Incident Report 79208 (Reference #:79208 CONFIDENTIALITY NOTE 5 The documents accompanying this telecopy transmission may contain information that is con?dential arid/or legally privrlegcd. The information is intended only for the use by the individual or entity names on this transmissmn sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the Contents of this talc-copied information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange. for the return of the original documents to us at no cost to vou. Than it . PBS Front Line PRA Request 3-2011 Incident Reports) 000145 Families?'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 CL Report Monday, April 29, 2013 The time period of this report is from 7:00 am. (prior office working day) to 7:00 am. (current of?ce working day) MW 2mm Widens Jade RTP 04/27/13 - Campus/Public left supervision off of campus. madman: 3mm Eric Benoit - Law Enforcement Contact Assisting; Marcos Almelda 0 - Accident/Injury to Child Assisting; Jared Hungerford Other Incident Report at: 79233 (Reference #:79233 . Jade RTP 04/28/13 Off Campus left supervision, cut herself, and gave statements about what happened on her prior AWOL. mg; Patrick Oleson-Wheeler - Law Enforcement Contact Jose Garibay - Accident/Injury to Child - Suicidal Ideation - Short-Term Runaway Other Other Incident Report 79211 (Reference #:79211 Adventurer RTP 04/ 28/13 van made a statement about incidents that occurred on his home visit this weekend. Reporting: Islam Hassanein Other Other Incident Report 79188 (Reference #:79188 Ranger DTP 04/26/13 5th and Pole Line Rd left campus and was able to get out of supervision by sliding down the side of the overpass. He was brought back by Davis Police. . gem Kelsey Blissett - Law Enforcement Contact 0 - Short-Term Runaway Incident Report 79199 (Reference #:79199 Emsnm Wet Ranger RTP 04/27/13 House CONFIDENTIALITY NOTE 6 The documents accompanying this transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmissmn sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request '(2013-2011 Incident Reports) 000146 Faml'liesE'rst, Inc. 2100 Fri?!) Street, Davis, CA 95616 24 Hr. CL Report Monday, April 29, 2013 The time period of this report is from 7:00 amt (prior of?ce Working day) to 7:00 a.m. (current of?ce working day) - - walked out of the house this morning Without permission. He eventually walked off campus to the police station. He returned to Ranger House after about 45 minutes. geporting: Chris Marshall 5 - Law Enforcement Contact Assiging; Antonio Garibay Other Incident Report 79217 (Reference #:79517 WW Ranger RTP 04/28/13 Off Campus walked out of his house this morning and left staff supervision. Jose Garibay - Law Enforcement Contact 0 - Short-Term Runaway Incident Report 79204 (Reference #:79204 2mm Wooden Musing: Jade RTP 04/27/13 House made a statement of wanting to die. 3399533; Eric Benoit - Suicidal Ideation Marcos Almeida Incident Report 79206 (Reference #:79206 Jade RTP 04/27/13 - Bedroom #1 made statements about prior abuse and neglect from her - mounting; gm Andrea Chiles Other Incident Report 79231 (Reference #:79231 Wins anagram WW Jade RTP 04/28/13 Hallway forcefully and repeatedly pushed into staff and would not respond to verbal intervention attempts. so restraint was initiated. (34 min) cl mm mm; Kristin Mann?que - Restraint Standing Assi?ng; Patrick Oleson-Wheeler - Assault/Aggression Assisting: Jesus Zamudio Incident Report 79230 (Reference #:79230 Jade RTP 04/ 28/ 1 3 1 5th Street CONFIDENTIALITY NOTE 7 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmissmn sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. If you have received this in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to vou. Thank ou. PBS Front Line PRA Request (2013-2011 Incident Reports) 000147 Farniljcerst, Inc. 2100 Fi?b Street, Davis, CA 95616 24 Hr. CL Report Monday, Apa'129, 2013 The time period of this report is from 7:00 am. (prior office working day} to 7:00 a.m. (current office working day) left campus without permission, so the police were noti?ed. She returned on her own. Kristin Manrique - Law Enforcement Contact gem Patricia Button Other Incident Report 79223 (Reference #:79223 2mm Sapphire RTP 04/28/13 5th Street and her peer walked off campus. mum - Michele Bettega - Law Enforcement Contact Kristin Mann'que Other Incident Report 79225 (Reference #:79225 2mm Winona: Sapphire RTP 04/28/13 House - left staff Supervision, attempted to create super?cial wounds on her left arm, attempted to assault staff using her ?st, whic at point resulted in 3 Quiet Room restraint. (10 min) 5m; Leola Taylor - Restraint Quiet Room Christian Villela 0 - Assault/Aggression Incident Report 79226 (Reference #:7926 WWII: Emmi: Walden: - Sapphire RTP 04/ 28/ 13 09235PM School Quiet Room Once the police officers got- into the Quiet Room, she charged at me and I closed the door. (2 min) Kristan Warren - Law Enforcement Contact Quiet Room Assisting: John (Nick) Mariana - Restraint Assisting: Matthew Brown 0 - Assault/Aggression Incident Report 79189 (Reference #:79189 11mm Voyager DTP 04/26/13 Hause left the house through his window. He made attempts to leave the area and to climb fences, leading to forceful pus mg and posturing, for which he was restrained. (34 min) CONFIDENTIALITY NOTE 8 Thr- accompanying this tclecopy transmission may contain information that is confidential and/ or legally privileged. The information is only for the use by the individual or entity names on this transmissron sheet. if you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000148 Farm?es?rst, Inc. 2100 Street, D3 103', CA 95616 24 Hr. CL Report Monday, Ap11729, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 an]. (current of?ce working day) I . . lug-?gm 119;- i e: Witnessing: Misaki Curtis - Restraint Team Prone Witnessing: Kristen Warren 0 - Assault/Aggression Reporting: Logan Hess Other Assisting: Matthew Brown Assisting: John (Nick) Mariana Incident Report 79216 (Reference #:79216 2mm i 'de - i i Voyager RTP 04/28/13 5th Street Brief Descripsign:- left staff supervision at 7:27 PM. He walked of campus and was returned by police at 7:40 PM. Wei Reporting: Kristan Warren - Law Enforcement Contact Assisting: John (Nick) Moriana - Short-Term Runaway CONFIDENTIALITY NOTE 9 The documents accompanying this telecopy transmission may contain information that is confidential rind/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. if you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this telecnpy in error. please notify us by telephone immediately so that we can arrange For the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000149 Fanzl'lies?'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Tuesday, April 30, 2013 The time period of this report is from 7:00 a.m. {prior office working day) to 7:00 a.m. (current of?ce working day) Incident Report 79243 (Reference #:79243 . all]: I I. .ll Adventurer DTP 04/29/13 House made a statement about his step dad. mama: mm Adriana Escobar Other -) Incident Report 79250 (Reference #:79250 Emum Ranger DTP 04/29/13 - East Parking Lot Erie! was contained after repeatedly and forcefully pushing me. (6 min) Reporting; John (Nick) Monana Restraint Team Prone Kristan Warren 0 - Assault/Aggression Standing Incident Report 79251 (Reference #:79251 WW Emma; 23W Widens Ranger DTP 04/29/13 Campus lunged at me, punching me on my face. (11 min) Edgar Zamora - Restraint Standing 0 - Assault/Aggression Incident Report 79244 (Reference #:79244 Emnm Adventurer RTP 04/29/13 Resource Center went on a home visit and returned with the same number of medication he left with. Therefore, it appears he missed ree doses of - Noti?ed appropriate people. Reporting: Julie Vice - Med Error - Missed Dose at Home Incident Report 79255 (Reference #:79255 Bantam Went Sapphire DTP 04/29/13 Bedroom #5 CONFIDENTIALITY NOTE 1 The documents accompanying this telet?opy transmission may contain information that is Con?dential and/0r legally privdcged. The information is intended only for the use by the mdiv1dual or entity names on this transmissmn sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of original documents to us at no cost to you. Thank vou. PBS Front Line PRA Request (2013-2011 Incident Reports) 000150 Fanu'lies?'rst, Inc. 2100 Fifth Street, Dan's, CA 95616 24 Hr. CL Report Tuesday, Apn'l 30, 2013 The time period of this report is from 7:00 mi. (poor of?ce working day) to 7:00 a.m. (current of?ce working day) '-began hitting and punching staff, attempting to prevent them from containing her peer, so we initiated containment. (14 min) Andrew Enright - Restraint Team Prone Assisting: Brooke Piasecki - Accident/Injury to Child Standing Assisting; Michele Bettega - Assault/Aggression Incident Report 79256 (Reference #179256 Emnm W0: Sapphire DTP 04/29/13 Bedroom #3 W- assaulted staff by kicking them. (30 min) Repomng: Christopher Bryce - Restraint Team Prone Andrew Enright - Assault/Aggression Standing Bryce Lumbard Incident Report 79269 (Reference #:79269 I I I I . Eagles NPS 04/29/13 - Classroom/Hallway was off task the majority of the day. He found out his daily score and started pushing into me. (6 min) gem Kate Broida - Restraint Escort Assisg?m; Erin Milligan - Assault/Aggression Team Prone ?sisdng: Kyle Gariick Incident Report 79253 (Referenced-?99253 Sapphire DTP 04/29/13 Bedroom #5 was being assaultive by hitting, pushing, and kicking staff. (36 min) ChristOpher Bryce - Restraint Team Prone Stephen Lendzion 0 Assault/Aggression Team Prone Matthew Bettencourt Standing Incident Report 79254 (Reference #179254 Bantam Sapphire DTP 04/29/13 House continued to hit me and other staff. Kicked the door into me, threw broken shards and threatened me. (21 min) tut-inland- 60-00- Tmn- D-ofrginO Tun.- NOTE 2 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended rcc1picm, you are hereby noti?ed that any disclosure. copying, distribution, or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. If you have received this in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you Thank you PBS Front Line PRA Request '(201 3-2011 Incident Reports) 000151 Faznilies?'rst, Inc. 2100 Fifth Sacct, Davis, CA 95616 24 Hr. CL Report Tuesday, April 30, 2013 The time period of this repon ts from 7:00 am. (prior office Working day) to 7:00 a.rn. (current of?ce working day) Michele Bettega - Restraint Quiet Room Brooke Piasecki Assault/Aggression Quiet Room Ashley McLemore Quiet Room Qmet Room Incident Report 79240 (Reference #:79240 2mm Adventurer DTP 04/29/13 Dinning Room was charging at a peer and swung his fists to hit him, so I held his arms and deterred him from doing so, until additiona staff arrived. (1 min) Reporting; Islam Hassanein - Restraint Standing 0 - Assault/Aggression Incident Report 79239 (Reference #:79239 In 5 _9_qca_Pr In Women: Widen: Adventurer RTP 04/29/13 House tn?ed punching his peer- and staff had to stand in the way of the clients. He was directed back to his room. Reporting; Antonio Galvan - Assault/Aggression Incident Report 79241 (Reference #:79241 Emum WM Adventurer RTP 04/29/13 Front of Campus ran off campus with a peer. Police were noti?ed to help return them to campus. Kristan Warren - Law Enforcement Contact Rachel Fader - Short-Term Runaway Incident Report 79247 (Reference #:79247 Emma: Adventurer RTP 04/29/13 Resource Center mum- stated that- fed him toilet water in the past. m; John (Nick) Monana Other CONFIDENTIALITY NOTE 3 The documents accompanying this transmISSIon may contain Information that is con?dential and/or legally privileged The information Is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied Information 15 strictly If you have received this (cit-copy in error, please notify us by telephone Immediately so that we can arrange for the retum of the onginzl Re?lla?lm1 3-201 1 Incident Reports) 0001 52 Familr'eer-st, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Tuesday, April 30, 2013 timc period of this report is from 7:00 a.m. (prior of?ce working day) to 7:00 a.m. (current of?ce working day) Incident"Report 79242 (Reference #:79242 WW 2mm Adventurer RTP 04/29/13 Resource Center did not receive his 7 AM dose of medication prior to being taken to public school and he did not come to the of?ce to take it en called. Therefore,- did not take his medication. modem Wins: Mm; Julie Vice - Med Error - Missed Dose at Familiesl-?irst Mug; Christian Viilela Incident Report 79261 (Reference #279261 BMW 2mm WM Jade RTP 04/29/13 Resource Center was not on campus to receive her 7 PM medication. - gem; Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report 79262 (Reference #:79262 Went Jade RTP 04/29/13 Campus left campus supervision. Police were noti?ed. Kristen Warren - Law Enforcement Contact 0 - Short-Term Runaway Incident Report#: 79263 (Referenoet#:79263 WW 2mm Whom Wooden: Jade RTP 04/29/13 Outside Resource Center attempted to leave staff supervision. As staff attempted to stop her, she became aggressive and had to be contained. (14 min) John (Nick) Mariana - Restraint Team Prone Reporting: Jose Garibay 0 - Assault/Aggression Standing Daniel Zaragoza Christian Villela Incident Report 79245 (Reference #:79245 Bantam Wedded: Adventurer RTP 04/29/13 Resource Center - returned from a home visit with an unopened packet of medication. It appears he missed on visit. Appropriate noti?cations made. CONFIDENTIALITY NOTE 4 The documents accompanying this telecopy transmission may contain informatwn that is confidential and/or legally The information is intended only for the use the individual or entity names on this transmission sheet. If you are not the intended you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information IS strictly prohibited. If you have received this tn error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank u. PBS Front Line PRA Request (2013-2011 Incident Reports) 000153 FamiliesE'rst, Inc. 2100 Fi?h Street, Davis, CA 95616 24 Hr. CL Report Tuesday, April 30, 2013 The time period of this report is from 7:00 am. (prior om? Working day) to 7:00 a.m. (current of?ce working day) modem Jamming; Julie Vice - Med Error - Missed Dose at Home Incident Report 79258 (Reference #:79258 WW 2mm Wooden: Sapphire RTP 04/29/13 - Hallway 81 Quiet Room was scratching and punching staff?s legs, so we initiated containment. (26 min) Reporting: Andrew Enright - Restraint Team Prone Assisting: Christopher Bryce - Assault/Aggression Assisting: Ashley McLernore Incident Report 79259 (Reference #:79259 WNW 2mm Datum: Sapphire RTP 04/29/13 House forcefully pushed into me and punched me with a closed ?st in the stomach. We initiated a standing and released due to her dropping weight. She kicked us aggressnvely, so we initiated a standing and escorted her to the Quiet Room. (8 min) witnessing: Antonio Garibay - Restraint Escort gm Eduardo Viilaiobos - Assault/Aggression Standing Patricia Button - Suicidal Ideation Standing Quiet Room Incident Report 79260 (Reference #:79260 Emram mm Maximum Sapphire RTP 04/29/13 Resource anter was escalated and refused to take her 7 AM dose of medication. Several attempts were made and appropriate noti?cations were made. Indicating. Raging: Julie Vice - Med Err0r - Client Refused To Take Medication Patricia Button Incident Report 79246 (Reference #:79246 WW Emma Wu: Adventurer RTP 04/29/ 13 Resource Center retumed from a home visit with mom medication than he should have. Insidentlxiu: mm; Angela Lira - Med Error - Missed Dose at Home CONFIDENTIALITY NOTE 5 The documents accompanying this ielecopy transmission may contain information that is Con?dential and/or legally privdeged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received (hb telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original ?h?s?FPo??fim meanest {2?01 3-201 1 Incident Reports) 0001 54 Farm'II'csFirs t, Inc. 2100 Filth Street, Davis, CA 95616 24 Hr. CL Report Tuesday, April 30, 201.3 The time period of this report is from 7:00 a.m. (prior office working day) to 7:00 a.m. (current of?ce working day) Incident Report 79252 (Reference #:79252 I. . I I am Voyager DTP 04/29/13 Bedroom #2 swung a belt toward my head and face, so we initiated a standing restraint per his needs and services plan due to aggressive behavior. (14 min) Erica Retzer - Restraint Standing gagging; Rosa Retzer - Assault/Aggression Angela Lira Incident Report 79249 (Reference #:79249 pioneer 04/29/13 Dinning Room was off task, assaultive, and had left to go to the side porch and tried to force his way back into the house, so we escorted him away from the door and locked it. (1 min) Wm; Nolan Bradley - Restraint Escort gigging; John (Nick) Moriana - Assault/Aggression Adriana Escobar CONFIDENTIALITY NOTE 6 The documents accompanying this transmission may contain information that is con?dential and/or legally The information is intended only For the use by tht: individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution. or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have ?caved this in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Than It . PBS Front Line PRA Request y(??uo1 3-2011 Incident Reports) 000155 FaIm'II?csFirs t, Inc. 2100 me}. Street, Davis, CA 95616 24 Hr. CL Report Wednesday, May 01, 2013 This time pt-nod of this report is from 7.00 a.m. (prior office working day) to 7:00 a.m (current of?ce working day) Incident Report 79273 (Reference #:79273 WW 2mm Sapphire RTP 04/30/13 Hallway W-was assaultive to staff by scratching and hitting staff. (1 min) 1051mm tandem Esme; ?imssing: Aaron Alston - Restraint Escort Christopher Bryce - Assault/Aggression Incident Report 79277 (Reference #:79277 WW Emma: WM Widen: Pioneer RTP 04/30/13 House W-s?tuck his ?nger into- buttocks region (anus). Mug; Kamika Sherwood Other Assisting; Kyle Garlick Incident Report 79271 (Reference #:79271 Emnm Adventurer RTP 04/30/13 Off Campus/5th Street - left campus and when we cau ht up with him, Ryan initiated a standing containment. I immediately told him to release his hold and he did. ran from our supervision and returned approximately 2 hours later. (1 min) Reporting; [slam Hassanein - Law Enforcement Contact Standing - Restraint - Short-Term Runaway Incident Report 79282 (Reference #279282 MW Brenna: Jade DTP 04/29/13 - House left supervision when staff was unavailable immediately to take her to the play structure. John (Nick) Mariana - Law Enforcement Contact Nicole Silva - Short-Term Runaway Reynoso Trujillo CONFIDENTIALITY NOTE 1 The documents accompanying this transmissron may contain information that is con?dential and/or legally The information is intended only for the use by the individual or entity names on this transmissum sheet. If you are not the intended recipient. you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. if you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the of the original W01 3-2011 Incident Reports) 000156 Fazm'lz'esE'rst, Inc. 2100 Fifth Street, Dar/13', CA 95616 24 Hr. CL Report Wednesday, Ma 01, 2013 The time period of this report is from 7:00 am. (prior office working day) to 7:00 mm. (current of?ce working day) Incident Report 79276 (Reference-#09276 WW anagram Widen: Woman Jade RTP 04/30/13 House left supervision and returned on her own. She stated that she drank orange alcohol and smoked marijuana. Insulating; Nicole Silva - Law Enforcement Contact John (Nick) Mariana 0 - Short-Term Runaway Other Incident Report 79275 (Reference #:79275 MW Emam Walnut MSW Jade RTP 04/30/13 House left campus when she was given a direction that she didn't want to follow. Returned on her own after police were notified. Claimed that she bought weed and smoked it. Reporting; Nicole Silva - Law Enforcement Contact Assisting; John (Nick) Morlana - Short-Term Runaway Other Incident Report 79274 (Reference #179274 anagram Off Campus Jade DTP 04/30/13 attempted to leave supervision off campus. Police were notified. mm Wksus Zamudlo - Law Enforcement Contact Patrick Oleson-Wheeler Incident Report 79272 (Reference #:79272 WW Emeram Wanna: Sapphire DTP 04/30/13 Front Porch was contained after repeatedly and forcefully punching a window. (14 min) Reporting: John (Nick) Mariana - Restraint Standing Assig'ng: Kristan Warren 0 - Accident/Injury to Child 0 - Assault/Aggression k) CONFIDENTIALITY NOTE The accompanying this telecopy transmission may contain information that iS con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet If you are not the intended reqpient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have this in error, please notify us by telephone immediately so that We can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000157 Farm'II'csE'rst, Inc. 2100 Fifi]: Street, Davis, CA 95616 24 Hr. CL Report Thursday, May 02, 2013 The time period of this report is from "?200 am. (prior of?ce worlong day) to 7:00 am. (current working day) Incident Report 79294 (Reference #:79294 Adventurer RTP 05/01/13 Rooftop of House climbed the mod and threw large, hard objects toward staff. Police involvement occurred and- was arrested for property destruction. He also cut right Index ?nger. - Witnessing: Michelle Glicksman - Law Enforcement Contact Lisa Robertson 0 - Accndent/Injury to Child Witnessing: John (Nick) Mariana - Assault/Aggressuon Mm Marcos Almeida Other Reporting Islam Hassanein Adrian Mendoza Incident Report 79320 (Reference #:79320 Emma Muslim!) ime 1? Jade RTP 05/01/13 Front of House was Sitting in her room on her bed, ran out of her room thrOugh the back door and off campus, crossmg the street Without looking. She returned to campus on her own, but was not followmg directions, attempting to run and pushing into staff. (25 min) Witnessmg: Jared Hungerford - Restraint Team Prone Sarah McFadden - Assault/Aggressnon Team PrOne Marcos Almelda Other Standing Incident Report 79321 (Reference #:79321 . if I II. .II I. .l Jade RTP 05/01/13 House Brief Description:- left supervusnon. Flemming: Eric Benout - Long-Term Runaway Incident Report 79296 (Reference #:79296 WW Brennan: Ranger DTP 05/01/13 House stated that a peer exposed himself to him. msidenLSta?; Inci nt 1? e: gm Edgar Zamora Other CONFIDENTIALITY NOTE 1 The documents accompanying this transmission may contain information that is con?dential and/or legally The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or taking of an}r action in reliance on the contents of this information is strictly prohibited. lfyou have ft?CCth?d this in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000158 Fatm'lics?'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Thursday, May 02, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 am. (current nfticc working day) Incident Report 79298 (Reference #:79298 2mm I Voyager DTP 05/01/13 Hallway continued shoving into me and stomping on my foot, so we initiated a standing restraint per his needs and services plan ue to assaultive behavior. (9 min) Mm; En?ca Rener - Restraint Team Prone Imelda Davlla - Assault/Aggression Standing Dean Valencia Assi?ing: Brian Blanco Oscar Lopez Incident Report 79299 (Reference #:79299 I. Ell]: Voyager DTP 05/01/13 Bedroom #1 kicked me in the stomach, so we initiated a supine restraint per his needs and servuces plan due to assaultive dropping down immediately. (16 min) Regoging; Erica Retzer - Restraint Team Prone Assisting; John (Nick) Moriana - Accident/Injury to Child - Assault/Aggression Incident Report 79312 (Reference #:79312 Emma: Sapphire RTP 05/01/13 Parking Lot left supervisron and was directed to a designated safe area on campus. She refused to go, and due to her history of unsafe behawor while out of supervision, we deterred her from leaving. She pushed us and we initiated containment. (11 min) mixing; Andrew Enright - Restraint Team Prone Mm; Jared Hungerford - Assault/Aggressnon Standing Other Incident Report 79313 (Reference #:79313 4?Pf0 ram W03 Sapphire RTP 05/01/13 Basketball Court/Field was placed in a containment for forcefully pushing into staff. (36 min) Reporting; Ashley McLemore - Restraint Team Prone Andrea Chiles - Assault/Aggre55ion Standing CONFIDENTIALITY NOTE 2 'lhe documents accompanying this telecopy transmission ma) contain information that is con?dential and/0t legall) privileged The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this teleenpied information is Strictly prohibited. If you have received this telecnpy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000159 FamzZz'esFirst, Inc. 2100 Fifth Street; Davis, CA 95616 24 Hr. CL Report Thursday, Ma 02, 2013 The time period of this report is from 7:00 am. (prior office Working;r day) to 7:00 am. {current of?ce working day) Incident Report 79300 (Reference #:79300 ram gamma: Woman Voyager DTP 05/01/13 House Brief - was contained for assaulting staff. (33 min) anident syg?: Incident Type: e: Witnessing: Feiicia Thomas - Restraint Team Prone Regoging: Brian Blanco - Accident/Injury to Child Team Prone Assisting: Erica Retzer - Assault/Aggression Standing Incident Report 79301 (Reference #:79301 i Uni I Program page 81 Time 9f Incident WM Voyager RTP 05/01/13 House Brief was told he couldn?t participate in an activity he wanted to in due to his unsafe behavior. He attempted to leave supervisiion and became extremer assaultlve with forceful kicks, elbows, punches, and bite attempts which led to restraint. (12 min) i ff" mm e: Mummers Witnessing: Erica Retzer - Restraint Team Prone Regorting: Logan Hess Assault/Aggression Standing Incident Report 79302 (Reference #:79302 Beng?igg unit of Ingigeng Program page Iime of Incident Location of Incident Voyager RTP 05/01/13 Side Porch of House Brigf elbowed me in the chest, so we initiated a standing restraint per his needs and services plan due to aggressive behavior. (13 min) In Eesitaiutlmc: Regorting: Erica Retzer - Restraint Team Prone Assisting: Logan Hess - Accident/Injury to Child Standing 0 - Assault/Aggression Incident Report 79303 (Reference #:79303 Unit of Incident Program Date 3; Iime of Incident nggtion of moment Voyager RTP 05/01/13 House Brie! wandered out to go to the bathroom wearing only his underwear. LEM nt 5 ff: Immune; Witnessing: Jacob Babcock Other Witnessing: Erica Retzer Witnessing: Rosa Retzer Regorting: Logan Hess Incident Repart 79310 (Reference #:79310 Retailing?0mm Lawson: Sapphire DTP 05/01/13 Hallway CONFIDENTIALITY NOTE 3 The documents atcompani-?intT this telecopy transmission may Contain information that is Confidential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the Contents of this telecopied information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that We can arrange for the return of the original documents to us at no cost to you. 'l?hank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000160 Fam'lies?'rst, Inc. 2100 Street, Dan's, CA 95616 24 Hr. CL Report Thursday, May 02, 2013 The time period of [his report is from 7'00 am. (prior office working day) to am. {current office Working day) assaulted staff; pushing into staff and elbowmg staff?s ribs. (29 min) Incident?ta?z we i Witn?smg; Ashley McLemore - Restraint Team Prone Reporting: Christopher Bryce - AssaultJAggreSSion Standing Assisting: Andrew Enright Assisting: Jared Hungerford ASSiging: Oscar Lopez Incident Report 79324 (Reference #:79324 I.?.ln.ll Elan ?ill Adventurer RTP 04/28/13 Outside Room Brief made statements about what her and- did on an AWOL together. Insists-mine: gaming; Patrick Oleson-Wheeier Other Incident Report 79289 (Reference #:79289 Emmi: Adventurer DTP 05/01/13 Bedroom began to push into staff, which at that pomt we initiated a standing. He dropped weight, which we then transmoned into a team prone. (28 min) Repg?ing; Adrian Mendoza - Restraint Team Prone Efren Sanchez-Delgado - Assault/Aggression Standing Incident Report 79297 (Reference #:79297 I. .II El Eli I I. .II Ranger DTP 05/01/13 House was pushing Into staff and assaulted me by twisting my arm and clinching his ?ngernails into my skin simultaneously. Therefore, we transitioned into a standing restraint. (12 min) Efren Sanchez-Delgado Restraint Team Prone Assisting: Claudia Vazquez - ACCIdent/Injury to Child Standing 0 - Assault/Aggressmn Incident Report 79316 (Reference #:79316 I. .l In mum Emg?m Q?g Iimg gf mgiggng Location of Incident Jade RTP 05/01/13 Resource Center CONFIDENTIALITY NOTE 4 'Ihc documents acmmpanymg this telecop) transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient. you are hereby noti?ed that an} disclosure, copying, distribution, or the taking of my action in reliance on the Contents of this telewpied information is Strictly prohibited. If you have received this trlecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000161 Fann'lz'es?'rst, Inc. 2100 Street, Davis, CA 95616 24 Ht. CCL Report Thursday, May 02, 2013 The time period of this report IS from ?7 00 am (prior of?ce Working div) to "'00 am. :current office working day) After several separate attempts- still refused her 3 PM medication. Ming; Angela Lira - Med Error - Client Refused To Take Medication Andrea Chiles Incldent Report 79317 (Reference #:79317 WW Emnm Widen: Jade DTP 05/01/13 Front of Campus attempted to leave staff superwsion. We attempted to redirect her to another area, but she refused and stated she was 90an to jump in front of a car and get hit. She was upset, because staff let her know their last day. (20 mm) mm Inside?mm e: Johnny Tillis - Restraint Team Prone Assisting: John (Nick) Moriana - Assault/Aggression Standing Assig'ng: Brett Atwood Other Assiging: Lisa Little Assisting: Eric Benoit Incident Report 79319 (Reference #:79319 Emmi: of Jade RTP 05/01/13 Resource Center refused her 7 AM dose of medication. Several attempts were made priOr to her leaving campus. Appropriate people were noti?ed. nt aft: Julie Vice - Med Error - Client Refused To Take Medication 5mm Erin Milligan Incident Report 79311 (Reference #:79311 Wu: 2mm Sapphire DTP 05/01/13 Off Campus/Play Structure/Parking left campus, got glass, and cut herself on the play structure. She went back to the house and assaulted staff, so 5 was contained. (12 min) Incident?ta?; mi 6: witnessing: Stephen Lendzion - Restraint Team Prene Witnessing: Jared Hungerford - Acadent/lnjury to Child Reporting: Andrew Enright - SuiCIdal Ideation Aaron Alston - Assault/Aggressnon Assisting: Matthew Bettencourt - Short-Term Runaway Christopher Bryce Other CONFIDENTIALITY NOTE 5 The documents accompanying this telecopy transmission may contain information that is con?dential and/oi legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the Intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopietl Information is prohibited. If you have received Ielecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000162 Farmlz'cs?'rst, Inc. 2100 Fifi}: Street, Davis, CA 95616 24 Hr. CL Report Thursday, May 02, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 a.m. (current of?ce working day) Incident Report 79306 (Reference #:79306 2mm Sapphire DTP 05/01/13 Administration Building was placed in a team prone containment for assaulting staff. (28 min) Jared Hungerford - Restraint Team Prone gm Ashley McLemore - Accident/Injury to Child Standing mama; John (Nick) Monana - Assault/Aggression Felicia Thomas Inddent Report 79307 (Reference #:79307 Sapphire DTP 05/01/13 - Bedroom #4 grief Dgsg?mign: - was escarted to the Qutet Room for assaulting staff. (8 min) Ashley McLemore - Restraint Esc0rt - Assault/Aggression Quiet Room Incident Report 79305 (Reference #:79305 WW Emmi Wooden: Location?cum Sapphire RTP 05/01/13 House - made verbal threats to kill herself. She attempted to run toward the street. I physically deterred her, she forcefully punch me. We initiated an escart to the Quiet Room. She charged and the d00r closed. (9 min) 33mm; Eduardo Villalobos - Restraint Escort David Waites - Suicidal Ideation Quiet Room 0 - Assault/Aggression Other Incident Report 79308 (Reference #:79308 uni; 9f Emgram page 3; Iimg of Incident of Sapphire RTP 05/01/13 Hallway was placed into containment far assaulting staff. (14 min) Andrew Enright - Restraint Escort Rgpogjng: Christopher Bryce - Assault/Aggression Team Prone John (Nick) Moriana Assisting: Claudia Vazquez Incident Report 79304 (Reference #:79304 a I- .II I I. Voyager DTP 05/01/13 House CONFIDENTIALITY NOTE 6 The dOCuments accompanying this telecopy transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmissmn sheet. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopietl information is strictly prohibited. If you have received this in error. please notify us by telephone immediitcly so that we can arrange for the return ot? the original documents to us at no cost to you. Thank yuu. PBS Front Line PRA Request (2013-2011 Incident Reports) 000163 Fannlies?'rst, Inc. 2100 H?b Street, Davis, CA 95616 24 Ht. CL Report Tbutsda y, May 02, 2013 The time period of this report is from 7:00 am. (prior of?ce Working day) to 7:00 a.m. (current of?ce Working day) was not following directions and trying to wander around the house. He went to the TV and was pushing us, posturing wit closed ?st, grabbing Misaki's hair, and head butting, which led to restraint. (34 min) Insidentlmei new wimgssing: Misaki Curtis - Restraint Team Prone Jared Hungerford 0 - ACCIdent/Injury to Child Standing Logan Hess - Assault/Aggression Assisting; Erica Retzer Assiging; Jacob Babcock Incident Report 79295 (Reference #:79295 Widens Emmam Pioneer DTP 05/01/13 - Ranger House A peer stated that- exposed himself to him. Reporting: Edgar Zamora Other CONFIDENTIALITY NOTE 7 The documents accompanying this telecopy transmission may Contain information that is con?dential and/or legally The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopic-d information is strictly prohibited If you ll?VC received this ti-lecopy in error? please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000164 FamiliesE'I-st, Inc. 2100 Fifth Street, Dan's, CA 95616 24 Hr. CL Report Fridays Ma 03, 201.3 The time period of this report is Crom 7:00 am. (prior of?ce working day) to 7:00 am. (current of?ce working day) Incident Report 79332 (Reference #:79332 Wooden; Adventurer DTP 05/02/13 House had been struggling all day after hearing news that his previous supervisor is leaving, and he left campus after talking about it with staff. Indium Sule Anibaba - Long-Term Runaway Rachel Fader Assisting; Jared Hungerford Incident Report it: 79333 (Reference #:79333 WM Emmn Adventurer RT 05/02/13 - Resource Center missed his 7 PM medication due to being off campus. Rewriting: Andrea Chiles - Med Error - Missed Dose at -) Incident Report 79338 (Reference #:79338 ?rearm Ranger RTP 05/02/13 House alleged that a peer from another house showed him his genitals and asked him to do the same. Kelsey Blissett Other Incident Report 79344 (Reference #:79344?) Email]: I Sapphire DTP 05/02/13 - Field/Quiet Room was pushing into Jared and per her safety plan she was contained. (5 min) Mm; Jared Hungerford - Restraint Escort 0 - Assault/Aggression Standing Other Incident Report 79343 (Reference #:79343 Dome-030?? lie-IO I. ?In- 'nridnn. I npg?nn CONFIDENTIALITY NOTE 1 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally privileged. The information is only for use by the IndiVidual or entity names on this transmission sheet. If you are not the intended reczpient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the of this information is strictly prohibited. If you have received this telecopy to error, please notify us by telephone immediately so that we can arrange for the return of the original de?ections ?e?d?'?'il?tim 3-201 1 Incident Reports) 000165 Families?'rst, Inc. 2100 Street, Davis, CA 95616 24 Hr. CL Report Friday, Ma 03, 2013 The time period of this report is from "7:00 amt (pour of?ce working day) to 7:00 am. (current of?ce working day) Voyager RTP 05/02/13 Bedroom #5 called, impersonating his hung up. Regortigg; Kristen Warren Other Incident Report it: 79334 (Reference #:7934 Adventurer DTP 05/ 02/ 13 0514SPM Backyard attempted to leave supervision, pushed into staff and then was guided to the sensory room. A ?ve minute closed door containment ensued when he charged the door. (5 min) Wimggsing: Efren Sanchez-Delgado - Restraint Quiet Room Remrting: Brian Blanco - Assault/Aggression ?sisting; Sule Anibaba Other Incident Report it: 79335 (Reference #:79335 anagram Mum Adventurer RTP 05/02/13 Apartments on 5th Street ran outsude, ciimoea dumpsters, ran an campus, refused to stop pusmng into us, and so we were forced to initiate containment. (5 min) Noel Salazar - Restraint Team Prone Begging; Rachel Fader - Suicidal Ideatlon Standing Jared Hungerford - Assault/Aggression Anthony Aispuro-Sanchez - Short-Term Runaway Luanna Toney -) Incident Report 79336 (Reference #:79336 Adventurer RTP 05/02/13 Resource Center destroyed his 7 PM medication by putting his medicatiOn in his water cup. Incidentm modem Andrea Chiles - Med Error - Client Destroyed Medication Incident Report it: 79348 (Reference #:79348 21:29an Jade DTP 05/02/13 O3 Public left the house and barricaded herself in the restroom. She was also Cutting on her hands. CONFIDENTIALITY NOTE 2 The documents accompanying this transmissmn may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission slicer. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original . 'l?h . he?" Incident Reports) 000166 Families?'rst, Inc. 2100 Fifth Sa'cct, Davis, CA 95616 24 Hr. CL Report Friday, May 03, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 a.m. (current of?ce working day} momma: - Eric Benoit - Law Enforcement Contact Jared Hungerford - Short-Term Runaway Other Incident Report 79347 (Reference #179347 Bantam Wat Jade RTP 05/02/13 Living Room had just gotten out of the shower when she walked into the living room and said she was going to the play structure. walked off out of the house and ran off campus. Renee Paiombi - Law Enforcement Contact Begomng: Reynoso Tru3iilo - Short-Term Runaway mating; Lisa Little Other Kyle Garlick Kamika Sherwood Incident Report 79350 (Reference #9935!) anticommunist 21mm Widen: on cid Jade RTP 05/02/13 House left supervision off campus. - Eric Benoit - Law Enforcement Contact Assi?ng: Jared Hungerford 0 - Short-Term Runaway Incident Report 79339 (Reference #:79339 Voyager DTP 05/02/13 - House Wm It was time for to take a shower and he refused. He wandered the house, repeatedly trying to leave supervision, aggressively kicke punched, pushed, and attempted to bite staff which led to containment. (76 min) Kristan Warren - Restraint Team Prone Courtney Ghilain 0 - Accident/Injury to Child Standing mm Logan Hess - Assault/Aggression Matthew Brown Other Incident Report 79340 (Reference #:79340 Went Voyager RTP 05/02/13 Parking Lot left the house without permission and was walking towards the front of campus. When Nick and I approached him, he came assaultive and was placed in containment. (13 min) anldonO coau- anldoni' Tuno- Tun-e CONFIDENTIALITY NOTE 3 The documents accompanying this telecopy transmissxon may contain information that is con?dential and/ or legally privrleged. The information is intended only for the use by the indivrdual or entity names on this sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the of any action in reliance on the Contents of this mformatmn is prohibited If you have received this telecopy in error, plcasc notify us by telephone immediately so that we can arrange for the return of the original d?fesc??i?hisi?i?? 3-201 1 Incident Reports) 0001 67 Families?'rst, Inc. 2100 E'?b Sac-ct, Davis, CA 95616 24 Hr. CL Report Friday, May 03, 2013 The nme period of this report is from 7:00 a.m. (prior uf?cc working day) to 7:00 aim. (current of?ce working day) gem Logan Hess - Restraint Team Prone Assisting; Jared Hungerford - Accident/Injury to Child Standing Noel Salazar 0 - Assault/Aggression Other Incident Report 79346. (Re?nance #179346 Magnum Emma: Jade DTP 05/02/13 Bedroom #3 made statements of sexual abuse and wanting to kill herself. - Suicidal Ideation Other CONFIDENTIALITY NOTE The documents accompanying this tclecopy uansmissron may contain information that is con?dential and/ or legally privileged The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this talc-copied information is strictly prohibited. If ynu have this tclecupy in error, please notify us by telephone immediately so that we can arrange for the return of the original ?ll? y(5?01 3-201 1 Incident Reports) 0001 68 FamiliesFirst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Monday, May 06, 2013 The time period of this report is from 7:00 a.m. (prior of?ce Working day) to 7:00 a.m. (current office working day) Incident Report 79415 (Reference #:79415 Bgnm?ng uni; g1 {?gment Bantam im Ranger RTP 04/27/13 Basketball Court repeatedly attempted to assault police of?cers on campus. (17 min) Stephen LendZIon - Restraint Team Prone Reporting: Marcos Almeida - Assault/Aggressnon Standing ASSisting: Matthew Brown Incident Report 79360 (Reference #:79360 MW Emum mm Adventurer RTP 05/03/13 - Resource Center missed his 3 PM medication due to being off campus. mum Insidentlme. Reporting; Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 79361 (Reference #:79361 WW 2mm 233W Adventurer RTP 05/03/13 Resource Center missed his 7 PM medication, due to being ol?lE campus without permussuon. nt - Reporting: Andrea Chiles - Med Error - Missed Dose at FamiliesFIrst Incident Report 79377 (Reference #:79377 unit Ingidgnt 23;; Time 9! Incident Adventurer RTP 05/04/13 Resource Center was off campus Without permisswn, during his 7 PM medication. Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 79389 (Reference #:79389 Adventurer RTP 05/05/13 House was not followmg directions all morning, began thrownng CDs at staff, pushing into staff, and when he pushed a staff member off of the couch, they initiated a containment. (7 min) witnessmg: Jonathan Stone - Restraint Escort Jason Wade 0 - Assault/Aggressuon Standing \Iler-noee-inn - Caluan CONFIDENTIALITY NOTE 1 The documents accompanying this telecopy transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. if you are nor the intended recipient, you are hereby notified that any disclosure, copying, distributiOH, or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you PBS Front Line PRA Request (2013-2011 Incident Reports) 000169 FamiliesE'rst, Inc. 2100 Fi?b Street, Davis, CA 95616 24 Hr. CL Report Manda y, May 06, 2013 The timc period of this report is from 7:00 am (prior of?ce Working day) to 7:00 am. (current of?ce working day) Remrting: Rachel Fader A?SI?ting; Daniel Zaragoza Antonio Garibay Incident Report 79390 (Reference #:79390 of Inci Program gate a; Time of Incident WM Adventurer RTP 05/05/13 Front of Campus left off of campus and returned With a lighter. He smoked Cigarettes and lit items on fire ori campus. He 3 so stated that he was in posseSSion of stolen property. John (Nick) Moriana - Law Enforcement Contact A55isting Nolan Bradley 0 - Assault/Aggressmn Other Incident Report 79367 (Reference #:79367 ni mm Trailblazer RTP 05/03/13 Resource Center missed his 7 PM medication, due to being off campus on a Vi5it. Rem Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 79398 (Reference #:79398 BMW _o_?i_a_Pr w?m i Waggon: Pioneer RTP 05/05/13 Back Parking Lot of School assaulted me past the clear limit to stop hitting me with a large, hard traffic pole, so we initiated a standing restraint. min Insidentite?; mm 1195: Reporting; Nolan Bradley - Restraint Standing A?Sisting: Adriana Escobar - Amident/Injury to Child Assisting: Eric Bench; 0 - Assault/Aggressuon Incident Report 79365 (Reference #:79365 Emmi: WM oca i Pioneer RTP 05/03/13 Resource Center Brief Qgsg?gtlon:- missed his 3 PM medication, due to leavmg off campus on his home visit. Vanilla".- Co's"- Innidanf T\rno- CONFIDENTIALITY NOTE 2 The documents accompan?'ng this transmission may contain information that is con?dential and/or legally privileged. Tllc? information is intended only for the use by the individual or entity names on this transmission SIICCII If you are not the intended recipient, you on: noti?ed that any disclosure, copying, (listi?ibution? or taking of any action in reliance on the contents of this telecopied information is strictly piohibitcd. If you have received this telecopy in error, pic-rise notify us by telephone immediately so that we can for the return of the original to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000170 FamiliesFirs t, Inc. 2100 Eli]: Street, Davis, CA 95616 24 Hr. CL Report Monday, Ma 06, 2013 The time period of this report is from 7:00 am. (print of?ce Working day) to 7:00 am. (current of?ce working day) genomng: Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 79397 (Reference #:79397 Re i fIn 2mm Lom- 'on f_.I__c_d_entn i Pioneer RTP 05/05/13 Resource Center home Vi5it medication was not prepared correctly. gm Angela Lira - Med Error - Missed Dose at Home Incident Report 79364 (Reference #:79364 I. .II El .II I I. Pioneer DTP 05/03/13 Campus Brief was talking to a peer and made a statement that he had prevrously mentioned to a peer that he was gomg to bring a knife and stab a staff member. Zorobabel Pruneda Other Incident Report 79380 (Reference #:79380 . .II I I. f! .l Trailblazer RTP 05/04/13 Resource Center grief - left on an outing without taking his 3 PM medication. Repomng: Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 79362 (Reference #:79362 . Adventurer RTP 05/03/13 - Basketball Court rief left the house and ran to the basketball court where we deterred him from running further. He began ramming us his head, so we escorted him to the Room for safe time. (1 mm) mm m. mm Reporting: Brian Blanco - Restraint Escort Marcos Almeida - Assault/Aggressuon Ass:sting: Anthony Aispuro-Sanchez Other ?msting: Matthew Brown mm Jared Hungerford Incident Report 79394 (Reference #:79394 CONFIDENTIALITY NOTE 3 The documents accompanying this telecopy transmissron may contain information that is con?dential and,'or legally privileged. The information is intended only for the use by the indwiduzu' or entity names on this transmissnm sheet. If you are not the intended recipient, you are hereby notified that any disclosure, Copying, distribution, or the taking of any action in reliance on the Contents of this telecopied information is strictly prohibited. If you have received this telecnpy in error, please notify us by telephone immediately so that we can arrange for the return of the original doCuments to us at no cost to you Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000171 FamiliesE?rst, Inc. 2100 Fifth Street; Davis, CA 95616 24 Hr. CL Report Monday, May 06, 201.3 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 am. (current office working dayAdventurer RTP 05/05/13 Basketball Court A peer told me that. and a female peer had sexual intercourse when they left campus together the prewous day. . I ff: Incidentlmes Reporting: Rachel Fader Other Incident Report 79395 (Reference #:79395 I. II all: .II I I. .l Adventurer RTP 05/05/ 13 South Side of 5th Street ran away from campus With a peer and entered a nearby private property. Law enforcement was contacted to asset With the Situation. ent ff: Insidenuxm Reporting: John (Nick) Morlana - Law Enforcement Contact Other Incident Report 79401 (Reference #:79401 Emcee: WEEDS LAW Jade RTP 05/05/13 Hallway/Bedroom We initiated a standing when she repeatedly pushed into stalt. Escorted to her room as she was provoking he peers in the hall. TranSitioned to a team prone when she struggled and dropped her weight. (26 min) Messing; Sergio Sanders - Restraint Escort Repgging' Nicole Silva 0 - Accudent/lnjury to Staff Team Prone mm; Antonio Ganbay - Assault/Aggre55ion tanding Standing Incident Report 79376 (Reference #:79376 Mam Tim Adventurer RTP 05/04/13 Sensory Room talked to me about allegedly haying intercourse With a female peer in the during NPS. Mg; Rachel Fader Other Incident Report 79359 (Reference #:79359 WW Remain Adventurer RTP 05/03/13 Resource Center missed his 3 PM medication due to being off campus. CONFIDENTIALITY NOTE 4 The documents accompanying this telecnpy transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any :iction in reliance on the contents of this telccopicd information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000172 Fann'lz'csE'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Monday, May 06, 2013 'l'hc time period of this report is from 7:00 a.m. (prior officc working day\ to 7:00 am. (current of?ce working day) Reporting: Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 79375 (Reference #:79375 Adventurer RTP 05/04/13 House told me that_ used to beat him With extensron cords. Wes; Re?ning: Rachel Fader Other Incident Report 79366 (Reference #:79366 WW Mum _c_t_o_n_o_Lo a i Incident Ranger RTP 05/03/13 - Resource Center missed his 7 PM medication, due to being off campus Without staff permussron. Incident Sta?: Incident Reporting Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 79379 (Reference #:79379 Emma: WM Ranger RTP 05/04/13 - Resource Center During this time,- was off campus without permisswn. Therefore, he missed his 7 PM medication. i 1 Reporting Andrea Chiles - Med Error - Missed Dose at FamiliesFIrst Incident Report 79373 (Reference #:79373 Jade DTP 05/03/13 House agigf Description: - left supervrsion off campus. wimessmg: Felrcua Thomas - Law Enforcement Contact Reporting; Eric Benort - Long-Term Runaway Incident Report 79374 (Reference #:79374 Jade RTP 05/03/13 Resource Center Brief missed her 7 PM medication, due to being off campus Without permussuon. gm Andrea Chiles - Med Error - Missed Dose at FamiliesFirst CONFIDENTIALITY NOTE 5 The documents aCCompanying this transmission may contain information that is con?dential and/ er legally privileged. The information is intended only for use by the individual or entity names on this transmission sheet. If you are not the rcc1pient. you are hereby notified that any disclosure, copying, distribution, or the taking of any action in reliance on fi?lt? contents of this information is strictly prohibited. If you have received this in error, please notify us by tcleplionc mirncdiatcly so that we can arrange for the return of the original documents to us at no Cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000173 Farm'li'esFirst, Inc. 2100 Fifi]: Street, Dar/125?, CA 95616 24 Hr. CL Report Monday, May 06, 2013 The timc period of this report is from 7:00 a.rn. (prior of?ce working day) to 7:00 am. (current of?ce working day) Incident Report 79407 (Reference #:79407 Bgnm?ng uni; [Egan] Dag: Iimg gt Jade RTP 05/05/13 Basketball Court A peer told me that. and another male peer had sexual intercourse when they left campus the previous day. m: 6: Repomng: Rachel Fader Other Incident Report 79408 (Reference #:79408 Jade RTP 05/05/13 Resource Center was not on campus to receive her 3 PM medication. 351m Angela Lira - Med Error - Missed Dose at FamiliesFIrst Incident Report 79410 (Reference #:79410 Jade RTP 05/05/13 ActIVIty Center Bathroom Intentionally cut her arm with a razor blade. Basrc First-Aid (antiseptic, bandage) applied. Reporting: John (Nick) Monana - AccadentJInJury to Child Other Incident Report 79411 (Reference #:79411 . . . I I. [1.l Jade RTP 05/05/13 House minimum left the house and ran off campus when staff wasn't Immediately available to take her to the play structure. Upon Ieavmg, stated she was gomg to herself. Supervnsuon was maintained. Police were notified and she returned on her own. Inle?ent St_aff__: Incidenuxui Witnessmg: John (Nick) Moriana - Law Enforcement Contact Reporting: Nicole Silva - Short-Term Runaway Assisting: Adnana Escobar Other Incident Report 79403 (Reference #:79403 Jade RTP 05/05/13 Bedroom We initiated a standing restraint after- repeatedly hit and kicked staff. Transitioned to a team prone when she continued to struggle and kick staff. (14 mm) Donnann- Mir-Ala Cilu-a f? - Toam Drnna CONFIDENTIALITY NOTE 6 The documents accompanying this telecopy transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity namts on this transmission sheet. If you are not the intended you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this liilCCOplCd information is strictly prohibited. If you have this in error. please notify us by telephone unmcdiatcly so that Wt can arrange for the rctuni of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000174 FanHZt'esE'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Monday, May 06, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 am. (current office working clay) Assisting: Patrick Oleson-Wheeler - ACCIdent/Injury to Staff Standing 0 - Assault/Aggressmn Incident Report 79378 (Reference #:79378 Bantam Qatejilimui?insidmt Location of Ranger RTP 05/04/13 Back Porch/Quuet Room was escorted to the Qmet Room in accordance With his plan for attempting to leave staff supervismn. He continue to be aggresswe, causmg the Qunet Room door to be closed. {2 mm) Witnessing: Efren Sanchez-Delgado - Restraint Escort Reporting Lanai O'Brian - Assault/Aggression Quuet Room A55isting: Anthony Aispuro-Sanchez Other -) Incident Report 79371 (Reference #:79371 'n I i Etggtam Eat; Iimg of Incident ngagl'gn gt Jade DTP 05/03/13 House left off of campus. Reporting: Eric Benoit - Law Enforcement Contact Assisting: Jared Hungerford - Long-Term Runaway Incident Report 79372 (Reference #:79372 Bantam Tim 1' Jade RTP 05/03/13 Resource Center missed her 7 PM medication, due to being off campus Without permissmn. I - Reporting: Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 79370 (Reference #:79370 Jade RTP 05/03/13 OutSIde Quuet Room grief Description: - was contained for assaulting staff. (7 min) Christian - Restraint Standing Curtis Richardson 0 - Assault/Aggression Quiet Room Assisting: Erin Milligan Other Incident Report 79412 (Reference #:79412 Wt Emma) Wooden]; Jade RTP 05/05/13 Resource Center CONFIDENTIALITY NOTE 7 The accompanying this transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking,7 of any action in reliance on the contents of this tclecopied information is strictly prohibited. I you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us :it no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000175 FamiliesE'rst, Inc. 2100 Fifth Street, Dan's, CA 95616 24 Hr. CL Report Monday, May 06, 2013 Thu time period of this report is from 7:00 am. (prior office Working day?. to 7:00 a.m. (current of?ce working day) was not on campus to receive her 3 PM medication. Insidsnma?. Insulating. Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report 79414 (Reference #:79414 I. Emaram mg: Ijmg of Location 91 Incident Jade RTP 05/05/13 08: 10PM Front of Campus was walking off campus, so I shadowed her until I lost Sight. - i . gem Adriana Escobar - Short-Term Runaway Other Incident Report 79405 (Reference #:79405 I. ".ln.ll El?n I I. ?ill Jade RTP 05/05/13 04.30PM South Side of 5th Street ran away form campus With a peer and entered a nearby private property. Law enforcement was contacted to a55ist With the Situation. 19W Reporting: John (Nick) Moriana Law Enforcement Contact 0 - AcCIdent/lnjury to Child Other Incident Report 79406 (Reference #:79406 MW _g_a_Pro WM Jade RTP 05/?05/13 Off Campus left superVISion and gave statements of what occurred on during her AWOL. Reporting: Patrick Oleson-Wheeler Other Incident Report 79368 (Reference #:79368 I Incid _rm_Pr ram WM Went Sapphire DTP 05/03/13 Front of Ranger House did not want to be in the house, so she went to the trash and began to push into staff forcefully. A standing containment was Initiated and we transitioned to a team prone, due to her kicking. (12 min) witnessing: Christopher Bryce - Restraint Team Prone Luanna Toney - Assault/Aggressmn Standing A55i_s_t;ing: Jared HungerfOrd CONFIDENTIALITY NOTE 8 Nu documents accompanying this transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby notified that any disclosure, copying, disnibution, or the taking of any action in reliance on the contents of this iclccopicd information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediater so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000176 FamiliesE'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Monday, May 06, 2013 The time period of this report is from 7:00 am. (prior office working day) to ":00 am. (current of?ce working day) Incident Report it: 79369 (Reference #:79369 110.9331 Sapphire RTP 05/03/13 Parking Lot of Goodyear assaulted by hitting staff With closed fists. (27 min) Mam; Annette Carbone - Restraint Team Prone gem Bryce - Assault/Aggresswn Assisting Anthony Aispuro-Sanchez Other Incident Report 79383 (Reference #:79383 W01 Wm Sapphire RTP 05/04/13 - Actiwty Center had wandered off campus and was pushing and punching staff. An escort was initiated. (3 min) Witnessing: Annette Carbone - Restraint Escart Reporting: Luanna Toney - Assault/Aggressmn QUiet Room Aging; Marcos Almeida Other Incident Report 79384 (Reference #:79384 I. .ll Elan ?.ll . . Jade RTP 05/04/13 Side of Room was attempting to leave supervtsion and aggressively pushed staff when prommity support was offered. Containment initiated for pushing past clear limit. We tranSItioned to team prone once she dropped weight. (26 min) mods?ice e: Reporting. Luanna Toney - Restraint Team Prone A?5isting: Marcos Almeida 0 - Assault/Aggresson Standing Assisting: Anthony Aispuro-Sanchez Other Incident Report 79385 (Reference #:79385 2mm Sapphire RTP 05/04/13 Field was throwmg sticks at staff, pushed and punched staff as we prowded prOXImity support. Containment was ini ia and we tranSItioned to a team prone when she struggled and dropped weight. (9 min) mum 813131911129; Mug; Luanna Toney - Restraint Team Prone A55isting: Annette Carbone - Assault/Aggression Standing Efren Sanchez-Delgado Incident Report 79399 (Reference #:79399 Went Emma: Sapphire RTP 05/05/13 - 5th Street/Field punched, pushed, and slapped staff so we initiated containment. (14 min) Insidentita?: In i e: Reporting: Andrew Enright - Restraint Team Prone Assisting' John (Nick) Mariana 0 - Assault/Aggression Standing Assisting: Steven Knowles CONFIDENTIALITY NOTE 9 The documents accompanying this transmission may contain information that is con?dential and/or legally privileged. The information is intended only for use by the indmdual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibitcd. If you have received this in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000177 Famr?es?'rst, Inc. 2100 Street, Davis, CA 95616 24 Hr. CL Report Monday, May 06, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 am. (current oft-ice working day) Incident Report 79400 (Reference #:79400 WW In new Went Sapphire RTP 05/05/13 Bedroom #4 grief was forcefully pushing into staff, so we Initiated containment. (11 min) Watt; Indicating Regulating Andrew Enright - Restraint Team Prone Assusting: Daniel Zaragoza - Assault/Aggresswn Standing -) Incident Report 79381 (Reference #:79381 lrallblazer RTP 05/04/13 Resource Center Brief Q::griptlon:- left on an outing Without taking his 3 PM medication. Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 79404 (Reference #:79404 Jade RTP 05/05/13 - 10315AM House gave statements of surcrdal ideation. ngorting: Patrick Oleson-Wheeler - Sutcudal Idcation Other Incident Report 79396 (Reference #:79396 Pioneer RTP 05/05/13 House was very aggresswe, punching staff repeatedly. I set a clear limit and evaded and - continued running after me, so we contained him. (14 min) Incident Staff; Incident Type: wortmg Adriana Escobar - Restraint Team Prone ASSIstmg: Nolan Bradley 0 Assault/Aggressnon Standing CONFIDENTIALITY NOTE 10 The documents accompanying this telecopy transmission may contain information that is confidrntinl and/or legally privileged. The information is intended only for the use by the or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, Copying, distribution, or the taking of an} action in reliance on the contents of this telecopied information is strictly prohibited. lfyou have received this tclecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no Cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000178 FamJ'lieerst, Inc. 2100 Eli]: Sweet, Dan's, CA 95616 24 Hr. CL Report Wednesday, May 08, 2013 The time period of this report is from 7:00 31.111. (prior office working day) to 7:00 am. (current of?ce working day) -) Incident Report 79468 (Reference #:79468 Jade DTP 05/07/13 Off Campus left supervision off campus widi peers- . from Jade House. 3mm; Patrick Oleson-Wheeler - Law Enforcement Contact WJohn (Nick) Moriana - Short-Term Runaway Incident Report 79469 (Reference #179469 Wen: Emma; Jade RTP 05/07/13 Resource Center was not on campus during the time frame of 3 PM and 7 PM medication. Ming; Angela Lira - Med Error - Mlssed Dose at FamiliesFirst Incident Report 79465 (Reference #:79465 Ranger RTP 07/ 13 - House refused to take his 7 AM medications. Brenda Vermette - Med Error - Client Refused To Take Medication Incident Report 79485 (Reference #:79485 WW 2mm WM Sapphire RTP 04/29/13 Living Room continued to aggressively attempt to get to another child who was in containment. (12 min) Jonathan Stone - Restraint Escort Matthew Bettencourt - Assault/Aggression Quiet Room Incident Report 79460 (Reference #:79460 WW 2mm WM Adventurer DTP 05/07/13 Offsite visit in Falr?eld CONFIDENTIALITY NOTE 1 The documents accompanying this transmissmn may contain informanon that is con?dential and/ or legally privileged The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that (my disclosure, copying, distribution, or the taking of any action in reliance on contents of this information is strictly prohibited. If you have received this telecopy in crrox. please notify us by telephone immediately so that WC can arrange f0r the return of original documents to us at no cost to vou. 'l'hiink 0U. PBS Front Line PRA Request y(201 3-2011 Incident Reports) 000179 FamiIJ'cerst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Ht. CL Report Wednesday, May 08, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 a.m. (current of?ce working day) made a statement about staff. modem Em Michelle Glicksman Other Incident Report a: 79483 (Recount-Le #:79483 WW Brawn Adventurer RTP 05/07/13 Bedroom A female peer was making allegations that- and her had engaged in Inappropriate acts while together. Rgporting: Erin Milligan Other Incident Report 79461 (Reference #:79461 Weddell: Adventurer RTP 05/07/13 on Campus - I received a call from Nick stating that- was off campus with 3 of his female peers. He was away from our facility for over 4 hours. Islam Hassanein - Law Enforcement Contact (Nick) Moriana Incident Report it: 79472 (Reference #:79472 WW Brennan Jade DTP 05/07/13 on Campus left supervision off campus with peers-, - from Jade House. Police were noti?ed. menu. Wm; Patrick Oleson-Wheeler - Law Enforcement Contact 55m; John (Nick) Mariana - Short-Term Runaway Assisting; Jared Hungerford Incident Report at: 79474 (Reference #:79474 WW Emmi Widen Jade RTP 05/07/13 Resource Center was not on campus during the time frame of 3 PM and 12 PM medication. momma. Beam; Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report 79482 (Reference #:79482 Winn anagram When; Jade RTP 05/07/13 Bedroom made statements alleging inappropriate acts with a male peer while off campus. She also gave me Vodka that she had in her room. CONFIDENTIALITY NOTE 2 'lhe documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally The information is intended only for the use by the individual or entity names on this transmisston sheet. If you are not the intended recipient. you are hereby noti?ed that any disclosure, copying, distiibution, or the taking of any action in reliance on the. contents of this information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the train] of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000180 FaImIiesE'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Wednesday, May 08, 2013 The time period of this report is from 7:00 am. (prior of?ce workuig day) to TOO am. (current of?ce working day) Reporting: Erin Milligan Other Other Incident Report 79471 (Reference #:2779471 Bengm'ng gm; Igg'ggnj 25;; lime Q1 Ingiggng nga?gg g1 Jade RTP 05/07/13 - Resource Center refused her 7 AM and 12 PM medication. Insident?ta?. mm Reporting: Brenda Vermette - Med Error - Client Refused To Take Medication Incident Report 79475 (Reference #:79475 Inci Da Tim ncid Lgcation 9f Ingiggn; Jade DTP 05/07/13 Off Campus left supervision off campus with peers. and .from Jade House. Police were noti?ed. Witnessing; Jared Hungerford Law Enforcement Contact m3; Patrick Oleson-Wheeler 0 - Short-Term Runaway Assisting: John (Nick) Moriana Incident Report 79476 (Reference #:79476 Renown Uni of Inc'd Heston Tim cid WEED: Jade RTP 05/07/13 Resource Center was not on campus during the time frame of 3 PM and 12 PM medication. I Reporting: Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report it: 79477 (Reference #:79477') rtin of Inci ?egcam Minnow?cat We; Jade DTP 05/07/13 Off Campus . - - left campus this afternoon. The police were contacted because- was standing in the street. She left the street and ran down the bike path, passed the post office. Police were contacted 15 minutes when she had not returned. I I It. I Reparting: Jared Hungerford Law Enforcement Contact Assisting: John (Nick) Moriana Other Incident Report 79463 (Reference #953463 Adventurer RTP 05/07/13 - Front of Campus CONFIDENTIALITY NOTE 3 The documents accompanying this transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this tclecopicd information is strictly prohibited. If you have received this relecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original d??g $33 M?ho?q3?? Incident Reports) 000181 Fam?icsE'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Wednesday, May 08, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 a.m. (current office working day) - - started assaulting staff to get Involved in his peer?s containment, so we escorted him away from the area. (3 min) Brooke Piaseckl - Restraint Seated Restraint Claudia Vazquez - Assault/Aggression Escort Ming; Islam Hassanein Other Noel Salazar Incident Report as: 79466 (Reference #:mss Range,- DTP 05/07/13 Side Porch punched staff in the face. (52 min) Rggom'ng; Edgar Zamora - Restraint Team Prone - Assault/Aggression Standing Incident Report 79478 (Reference #:79478 Winn: Emmi: Meditation Room Jade DTP 05/07/13 made a statement regarding sexual abuse in her past while in group processing. Reynoso Trujillo Other Incident Report at: 79480 (Reference #99480) 2mm Women: modem Jade DTP 05/07/13 House left campus supervision. Warn Nicole Silva 0 - Short-Term Runaway mm; Jared Hungerford Incident Report 79481 (Reference #994131 WW 2mm Widen: Jade DTP 05/07/13 Off Campus left supervision off campus. Police were noti?ed. modem Lrisinentms; 33mm; Patrick Oieson-Wheeler - Law Enforcement Contact Jared HungerfOrd 0 - Short-Term Runaway CONFIDENTIALITY NOTE 4 The documents accompanying this telecopy transmission may contain information that is confidential and/or legally privileged. The information is intended only For the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure. copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this tclecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000182 Fann'lz'csE'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Wednesday, May 08, 2013 The tune period of this report is from 7.00 a.m. (prior of?ce working day) to 7:00 a.m. [current oft-ice working day) Incident Report 79484 (Reference #:79484 WW ?rearm Jade RTP 05/07/13 In Front of Resource Center I saw- leaving campus- Adriana Escobar - Short-Term Runaway Incident Report #2 79462 (Reference #:79462 WW anagram mum Adventurer RTP 05/07/13 Front of Campus was encouraging his peers to be escalated and stop listening to staff, and when we set a space, he continued to push and was put in containment. Staff was injured in this Incident. (10 min) Noel Salazar - Restraint Team Prone John (Nick) Moriana - Acadent/Injury to Staff Team Prone Repomng: Islam Hassanein 0 - Assault/Aggression gigging; Brooke Piaseckl Other Assign; Claudia Vazquez - Incident Report 79464 (Reference #:79464 WW Bantam WM Adventurer RTP 05/07/13 Front Porch - began to spit and assault us which at that point we initiated a standing. He began to try to break out, so we transitioned into a team prone. (14 min) 55mg; Adrian Mendoza - Restraint Team Prone Assisg?m: Sule Anibaba 0 - Assault/Aggresslon Standing Incident Report 79479 (Reference #:79479 WW Erasure Jade DTP 05/07/13 Meditation Room While participating in group processing, - insinuated that she was sexually abused in the past. Insident?ne: Wm; Reynoso Trujillo Other CONFIDENTIALITY NOTE 5 The documents accompanying this telecopy transmission may contain information that is con?dential and/or legally privileged. The information 15 intended only for the use by the indiVidual or entity names on this transmissmn sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying? distribution, or the taking of any action in rcliancc on the contents of this information is strictly prohibited. If you havc received this in error, please notify us by telephone immediately so that we can arrange for the return of the original W?a?i?i?i?i?i? 3-201 1 Incident Reports) 0001 83 Inc. 2100 Fifi]; Street, Bank, CA 95616 24 Hr. CL Report Wednesday, May 08, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 a.m. {current of?ce working day) CONFIDENTIALITY NOTE 6 The documents accompanying this telecopy transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet, If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank vou. PBS Front Line PRA Request "(2013-2011 Incident Reports) 000184 Farm'II'csE'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Tuesda? May 14, 2013 The time period of this report is from 7:00 a.m. (prior office working day) to 7:00 a.mi (current of?ce working day] Incident Report 79665 (Reference #:79665 Jade DTP 05/13/13 - 5th Street left campus with a peer, so the police were noti?ed. HEW Kristin Manrique - Law Enforcement Contact Agassi-pg; John (Nick) Morlana - Short-Term Runaway Incident Report 79666 (Reference #:79666 Wooden: 11mm WW Jade RTP 05/13/13 Resource Center was not on campus to receive her 7 PM medication. Reporting: Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report 79667 (Reference #179667 .l . I Jade RTP 05/13/13 Quiet Room stated that she was taken advantage of while under the In?uence of drugs by her peer- Bemcig; Adrian Mendoza Other Chris Marshall Assigns}; Curtis Richardson Incident Report 79645 (Reference #:79645 Wanna: Ranger RTP 05/13/13 Outside Quiet Room was pushing forcefully into me. (11 min) mm mm Messing; John (Nick) Moriana - Restraint Standing Keana West 0 - Assault/Aggression mixing; Edgar Zamora Adrian Mendoza Incident Report 79652 (Reference #:79652 WM 2:29am dd Sapphire RTP 05/13/13 Resource Center arid haco?n?inn- -ksd is up.- rah omarl in Pamniu- huh mac- #3119 ha! nadir-a?oat- Conga! anamnn? ?-;arg CONFIDENTIALITY NOTE 1 The documents accompanying this telecopy transmission may contain information that IS con?dential md/ or legally privileged. The informanon is mtendcd only for the use by the mdivndual or entity names on this transmissron sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank vou. PBS Front Line PRA Request (2013-2011 Incident Reports) 000185 FamiliesE'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Tuesday, May 14, 2013 The nme period of this report is from 7:00 am. (prior of?ce working day) to 7:00 am (current of?ce working day) made and appropriate staff noti?ed. Mm; Julie \?ce - Med Error - Client Refused To Take Medication Assigning; David Waites Incident Report it: 79653 (Reference #09653 anagram Sapphire RTP 05/13/13 House left the house without permission and proceeded to leave campus. - eventually returned to campus. I verbally irected her to a Quiet Room, but she refused and proceeded to leave campus again. Eduardo Villalobos - Long-Term Runaway Incident Report 79654 (Reference #:79654 Emu-m Sapphire RTP 05/ 13/13 House stated that she wanted to go lie down in the street and die. Given her extremely unsafe behavior when out of supervision, we deterred her from leaving. She eventually pushed forcefully into staff and was contained. (4 min) Reporting; Andrew Enright - Restraint Escort Assisting: Dino Clark 5 - Suicidal Ideation Standing 0 - Assault/Aggression Incident Report 79662 (Reference #:79662 Wen Emerarn Widen: Jade DTP 05/13/13 House n: said Sapphire House girls told her they made plots to make false allegations against Andrew Enright to get him in trou e. Patrick Oleson-Wheeler Other Incident Report 79647 (Reference #:79647 mien: Widen: Voyager RTP 13/ 13 Resource Center refused to wake up and take his 7 AM dose of medication. Several attempts were made and appropriate people notl ed. new mm mm Julie Vice - Med Error - Client Refused To Take Medication Assisting; Jason Wade CONFIDENTIALITY NOTE 2 The documents accompanying this telecopy transmissmn may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the Contents of this telecopied information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to on. Thank vo PBS Front Line PRA 3-2011 Incident Reports) 000186 Farm'II'csFirst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Ht. CL Report Tuesday, May 14, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 a In (current of?ce working day) Incident Report 79672 (Reference #:79672 . I . . I ?rearm WM Adventurer DTP 05/ 13/13 outside Wm A peer reported that she and- engaged in a sexual act while off campus without permission. Insident?a?: magnum Dianna Wade Other Incident Report 79646 (Reference #:79646 Winn: Emnm Trailblazer RTP 05/13/13 Resource Center is not yet back from a home visit that was scheduled through Sunday evening. Therefore, it appears he missed medication. Noti?ed appropriate people. Wjulie Vice - Med Error - Missed Dose at Home Hilary Sleuter Incident Report 79659 (Reference #:79659 BMW ammo Jade RTP 05/ 13/13 Resource Center was not on campus to receive her 3 PM and 7 PM medication. Reporting: Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report'#: 79658 (Reference #:79658 Jade RTP 05/13/13 Resource Center is not on campus and will not have taken her 7 AM and noon medications. Noti?ed appropriate people. Reporting: Julie Vice 0 Med Error Client Refused To Take Medication Patricia Button Incident Report 79639 (Reference #:79639 CONFIDENTIALITY NOTE 3 The documents accompanying this tclecopy transmussron may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet If you are not the intended you are hereby noti?ed that any disclosure. copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. lf you have received this telecopy in error, please notify us by telephone Immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank vuu. PBS Front Line PRA Incident Reports) 000187 Farmlics?rst, Inc. 2100 Fifth Sweet, Davis, CA 95616 24 Hr. CL Report Tuesday, May 14, 2013 The tune period of this report is from 7:00 a.m. (prior office wurkmg day) to 7:00 am. (current office working day) 2mm Adventurer DTP 05/13/13 Off Campus left supervision at 4:30 PM with two of his peers,- and He returned on his own around 9:00 PM. mm Noel Salazar - Long-Term Runaway Incident Report 79640 (Reference #9964!) Went 2mm Adventurer RTP 05/13/13 Dinning Room reported to me, past abuse that_ and other aduiB inflicted on him. Clinical on-call, Andrea Guthrie was noti?ed. mm mm John (Nick) Moriana Other Wm; Islam Hassanein Incident Report 79638 (Reference #:79638 WW Emma Adventurer RTP 05/13/13 House I verbally directed. to return to the house.- refused and proceeded to leave campus. mutant; - mag; Eduardo Villaiobos - Long-Tenn Runaway mm; Matthew Bettencourt Incident Report 79643 (Reference #994543 MW Emnm Widen: Window Ranger DTP 05/13/13 House left campus without permission. mum John (Nick) Moriana - Long-Term Runaway Edgar Zamora Claudia Vazquez Incident Report 79644 (Reference #:79644 Ranger RTP 05/ 13/13 - Resource Center was not on campus to receive his 7 PM medication. mm mm Angela Lira - Med Error - Missed Dose at CONFIDENTIALITY NOTE 4 The documents accompanying this (cit-copy may Contain information that is con?dential and/or legally privileged. The information is intended only for the use by the mdivtdual or cntiry names on this transmismon sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the Contents of this mformauon is strictly prohibited If you have received this in error, please notify us by telephone immediately so that we can arrange for the return of the origmal documents to us at no cost to on. Thank PBS Front Line PRA equest?f?'m 3-2011 Incident Reports) 000188 Fam'lr'esFirst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Tuesday, May 14, 2013 The time period of this report is from 7:00 2.111. (prior of?ce working day) to 7:00 a.m (current of?ce working day) Incident Report 79664 (Reference #:70664 2mm Jade DTP 05/13/13 - Campus left supervision and became assaultive. (9 min) mm Mug; Eric Benoit - Restraint Seated Restraint - Accident/Injury to Child Team Prone - Assauit/Aggression Standing Other Other Incident Report 79663 (Reference #:79663 MW Emnm Jade DTP 05/13/13 House was contained both times for assault to staff. (39 min) Jesus Zamudio - Restraint Team Prone gem Patrick Oieson-Wheeler - Assault/Aggression Team Prone Assisting; Eric Benoit Standing 555m Brooke Piasecki Kristin Manrique Incident Report 79651 (Reference #:79651 WW 2mm WM Sapphire DTP 05/13/13 Front of Campus began forcefully pushing into me and assaulting me by kicking me, at that time containment was initiated. (8 min) Indicating; gem Erin Milligan - Restraint Team Prone Genevieve Carnes 0 - Assault/Aggression Standing Emerald Rogers Incident Report 79649 (Reference #:79649 WW Emmi: Sapphire RTP 05/13/13 Resource Center - refused to take her 7 AM dose of medication and then left campus. Minimal attempts could be made. Appropriate peop were noti?ed. mansion; lug-?m In: Julie Vice - Med Error - Client Refused To Take Medication Eduardo Villalobos CONFIDENTIALITY NOTE 5 The documents accompanying this tclecopy transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the mdivxdual or entity names on this transmission sheet. If you are not the intended rec1pient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. If you have received this telecopy in error. please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000189 Fam?icerst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Tuesday, May 14, 2013 The time period of this report is from 7:00 a.m. (prior of?ce working day) to 7:00 1m. (current office working day) Incident Report 79650 (Reference #:79650 Widen! Barnum Wooden: Lineman: Sapphire RTP 05/13/13 House mm- lc?: the house without permission at 7:56 AM. She proceeded to leave campus. mm Eduardo Villalobos - Long-Tenn Runaway David Waites Incident Report 79673 (Reference #9957: Emum Sapphire DTP 05/13/13 OutSIde reported that she willingly engaged in sexual acts with her peer, during AWOL a few nights ago. mm mpg; Dianna Wade Other Incident Report 79657 (Reference #579657 Eastern Sapphire RTP 05/13/13 Resource Center was not on campus to receive her 7 PM medication. Angela Lira - Med Error - Mlssed Dose at Incident Report 79656 (Reference #279656 Sapphire RTP 05/ 13/13 Resource Center refused to take her medication for 7 AM dosage. Several attempts were made. Appropriate people were noti?ed. my; Julie Vice - Med Error - Client Refused To Take Medication Incident Report 79655 (Reference #:79655 2mm Sapphire RTP 05/ 13/13 House left the house without permission at 7:56 AM. - proceeded to leave campus. Radio call was made and supervisor was notified. Eduardo Villalobos - Long-Term Runaway CONFIDENTIALITY NOTE 6 documents accompanying this transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. lf you are not the intended recrpient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this in error. please notify us by telephone immediately so that we can arrange for the (Cturn of the original documents to us at no cost to vou. Than '0 . PBS Front Line PRA Request )(2u013-2011 Incident Reports) 000190 Fam'll'cs?rsr, Inc. 2100 Fifth Street, Daw's, CA 95616 24 Hr. CL Report Tuesday, May 14, 2013 The lime period of this report is from .7100 (rm. (prior of?ce working day) In WOO arm. (current ol't?iCc working day) . - .- .- ?m I-lmm?nh M.- . 4.. -.. Incident Report 79661 (Reference #:79661 mm Lima i am: Sapphire DTP 05/13/13 5th Street Brief left campus and was screamed at by a citizen. was then out of supervision for approximately ten minutes off campus. :1 - Witnessing: Ashley McLemore - Short-Term Runaway Reporting: John (Nick) Mariana Other Assisting: Kristen Warren Incident Report 79641 (Reference #:79641 w-"iw. .mw-m- .. Reggm'ng unit of Incident, Qate lime g: Incidgng of Lngideng Adventurer RTP 05/13/13 Resource Center returned with more medication than he should have. - Reporting: Angela Lira Med Error - Missed Dose at Home CONFIDENTIALITY NOTE 7 The accompanying this telecopy transmissmn may contain information that is con?dvntial and/or legally privileged. The information is Intended only for the use by the individual or Cf]le names on this transmission sheet. If you are not the intended reapicnr. you hereby notified that any disclosure. copying, distribution, or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. If you have waived this in error. please notify us by telephone immediately so that we can arrange lor the return ()ftbt? original documents to us :it no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000191 Fann'licsEr-st, Inc. 2100 Street, Davis, CA 95616 24 Hr. CL Report Wednesday; May 15, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 a.m. (current of?ce working day) Incident Report 79708 (Reference #:79708 WW 2mm Wanner]: Jade DTP 05/14/13 - Off Campus left staff supervision off campus. Police were noti?ed. - Begomng: Patrick Oleson-Wheeler - Law Enforcement Contact Assisting: John (Nick) Mariana - Long-Term Runaway Incident Report 79709 (Reference #:79709 3W anagram MW momma: Jade RTP 05/14/13 - Resource Center was not on campus to receive her 3 PM medication and 7 PM medication. Angela Lira - Med Error - Missed Dose at Incident Report 79693 (Reference #:79693 Wuhan: Wanna]: Pioneer DTP 05/14/13 Game Room was kicking and punching Kamika's leg past the clear limit to stop assaulting. (14 min) Nolan Bradley - Restraint Escort Mg; Kamika Sherwood - Assault/Aggression Quiet Room Incident Report 79699 (Reference #:79699 2mm MW Voyager DTP 05/14/13 Hallway jumped off the table and charged to doorway and started to punch at me, so we initiated a supine restraint per is needs and services plan; due to aggresswe havior and - dropping immediately to the ground. (21 min) Darius Randall - Restraint Team Prone Kristan Warren 0 - Accident/Injury to Child Team Prone gagging; Erica Retzer 0 - Assault/Aggression Matthew Brown Genevieve Carnes Brooke Piaseckl Christopher Bryce CONFIDENTIALITY NOTE 1 The documents accompanying this tclecopy transmission may contain iniorrnation that is con?dential and/0r legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended you are hereby noti?ed that any disclosure, copying, distribution? or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. lfyou have received this wimpy in error. please notify us manhonmnn?aminequew (earls-120411 maiden: Watts) 0001 92 documents to us at no cost to you. Thank you. FamZiesFirst, Inc. 2100 Street, Davis, CA 95616 24 Hr. CL Report Wednesday, May 15, 2013 The time period 0t this report ts from 7:00 am. (prior of?ce working day) to 7:00 a.m. (current of?ce working day) Incldent Report 79714 (Reference #:79714 I. .I I Emmi: Jade RTP 05/14/13 Resource Center was not on campus to receive her 7 PM medication. mum Mpg; Angela Ura - Med Error - Missed Dose at FamiliesFirst Incident Report it: 79690 (Reference #:79690 . Adventurer DTP 05/14/13 - Campus reported that she had sex with- sometime last week and requested a pregnancy test. mm mm Kristin Manrique Other Incident Report 79691 (Reference #:79691 Adventurer RTP 05/ 14/13 Bedroom #2 - was forcefully hitting me with his ?sts, so we initiated a containment- also made statements of wanting to kill himself. (31 min) mug; John (Nick) Moriana - Restraint Team Prone ngorting: Islam Hassanein - Assault/Aggression Standing Noel Salazar Other Adrian Mendoza -- - Incldentleport 79710 (Reference #99710 mm min Woollen: Jade RTP 05/14/13 Resource Center was not on campus to receive her 3 PM medications. She refused her 7 PM medication after several separate attempts. mm Incidentlm. 3mm Angela Lira - Med Error - Missed Dose at FamiliesFirst - Med Error - Client Refused To Take Medication Incident Report 79711 (Reference #:79711 WW Bantam Widens mn?munddent Jade DTP 05/14/ 13 Campus informed me that she felt she should take a pregnancy test, because she had sex with another client last week. CONFIDENTIALITY NOTE 2 The documents accompanying this telecopy transmissmn may contain information that is con?dential and/ or legally The information is intended only for the use by the individual or entity names on this transmismon sheet. If you are not the intended recipient. you are hereby noti?ed that any disclosure, copying. distribution. or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. If you have received this mm? We? ?5 bISEEPi-?iah dam ?ll?f We?re) 0001 93 documents to us at no cost to you Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CCL Report Wednesday, May 15, 2013 The time pcnod of this report is from 7:00 am. (prior office working day) to 7:00 am. (current of?ce working day) mm mm Repgrting: Kristin Manrique Other Incident Report 79712 (Reference #:79712 Emntam Went Jade DTP 05/14/13 - Off Campus made a statement about staff. MSW Eric Benoit Other Jesus Zamudio Incident Report 79713 (Reference #:79713 WW 2mm Widen]: Jade RTP 05/14/13 - Activity Center stated that she is sexually active with a client on campus and that she may be pregnant. WM Angela Lira Other Eric Benoit Incident Report 79688 (Reference #:79688 mm min nan-Madden: Wooden: Adventurer DTP 05/14/13 Front of Campus/5th Street left staff supervision off campus with his peer-. I shadowed them both until I lost supervision. mum Islam Hassanein - Long-Term Runaway Incident Report 79689 (Reference #:79689 WW Walden: Adventurer RTP 05/14/13 - Resource Center was not on campus to receive his 7 PM medication. mg; Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report 79697 (Reference #:79697 WW Bum-am Wooden: Ranger DTP 05/14/13 Front of Campus/5th Street left staff supervision off campus with his peer I shadowed the, both until I lost supervision. Ynn??-M 'nnidonO Tunn- CONFIDENTIALITY NOTE 3 The documents accompanying this tclecopy transmission may contain intormauon that is con?dential and/ or legally privileged. The information is only for the use by the individual or entity names on this transmission sheet. If you are not the intended reapicnt. you are hereby noti?ed that any disclosure, copying, diStribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this wimpy mm, please notify us mnemonmneapkmnequesa (em-92min linemen]: Watts) 0001 94 documents to us at no cost to you. Thank you. Fanzilieerst, Inc. 2100 Street, Davis, CA 95616 24 Hr. CL Report Wednesday, May 15, 2013 The time period of this report is from 7:00 a.m. (prior of?ce working day) to 7:00 a.m. (current of?ce working day) mug; Islam Hassanein - Long-Term Runaway Incident Report 79698 (Reference #:79698 2mm WW Wm Ranger RTP 05/14/13 Resource Center was not on campus to receive his 7 PM medication. Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report #2 79706 (Reference #:79706 BMW 2mm WW Jade DTP 05/14/13 5th Street was escorted for attempting to run in front of oncoming traf?c. (24 min) Noel Salazar - Restraint Escort witnessing; Angela Lira - Suicidal Ideation Team Prone Patrick Oleson-Wheeler - Assault/Aggression Standing 5551531119; Bryce Lumbard Assisting; Christopher Bryce John (Nick) Mariana Incident Report 79705 (Reference #:79705 Jade RTP 05/14/13 Resource Center refused to take her 7 AM medication. tandem mitigating. Wag; Brenda Vermette - Med Error - Client Refused To Take Medication Incident Report ii: 79696 (Reference un?nn?nm Bantam WM WM 1 Ranger DTP 05/14/13 House lunged at me, kicking me on my legs very forcefully. (13 min) Mug; Edgar Zamora - Restraint Team Prone Assisting; Aaron Alston - Assault/Aggression Standing Robert Dehn - CONFIDENTIALITY NOTE 4 The documents accompanying this telecopy transmission may contain mformation that is confidential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended rec1picnt, you are hereby noti?ed that any disclosure. copying. distribution. or the taking of any action in reliance on the contents of this tclecopied informanon is strictly prohibited. If you have received this mow PM not"? yestersam?eamoe?a? cmgie?ari ?Ic??c'l?d??nlie?g??c?fits) 0001 95 5 documents to us at no cost to you. an FannZI'csE'tst, Inc. 2100 Street, D3 w's, CA 95616 24 Hr. CCL Report Wednesday, May 15, 2013 The time period of this report is from 7:00 a.m. (poor office working day) to 7:00 am. (current of?ce working day) Incident Report #1 79704 (Reference #:79704 Emmi Wm Lmsieuuncidons Jade RTP 05/14/13 Resource Center refused her 7 AM medications. lamenting: Brenda Vermettie - Med Error - Client Refused To Take Medication Incident Report 79685 (Reference #:79685 WM Widen: Stingrays NPS 05/14/13 Classroom began to assault and push into Genevieve and 1. At that point, containment was initiated. (11 min) Reporting; Erin Milligan - Restraint Team Prone Genevieve Games 0 - Assault/Aggression Standing Brett Atwood Incident Report 79703 (Reference #:79703 Sapphire RTP 05/14/13 Resource Center was not on campus to receive her 7 PM medication. Wu:- Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report 79701 (Reference #:79701 Rammed?: Balsam Walden: Sapphire RTP 05/14/13 Resource Center was not on campus to received her 7 PM medication. mm Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report 79702 (Menace #:79702 ammonia; Bantam Went Sapphire RTP 05/14/13 Resource Center refused her 7 AM medications. Beaming; Brenda Vermette - Med Error - Client Refused To Take Medication CONFIDENTIALITY NOTE 5 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the indivtdua] or entity names on the transmissmu sheet. If you are not the intended reCipient. you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this wimpy in error. please from us mm?memcnwueswzmazmw mm?nItcReimits) 0001 96 documents to us at no cost to you. Thank you. Famill'eerst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Wednesday, May 15, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 a.m. (current office working day) Incident Report 79-700 (Reference #:79700 WW 2mm Sapphire DTP 05/14/13 - Grass Outside of Resource Center stated she was "going to run away and kill herself,? so we deterred her from leaving campus. Eventually, she pushed and hit staff so we initiated containment. (4 min) Mm; Andrew Enright - Restraint Escort Aaron Alston - Assault/Aggression Standing Other Incident Report 79692 (Reference #:79692 . I I Adventurer RTP 05/14/13 In Front of Voyager Porch left supervision from the house and attempted to run into Voyager House while he was not following directions. Adrian and I attempted to physically deter him from disrupting his peers. He repeatedly punched staff. Containment initiated. (23 min) 3mm; Sule Anibaba - Restraint Team Prone Adrian Mendoza - Assault/Aggression Andrew Enright Incident Report 79715 (Reference #:79715 BMW 2mm Pioneer DTP 05/07/13 Phone call with mom A phone call between- and his mother that was ended by me, due to repeated negative comments towards this company that was creating a split for- and becoming traumatic again for him. madam Indium Rosa Retzer Other Incident Report 79716 (Reference #:79716 Pioneer DTP 05/08/13 Campus began to push and punch. (20 min) Anthony Aispuro-Sanchez - Restraint Team Prone - Assault/Aggression Standing CONFIDENTIALITY NOTE 6 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. if you are not the intended recipient. you are hereby noti?ed that my disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this Pm 35%? 000197 documents 0 us a no cost to you. Families?'rs t, Inc. 2100 Fifth Street, Dan's, CA 95616 24 Hr. CL Report Thursday, May 16, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 a.m. (current office working day) Incident Report 79737 (Reference #:79737 2mm Jade RTP 05/15/13 Resource Center Winn; - was not on campus to receive her 3 PM medication. Mug; Angela Ura - Med Error - Missed Dose at FamiliesFirst Incident Report 79738 (Reference #:79738 2mm Wooden: Jade RTP 05/15/13 - Basketball Court A peer made statements of activities when off campus. Reporting: Adrian Mendoza Other Incident Report 79728 (Reference #:79728 .l . I I . Ranger RTP 05/15/13 House/Outside of Campus postured at staff and attempted to intervene in another peer's restraint and he continuously attempted to in?ict campus chaos by yelling in front of the houses to encourage others to get off task. gem Efren Sanchez-Delgado - Restraint Team Prone Assisting; Adrian Mendoza - Assault/Aggression Standing Incident Report 79729 (Reference #:79729 2mm Voyager RTP 05/15/13 Kitchen Counter began pushing and hitting me in the stomach, so we initiated a seated containment per his needs and services plan due 0 assaultive behavior. (3 min) Witnessing; Darius Randall - Restraint Seated Restraint Wing; Erica Retzer - Assault/Aggression Assistim; Bryce Lombard Efren Sanchez-Delgado Incident Report 79733 (Reference #:79733 CONFIDENTIALITY NOTE 1 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the or entity names on this transmission sheet. If you are not the intended reupient. you are hereby noti?ed that any disclosure, copying, distribution. or the taking of any action tn reliance on the contents ofthis information is strictly prohibited. If you have received this tclecopy in error, please notify us telephone immediatel?lsht: that we can urran for tht? return of the original m?rgnt stingy, mil-egg (39 3-2011 Incident Reports) 000198 FamilicsE'rst, Inc. 2100 Fifth Street, D3 W's, CA 95616 24 Hr. CL Report Thursday; May 16, 201.3 The time period of this report is from 7:00 mm. (prior of?ce working day) to 7:00 a.m. (current of?ce working day) Sapphire RTP 05/15/13 - 07215PM Parking Lot Behind School attempted to leave supervision to ?nd objects to hurt herself with. While near the shed, she found glass and attempte to reak it in order to cut, so we initiated containment. (9 min) Ashley McLemore - Restraint Escort Beaming; Andrew Enn?ght Other Standing Assisting: Kristen Warren Incident Report 79726 (Reference #:79726 WW Emcam Widen: Ranger DTP 05/15/13 House/Front Parking Lot assaulted staff by punching me on my chest, multiple times and once staff shown up to assist, we placed him in a stan ing restraint to make sure everyone remained safe. (25 min) Andrea Chiles - Restraint Team Prone Efren Sanchez-Delgado - Assault/Aggression Standing Oscar Lopez Incident Report 79723 (Reference #:79723 WW Emnm Adventurer RTP 05/15/ 13 Basketball Court A peer made statements of activities when off campus involving - Adrian Mendoza Other Incident Report 79739 (Reference #:79739 2mm Jade RTP 05/ 15/13 - Resource Center was not on campus to receive her 3 PM and 7 PM medication. Reporting: Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report 79740 (Reference #:797340 Bantam Widen: Jade RTP 05/15/13 Basketball Court stated to me incidents that happened when off of campus. CONFIDENTIALITY NOTE 2 The documents accompanying this tclecopy transmission may contain information that is con?dential and or legally privileged. The information is intended only {or the use by the individual or entity names on this transmission sheet. If you are not the intended recipient. you are hereby notified that any disclosure, copying, distribution. or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this telecopy in ?for. Plt?att? 0005' US ?(1063! (2012332011 0001 99 documents to us at no cost to you. Thank you. Fam'liesH'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Thursday, May 16, 2013 The time period of this report from 7:00 a.m. (prior office working day) to 7:00 vim (current of?ce working day) magni?ed: i - Reporting; Adrian Mendoza Other Incident Report 79725 (Reference #:79725 I nt Emmi: Adventurer RTP 05/15/13 Bedroom #3 - - stated to me that he had intimate contact with a female peer during RTP, about a week ago. refused and was not willing to give any more information. Brian Blanco Other Incident Report 79724 (Reference #:79724 WW Widen: Adventurer RTP 05/15/ 13 - Resource Center was not on campus to receive his 3 PM and 7 PM medication. laminating: Remaing; Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report 79727 (Reference #:79727 Range.- RTP 05/15/13 Resource Center was not on campus, therefore missing his 7 PM medication. i magnum Repg?ing: Andrea Chiles - Med Error - Missed Dose at FamiliesFitst Incident Report 79741 (Reference #:79741 2mm WM Jade RTP 05/15/13 - Resource Center was not on campus to receive her 7 PM medication. Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report 79742 (Reference #:79742 CONFIDENTIALITY NOTE 3 The documents accompanying this telecopy transmission may contain information that is con?dential and/0t legally The information is intended only for the use by the indiwdua] or entity names on this transmission sheet. If you are not thl' intended rCCipicnt, you are hereby notified that any copying? distribution. or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited lfyou have received this wimpy mm. please notify us mile-20h maiden: Ravens) documents to us at no cost to vou. Thank you. FamiliesE'tst, Inc. 2100171221) Street, Davis, CA 95616 24 Hr. CL Report Thumday, May 16, 2013 The time period of this report is from 7:00 a.m. (prior of?ce working day) to "7:00 a.m. (current of?ce working day) WW qusitam Jade RTP 05/15/13 Front Parking Lot was contained a?er forcefully pushing us in an effort to leave campus after making very speci?c threats to kill herself off campus. She also made statements regarding allegations of sexual assault. Marcos Almeida Law Enforcement Contact Team Prone John (Nick) Moriana - Restraint Christopher Bryce Accident/Injury to Child - Assault/Aggression - Short-Term Runaway Other Incident Report 79736 (Reference #:79736 Widen! Emma: Wooden: Wat Jade DTP 05/15/13 -- Outside House/Campus was restrained for attempting to leave campus per her plan and for assaulting staff. (30 min) mm Nicholas O'Dowd - Restraint Team Prone John (Nick) Moriana - Assault/Aggression Standing Assisting; Kristan Warren Other Assiging: Marcos Almeida Incident Report 79730 (Reference #:79730 a I. .I .l I Sapphire RTP 05/15/13 Resource Center was not on campus, therefore she missed her 3 PM and 7 PM medication. Millennium Reporting; Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report it: 79732 (Reference #:79732 Widen: 2mm WW Wu: Sapphire RTP 05/15/13 Resource Center Wm After several attempts, - refused her 7 PM medication. magnum Andrea Chiles - Med Error - Missed Dose at Ashley McLemore Incident Report 79734 (Reference #:79734 CONFIDENTIALITY NOTE 4 The documents accompanying this tclecopy transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended retipicnt. you are hereby notified that any disclosure, copying. distribution. or the taking of any action in reliance on the contents of this tclecopied information is strictly prohibited. If you have received this ?my in PM W: bii? .tad??iW?a? ?i2 igW-trbit 000201 0 US a CD you. an Fami'IJ'esE'rs I, Inc. 2100 Fifi!) Street, Davis, CA 95616 24 Hr. CL Report Thursday, May 16, 2013 The time period of this report is from 7:00 mm. (prior of?ce working day} to 7:00 a.m. (current of?ce working day) Wooden: Emma: Wm Sapphire RTP 05/15/13 Basketball Court A peer made statements about activities that occurred off campus. Remrting; Adrian Mendoza Other - - Incident Report 79731 (Reference #:79731 Wow Emmi: WW Sapphire DTP 05/15/13 - Living Room pushed into Luanna and I repeatedly, hitting me in the stomach and grabbing onto my arm and pinching me. (25 min) Annette Carbone - Restraint Team Prone Assisting: Ashley McLemore - Assault/Aggression Standing Assisting: Luanna Toney Andrew Enright Incident Report 79721 (Retention #:79721 Widen: Emmi: Wooden: Adventurer DTP 05/15/13 Bedroom #S/Basketball Court was off task for an hour before hopping out of his window, running to the Basketball Court and trying to involve on-task kids. He punched Adrian and I multiple times, so we contained him. (10 min) WJohn (Nick) Moriana - Restraint Seated Restraint Bgm??mg; Brian Blanco - Assault/Aggression Escort Adn'an Mendoza Other Quiet Room CONFIDENTIALITY NOTE 5 The documents accompanying this ielecopy transmission may contain that is con?denth and/or legally privileged. The information is intended only for the use by the indmdual or entity names on this lf?l?lSlIllSMUn sheet, If you are not the intended retipient. you are hereby notified that my copying? distribution. or the taking of my action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that We can arrange for the return of the origuial (2b13-2011 incident Reports) Fam?lics?'rsz; Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Fn'day, May 17, 2013 The tune period of this report is from 00 a In. {prior ott'iCe working day; to 7:00 am. (current working day} Incident Report 79754 (Reference #:79754 In i Emgnm mg: Iimg Qt Incident Location Qt Incident Jade RTP 05/15/13 - Resource Center Eng: Qgsg?ption: When I called for- to take her medication, I was informed that- was not on campus. I checked back several times and determined that she was still off campus at 12 PM when I went to distribute noon medications. Appropriate people were noti?ed. In i Reporting: Julie Vice - Med Error - Client Refused To Take Medication Assisting: David Waites Incident Report 79748 (Reference #:79748 I. ".ln.ll DIED ll Pioneer RTP 05/15/13 Resource Center refused to take his 7 AM dose of medication this morning because he was escalated in the Quiet Room, SCreaming and yelling. Several attempts were made over a period of time and- still refused. Notified appropriate people. Remains]: Julie Vice - Med Error - Client Refused To Take Medication A??i??ingz Kyle Garlick Incident Report 79768 (Reference #:79768 Sapphire RTP 05/16/13 Parking Lot Bri ri ion:- broke a mirror and was attempting to cut herself, so Marcos and I initiated a standing restraint and escorted her to the QUiet Room. (8 min) nt ff: magnum Wine; Reporting: Aaron Alston - Restraint Esc0rt Assisting: Marcos Almeida Other Esc0rt Other Incident Report 79772 (Reference #:79772 Jade RTP 05/16/13 on Campus CONFIDENTIALITY NOTE 1 The documents accompanying this telecop) transmission may contain information that is confidential and/ox legally privileged. The information is intended only for the use by the indmdual or entity names on this transmissmn sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, ill' the taking ol? any action in reliance on the Contents of this felt-Copied information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that We can arrange for the return of the original documents to us at no to you Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000203 Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CCL Report May 17, 2013 The time period of this report is from 7:00 mm. (prior of?ce Working day} to 7:00 a.m. (current of?ce working day) was venting about her frustrations and became escalated, leavmg campus out of staff's supervision. Dianna Wade - Long-Term Runaway Patricia Button Incident Report 79751 (Reference #:79751 would 1' Jade RTP 05/15/13 Rescurce Center When I went to distribute medication to Jade House, I called for. and was informed that she was not on campus. She did not return in time to take her 7 AM or 12 PM dose of medications. Notified appropriate people. Repogigg: Julie Vice - Med Error - Client Refused To Take Medication Assisting; Erin Milligan Incident Report 79774 (Reference #:79774 Welded: Emma: Wot-imp: Jade RTP 05/16/13 Resource Center missed her 7 PM mediratinn, due to not being on campus during this time. Witt: Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 79756 (Reference #:79756 Adventurer RTP 05/16/13 Resource Center missed his 3 PM and 7 PM medication, due to not being on campus during this time. lam?t Staff: Reporting: Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 79782 (Reference #:79782 I Bantam _tI_Loca 'on sat Incident Adventurer RTP 05/ 16/13 Hospital/Office had in the morning and due to reports of erratic behavior concerned citizens, police were contacted and requested a 5150 hold. While in the hospital awaiting his assessment, disclosed allegations about his peers. Ingmar; Reporting: Michelle Glicksman - Hospitalization (5150 Hold) - Problematic Interaction with Citzen - Law Enforcement Contact Other CONFIDENTIALITY NOTE 2 This documents accompanying this tclt?copy transmission ma) contain in formation that is con?dential and/or legally privileged. The information is intended only for the use by the indiVidual or entity names on this transmission sheet. If you are not the intended recipient. you are hereby noti?ed that any disclosure, copying, distribution, 01 the taking of any action in reliance on the contents of this telecopied information 1F strictly prohibited. If you have this in error, please notify us by telephoiic immediately so that we can arrange for the return of original documents to us at no Cost to you 'l?hnnk you PBS Front Line PRA Request (2013-2011 Incident Reports) 000204 Fann'lies?'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Ht. CL Report Fnday, May 17, 2013 The time of this report is from 7:00 a.m. (prior of?ce working day) to 7:00 mm. (current ofticc working day} Incident Report 79747 (Reference #:79747 I. .l I . I I Adventurer RTP 05/15/13 House When I went to distribute medication to Adventurer house, I called for! and was informed that he was not on campus. He did not return by 2 PM and therefore, he did not take his 7 AM dose of me ications. Noti?ed appropriate people. Reporting: Julie Vice - Med Error - Ciient Refused To Take Medication Assisting; Jose Garibay Incident Report 79757 (Reference #:79757 Begonias: uni; 91 Incident Dag: Ilme gf In?del]; Location of Incident Adventurer RTP 05/16/ 13 - Resource Center missed his 3 PM and 7 PM medication, due to not being on campus during this time. Incidentsta?. Incidentme. Beaming; Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 79752 (Reference #:79752 Bgng?ing unit of Incident 2mger 99;; lime o! Incident Location of Ranger RTP 05/15/13 - Resource Center When I went to distribute medication to Ranger House, I called for- and was informed that was not on campus. He did not return by 2 PM and therefore, he did not take his 7 AM dose of medication. Noti?ed appropriate people. Reporting: Julie Vice - Med Error - Client Refused To Take Medication Assisting: Nicholas Rhodes Incident Report 79750 (Reference #:79750 ni In '6 Mam mm of Incident Jade RTP 05/15/13 Resource Center When I went to distribute medication to Jade House, I was informed that had left campus. I checked back several times and she had not returned. Therefore,- did not take her 7 A ose of medicationsReporting; Juiie Vice - Med Error - Client Refused To Take Medication Erin Milligan Incident Report 79775 (Reference #:79775 CONFIDENTIALITY NOTE 3 The documents accompnn?ng this telccopy transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmissmn sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure. coming, distribution, or the taking of any action in (in the contents of this telecopied information is prohibited if you have received this telecopy in error, please notify us by telephone immediately so that Wt can arrangi- for tilt. return of liit? origin-.11 documents to us at no cost to you Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000205 Fann'IJ'esFirst, Inc. 2100 Fifth Street, Dan's, CA 95616 24 Hr. CL Report Friday, May 17, 2013 The time period of this report is from 7:00 a.m. (prior of?ce working day) to ":00 am. (current ol'?cc working day) Widen: Emnmm WW Jade DTP 05/16/13 Front of Campus was contained for assaulting staff. (37 min) Kristan Warren - Restraint Escort Marcos Almeida 0 - Assault/Aggression Team Prone Aaron Alston Assi?ng: Caitlin Scott Assisting; Brian Blanco Incident Report 79762 (Reference #:79762 Em WW Ranger DTP 05/16/13 Bedroom was being aggressive by pushing into staff, attempting to grab staff's radios. He attempted to bite staff, and was escorted to the Quiet Room per his plan. (9 min) Lanai O'Brian - Restraint Escort Efren Sanchez-Delgado - Assault/Aggression Quiet Room Incident Report 79773 (Reference #:79773 2mm Widens Jade DTP 05/16/13 - Bedroom #3 was assaulting staff and attempting to leave staff supemsion. (21 min) Courtney Ghilain - Restraint Standing gem; Felicia Thomas - Assault/Aggression Assisting: Reynoso Trujillo Incident Report 79753 (Reference #:79753 Emmi: Sapphire RTP 05/15/13 - Resource Center When I called for- to take her medication, I was informed that- was not on campus. I checked back several times and determined that she was still off campus at 12 PM, when I went to distribute noon medications. Appropriate people noti?ed. Reporting: Julie Vice - Med Error - Client Refused To Take Medication Assisting: David Waites CONFIDENTIALITY NOTE 4 The documents accompanying this tt?lt?cnp) transmissmn may contain information that is confidential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. ll- you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this telecopy in error. please notify us by telephone so that We can arrange for the return of the original dntume'nts to us at no (on to you. 'l hank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000206 FamiliesFirst, Inc. 2100 Hit!) Street, Davis, CA 95616 24 Hr. CCL Report mag y, Ma 17, 2013 The time pt'rIOCl of this report is from 7:00 a.m. (prior of?ce working' day} to 7:00 am. (current of?ce Wurling day) Incident Report 79749 (Reference #:79749 Sapphire RTP 05/15/13 Resource Center refused to wake up and take her 7 AM dose of medication. When I approached her she said she was too tired from being out all night. Several attempts were made, but_ continued to refuse. Appropriate people were notified. Reporting: Julie Vice - Med Error - Client Refused To Take Medication Assisting: DaVid Waites Incident Report 79765 (Reference #:79765 Widen: ra Widen! Sapphire RTP Resource Center After several attempts, refused her 7 PM medication. i Immune; Andrea Chiles - Med Error - Client Refused To Take Medication Incident Report 79764 (Reference #:79764 I. .ll pl .II I Sapphire RTP 05/16/13 House refused to wake up and take her 7 AM dose of medication. When I approached her, she said she was not going to take her medication anymore. Several attempts were made, but_ continued to refuse. Appropriate people were noti?ed. Incldentjta?: Julie Vice - Med Error - Client Refused To Take Medication David Waites Incident Report 79766 (Reference #:79766 El?n . Sapphire RTP 05/16/13 Kitchen peer -) reported that- stated she had done sexualized behavmr while out of supervision off campus. Luanna Taney Other Incident Report 79769 (Reference #:79769 Sapphire DTP 05/16/13 Front of Campus ran into the street and then back onto campus. As we offered proximity, - pushed into staff and punched staff a er the clear limit, so containment was initiated. (32 min) Tn?ddon. Yul-Ida?. Tuna: Un?t-Din. Tun.- CONFIDENTIALITY NOTE 5 The documents accompanying this tc-lccopy transmissmn may contain information that is confidential and/or lcgall)? The information is intended only for the use by the individual or entity names on this transmission sheet. If you not intended recipient. you are hereby ttorificd that any disclosure, copying, distribution, or thi- taking of any action in reliance on the contents (if-this information is strictly prohibited. lfyou received this talc-copy in error, please notify us by telephone immediately so that WC can arrange for the return oftlic original documch to us at no Cost to you. 'l'hnnk you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000207 Familli'eerst, Inc. 2100 Fifth Street, D3 vis, CA 95616 24 Hr. CL Report Friday, May 17, 201.3 The time period of this report is from 7:00 a.m. (prior of?ce working day} to 7:00 am. (current office working day) 33m; Luanna Toney - Restraint Escort Aaron Alston 0 - Assault/Aggression Team Prone Incident Report 79746 (Reference #:79746 I. .II El II. I .II Adventurer RTP 05/15/13 House refused to take his 7 AM medication as he was rolling around on the ?oor in his room to get up. When I went to talk to him, he spit at me and said he was not taking it. Several attempts were made and appropriate people no??ed. 1051mm Reporting: Julie Vice - Med Error - Client Refused To Take Medication Assisting: Jose Garibay Incident Report 79759 (Reference #:78759 ngg?ing unit 913 Incident Emgram page a lime of Incident Adventurer RTP 05/16/13 Hospital peer -) informed me that- had "groped my butt and foot." Michelle Glicksman Other - Incident Report 79745 (Reference #:79745 Woollen: we Wat Trailblazer RTP 05/11/13 House assaulted staff repeatedly and was placed in a standing containment. (6 min) Wimessing: Sarah McFadden - Restraint Standing Repgging; Marcos Almeida - Assault/Aggression Matthew Brown Sule Anibaba Assisg'ng: Brian Blanco Assisting: Aaron Alston CONFIDENTIALITY NOTE 6 The documents accompanying this tcleropy transmission may contain information that is con?dential and/or legall} privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient. you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this teli?mpied information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone unmedititely so that WC can arrange for the return of the original documents to us at no cost to you. 'l'hank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000208 Farm'IiesErst, Inc. 2100 Fifth Sweet, Davis, CA 95616 24 Hr. CL Report Monday, May 20, 2013 The time period of this report is from 7:00 am. (prior of?cc working day) to 7:00 am. (current working day) Incident Report 79815 (Reference #579815 Wat Emmi Widen: Jade RTP 05/17/13 Resource Center missed her 7 PM medication, due to not being on campus during this time. Wins. Reporting; Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 79341 (Reference #:nsu Emma WW Jade RTP 05/18/13 - Resource Center missed her 3 PM and 7 PM medication, due to not being on campus during this time. mm mm mm Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 79853 (Reference #:79853 Wilden! 2mm mum Jade RTP 05/19/13 Resource Center was not on campus to receive her medications. geogrting: Brenda Vermette - Med Error - Missed Dose at FamiliesFirst Incident Report 7.9794 (Wee #:79794 2mm Adventurer RTP 05/17/13 Resource Center missed his 7 PM medication, due to not being on campus during this time. Mug; Andrea Chiles Med Error - Missed Dose at FamiliesFirst Incident Report 79818 (Reference #:79818 handmade]: Emnm Adventurer RTP 05/18/13 Front of Campus and a peer left the house after sleeping and eating with a pie-packed backpack at 1:57 PM. They were not visibly escalated. witnessing: Sule Anibaba - Law Enforcement Contact ?itngsing: Marcos Almeida - Law Enforcement Contact Brian Blanco CONFIDENTIALITY NOTE I The documents accompanying this telecopy transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmissmn sheet. If you are not the intended rempicnt, you an: hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this tclecopicd information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for return of the vaginal documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000209 FaleiesE'nsg Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Manda y, May 20, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 a.m. (current of?ce working day) Incident Report it: 79819 (Reference #:79819 WW 2mm Adventurer RTP 05/ 18/ 13 Resource Center missed his 3 PM and 7 PM medication, due to not being on campus during this time. mm mm Mug; Andrea Chiles - Med ErrOr - Missed Dose at FamiliesFirst Incident-Report 79817 (Reference #:79817 WW Emsmun Adventurer RTP 05/18/13 Sapphire House A statement was made that. had 'sex" with another resident from campus, while they were out of staff supervision in the community of Davis, Ca. Wimgging; Christian Villela Other Remrting: Leola Taylor Incident Report 79344 (am #:79844 2mm Adventurer RTP 05/ 19/13 Resource Center was not on campus to receive his medications. locum": Incidentlmez 3mm; Brenda Vermette - Med Error - Missed Dose at FamiliesFirst Incident Report 79865 (Reference #279865 2mm Sapphire RTP 05/ 16/13 Resource center Wu, was not on campus during the distribution of 7 AM medication and did not return before the window to take the medication had passed. Therefore, she did not take her 7 AM dose of medication. more msidentlmei 3mm; Julie Vice - Med Error - Client Refused To Take Medication David Waites Incident Report 79864 (Reference #998?) a I. .l .l I 2mm Woodard . Wooden: Sapphire RTP 05/16/13 House/Front of Campus put her shoes on and went to her peer, .5 room and they both walked out of the house and off campus, leaving supervision. Remains; Luanna Toney - Long-Term Runaway Aaron Alston Marcos Almeida CONFIDENTIALITY NOTE 2 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally priv?eged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000210 Fanzilies?'rst, Inc. 2100 Fi?b Street, Davis, CA 95616 24 Hr. CCL Report Monday, May 20, 201.3 The tum: period of this report is from 7:00 a.m. (prior office working day) to 7:00 zi.m. (current office working day) Incident Report 79807 (Reference #:79807 sapphire DTP 05/17/13 03226PM Front Of Campus and her peer- left campus and was out of superwsion after several minutes. mm Luanna Toney - Long-Term Runaway gsiging: Courtney Ghilain Incident Report 79m (Reference #998? Widens 2min WW Sapphire RTP 05/17/13 Resource Center After several separate attempts, - refused her 7 PM medication. 3mm; Andrea Chiles - Med Error - Client Refused To Take Medication Incident Report 79806 (Reference #:79806 WW Bantam Widens Sapphire RTP 05/17/13 - House was not on campus during the distribution of 7 AM medication and did not retum before the window to take the medication had passed. Therefore, she did not take her 7 AM dose of medication. 0 Reporting; Julie Vice - Med Error - Client Refused To Take Medication David Waites Incident Report #1 79870 (Home. #:79870 WW Eastern Wooden: Jade RTP 05/ 16/13 Resource Center refused to take her 7 AM medications and was stating she didn't want to, because she is an Two attempts were made, prior to her leaving campus. Therefore, she refused her 7 AM medications. momma. Immune. Reporting; Julie Vice - Med Error - Ciient Refused To Take Medication Erin Incident Report 79811 (Reference #279811 Jade RTP 05/17/13 - Resource Center missed her 7 PM medications, due to not being on campus during this time. gem Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 79810 (Reference #:79810 CONFIDENTIALITY NOTE 3 The documents accompanying this relecopy transmission may contain information that is con?dential and/ or legally priv?egcd. The information is intended only for the use by the individual or entity names on this transmissmn sheet. If You are not the mtended you are hereby noti?ed that any disclosure. copying, distribution, or the taking of any action in reliance on the contents of this tciccnpied information is strictly prohibited. if you have received this telccopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to vou. 'l'barik vou. PBS Front Line PRA Request '(201 3-2011 Incident Reports) 000211 Farm'liesFirst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Monday, May 20, 2013 The time period of this report is from 7:00 am. (prior office working day) to 7:00 a.m. (current of?ce working day) MW EMBED Jade RTP 05/17/13 Resource Center was off campus at the time of 7 AM medication distribution. Therefore, she did not take her 7 AM medications. Julie Vice - Med Error - Client Refused To Take Medication Erin Incident Report 79837 (Reference #:79837 Jade RTP 05/ 18/13 - Resource Center missed her 7 AM medication, due to not being on campus during these times. Indium 3mm; Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 79854 (Reference #:79854 Brant-m Wooden: Jade RTP 05/19/13 Resource Center was not on campus to receive her 7 AM and 7 PM medications. mm mm Reporting: Brenda Vermette - Med Error - Missed Dose at FamiliesFirst Incident Report 79823 (Reference #:79823 WW Emntam Wooden: Voyager 05/ 18/13 Resource Center After several separate attempts, - refused his 7 AM medications. Remit]; Andrea Chiles - Med Error - Client Refused To Take Medication Logan Hess Incident Report 79862 (Reference #:79862 Wagner]: anagram WM Adventurer RTP 05/ 16/13 - Resource Center missed his 3 PM and 7 PM medication, due to not being on campus during this time. Will. Remrting: Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 79793 (Reierence #99793 CONFIDENTIALITY NOTE 4 The documents accompanying this transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recrpient? you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000212 Fam?I'eerst, Inc. 2100 Fifth Smear, Davis, CA 95616 24 Hr. CL Report Monday, May 20, 2013 The time pcnod of this report is from 7:00 a.m. (prior office working day) to 7:00 a.mi (current of?ce working day) WW 2mm Adventurer RTP 05/17/13 Rsource Center missed his 7 PM medication, due to not being on campus during this time. mm mm Bugging; Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 79792 (Reference #:79792 WM Wooden: Adventurer RTP 05/17/13 - Resource Center refused his 7 AM dose of medication and then left campus before I could ask additional times. Noti?ed appropriate peop e. Insidentlna. Reporting; Julie Vice - Med Error - Client Refused To Take Medication Assisting; Curtis Richardson Incident Report 79822 (Reference #:79822 WM Bantam Adventurer 05/ 18/13 - Resource Center missed his 7 AM and 7 PM medication, due to not being on campus during this time. Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 79847 (Reference #:79847 Einstein MW LEW Adventurer RTP 05/19/13 House I noticed that- had a "hickey" on his neck. 3mm Islam Hassanein Other Incident Report 79848 (Reference #:79878 WWI anagram WW Wm Adventurer RTP 05/19/ 13 House left the house unsupervised despite asking him to return. I could not follow, due to low staffing. He then left campus. Insidentlme: Islam Hassanein - Long-Term Runaway 553mg; John (Nick) Mariana Incident Report 79846 (Reference #:79846 2mm Adventurer RTP 05/ 19/13 Resource Center - refused to wake up for his 7 AM medication after multiple attempts. He also left campus and did not receive his 7 PM me ications. I?an.on Tun-- CONFIDENTIALITY NOTE 5 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. If you have received this in error, please notify us by telephone immediately so that We can arrange for the return of the original documents to us at no cost to you Thank you. PBS Front Line PRA Request?(201 3-2011 incident Reports) 000213 FamilicsEirst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Monday, May 20, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 a.m. (current of?ce working day) gem Brenda Vermette - Med Error - Missed Dose at FamiliesFirst - Med Error - Client Refused To Take Medication tneidt Report 7985-5 (Reremee #:mss I. .II 2mm Widens Jade RTP 05/19/13 Resource Center missed her 7 AM medications, because she refused to wake up. modem gem Brenda Vermette - Med Error - Client Refused To Take Medication - Incident Report at: 79869 (Reference #:79869 WW 2mm Wisp: Jade RTP 05/ 16/13 0716?? Resource Center When I went to distribute medication to Jade House, I called for. and was informed that. was not on campus. She did not return in time to take her 7 AM and her 12 PM dose of medications. Notified appropriate people. Rggor?ng: Julie Vice - Med Error - Client Refused To Take Medication ?sistigg: Erin Incident Report-49: 79813 (momma Wooden! 2mm Jade RTP 05/17/13 Resource Center missed her 7 PM medication, due to not being on campus during this time. 11191::th magnum. Reporting: Andrea Chiies - Med Error Missed Dose at FamiliesFirst Incident Report it: 79312 (antennae #:mu 2mm Jade RTP 05/ 17/13 Resource Center Winn; When I went to distribute medication to Jade House, I called for% and was informed that. was not on campus. She did not return in time for her 7 AM or her 12 PM dose of medications. otified appropriate people. modem lnddentlm. Reporting: Julie Vice - Med Error - Client Refused To Take Medication gm Erin Milligan Incident Report 79843 (Reference #:79843 Bantam Widen: Jade RTP 05/18/13 Resource Center missed her 7 AM and 7 PM medication, due to not being on campus during this time. CONFIDENTIALITY NOTE 6 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally The information is intended only for the use by the mdivtdual or entity names on this transmissmn sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopicd information is prohibited. If you have received this in error, please notify us by telephone immediately so that we can mange for the return of the original documents to us at no cost to you, Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000214 Farm'IiesE'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Monday, May 20, 2013 Thu timc period of this report is from 7:00 Lm. (prior office working day} to 7:00 a.m. (Current of?ce working Clay) Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Inddent Report it: 79856 (Reference #:79856 Jade RTP 05/19/13 Resource Center refused to wake up to take her 7 AM medications and her 7 PM medications. Brenda Vermette - Med Error - Client Refused To Take Medication Incident Report 79857 (Reference #:79857 Bantam Widen: Jade RTP 05/19/13 - Off Campus left supervision off campus. Police were noti?ed, but no assistance was required. momma; - Regomng: Patrick Oleson-Wheeler - Law Enforcement Contact - Long-Term Runaway Incident Report 79861 (Reference #:79861 WW Bantam Adventurer RTP 05/ 16/ 13 1 1 54AM Resource Center missed his noon dose of medication, due to not being on campus. mm mm Regoging: Julie Vice - Med Error - Missed Dose at FamiliesFirst Assisting: Imelda Davila Incident Report 79791 (Reference #:7979-1 WW anagram MW Adventurer RTP 05/ 17/13 Resource Center missed his 3 PM and 7 PM medication, due to not being on campus this time. Incidentjta?. Insidentlme. mm; Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 79790 (Reference #:79790 MW Adventurer RTP 05/17/ 13 - House When I went to distribute medication to Adventurer House. I called for? and was informed that- had been off campus most of the night and refused to get up. He therefore did not take his AM dose of medications. CONFIDENTIALITY NOTE 7 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally privdcged. The information IS intended only for thr- use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or the taking of any acuon in reliance on the Contents of this information is prohibited. If you have rccmed this in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cosr to vou. Thank yo U. PBS Front Line PRA Request (2013-2011 Incident Reports) 000215 Fandljes?rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Ht. CL Report Monday, May 20, 201.3 The time period of this report is from 7:00 am. (prior office working day) to 7:00 a.m. (current office working day) mm gagging; Julie Vice - Med Error - Client Refused To Take Medication Assisting; Curtis Richardson Incident Report a: 79320 (Reference #953320 Emma: Adventurer RTP 05/18/13 - Front of Campus W?and his peer grabbed their previously packed backpacks and blankets, and walked out the back door. They both supervision campus, despite Brian and I prompting and shadowing them. Insldaotjn?; Wag; Sule Anlbaba - Law Enforcement Contact Brian Blanco - Long-Term Runaway mm; Marcos Almelda Incident Report 79821 (scram-ice #99321 Wanna: Emamn Walnut Adventurer RTP 05/18/13 Resource Center After several separate attempts, - refused his 7 AM medication. He also missed his being off campus. Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Brian Blanco - Med Error - Cllent Refused To Take Medication Incident Report it: 79845 (Reference #:79845 2mm Adventurer RTP 05/19/13 Resource Center was off campus and did not receive his medications. mum Reporting; Brenda Vermette - Med Error - Missed Dose at FamlliesFirst Incident Report 79816 (Reference-#99816 .) Wat Mariam Widens Jade RTP 05/17/13 Resource Center missed her 7 PM medication, due to not being on campus during this time. Ming; Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 79840 (Reference #:79840 snow Emma: In Jade RTP 05/18/13 Resource Center missed her 7 PM medlcatlon, due to not being on campus during this time. Tut-inland- I?npldonf Tm.- CONFIDENTIALITY NOTE 8 The documents accompanying this transmission may contain information that is confidential and/ or legally The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended reapient. you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000216 FamiliesFirst, Inc. 2100 Street, Davis, CM 95616 24 Hr. CL Report Monday, May 20, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 am. (current of?ce wmking day) Mug; Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 79839 (Reference #:79839 Emmi: MAW Jade RTP 05/18/13 Sapphire House A statement was made that engaged in 'sex" with another resident from campus, while they were out of staff supervision in the community of Dav s, a. Christian Villela Other Emmy; Leola Taylor Incident Report 79858 (Reference #:79858 WW Bream MW Jade RTP 05/19/13 Resource Center was not on campus to receive her 7 AM and 7 PM medications. Instantly?: Brenda Vermette - Med Error - Missed Dose at FamiliesFirst Incident Report 79859 (Reference #:79859 mm Jade RTP 05/19/13 Off Campus left staff supervision off campus. Police were noti?ed. Ming; Patrick Oleson-Wheeler - Law Enforcement Contact Assisting: John (Nick) Moriana - Long-Term Runaway Other Ina'dent Report 79849 (Reference #:79849 I. ?.lu.l Ill? ?.ll . . Ranger RTP 05/ 19/ 13 Resource Center was not on campus to receive his 7 AM medication. Reporting; Brenda Vermette - Med Error - Missed Dose at FamiliesFirst Incident Report 79838 (Reference #:79838 MW 2mm Jade RTP 05/18/13 5th Street n-lrr?mnn- -=ec:nl6ad eta? renoafodlu tins-inn an aH-amnO- On cuimnilelnn and mac nlarnd in a "Efrain. CONFIDENTIALITY NOTE 9 The documents accompanying this Iclccopy transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this talc-copy in error, please notify us by telephone immediately so that We can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000217 FaIm'II'csFirst, Inc. 2100 Sac-ct, Davis, CA 95616 24 Hr. CL Report Monday, May 20, 2013 time period of this report is from 7:00 a.m. (prior of?ce working day) to 7:00 a.m. {current of?ce working day) (15 min) mm Marcos Almeida - Restraint Team Prone Aaron Alston - Assault/Aggression Standing Incident Report it: 79867 (Reference #:79567 2mm WW Sapphire DTP 05/16/13 Front of Campus was in front of campus, with a group of peers that were not following directions. - left campus and out of supervision or several hours. Indium Reming; Luanna Toney - Long-Tenn Runaway Assisting; Lisa Little Incident Report 79868 (Reference #:79868 2mm WW Sapphire RTP 05/16/13 Resource Center missed her 7 PM medication, due to not being on campus during this time. modem Renaming; Andrea Chiles - Med Error - Missed Dose at t?amiliesFirSt Incident Report 79801 (Reference #:79801 WW anagram WM Sapphire DTP 05/17/ 13 Front of Campus along with her peers -, left campus without permission and was out of supervision, after we shadowed for several minutes. Ming; Luanna Toney - Long-Term Runaway Assisting; Courtney Ghllain Incident Report 79802 (Reference #279802 WW Emerald Sapphire RTP 05/17/13 Resource Center missed her 7 PM medication, due to not being on campus during this time. 3mm; Andrea Chiles - Med Error - Missed Dose at Incident Report 79800 (Reference #:79800 Wot 2mm Sapphire RTP 05/ 17/13 - 07243AM Resource Center When I called for to take her medication, I was informed that was not on campus. I checked hat-Ir count-3 Hm-e and Aniawninnd Han? a :63" n? ramnne DM uuhon iunni- fn eHhuhs mgf?II-jQ-innc CONFIDENTIALITY NOTE 10 The documents accompanying this transmission may contain information that is con?dential and/ or legally privileged. The infomiation is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this in error. please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000218 Fanzilr'es?'r'st, Inc. 2100 Fifth Street, Davis, C4 95616 24 Hr. CL Report Monday, May 20, 2013 The time period of this rcport is from 7:00 am (prior of?ce working day) to 7:00 a.m. (current office working day) Appropriate people were noti?ed. - gem Julie Vice - Med Error - Client Refused To Take Medication David Waites Incident Report 79835 (Reference #:79835 Wanna: Sapphire RTP 05/18/13 Resource Center missed her 12, 3, and 7 PM medication, due to not being on campus during these times. mum magnum. gem Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 79836 (Reference #:79836 . I I nm . . Sapphire RTP 05/18/13 House left campus without permission and is/has been out of supervision. Luanna Toney - Law Enforcement Contact Aaron Alston - Long-Term Runaway Incident Report 79852 (Reference #:79852 In Widen: Sapphire RTP 05/19/13 Resource Center was off campus and missed her medications. Brenda Vermette - Med Error - Missed Dose at FamiliesFirst Incident Report 79863 (Reference #:79863 WNW 2mm Sapphire RTP 05/ 16/ 13 - House/Front of Campus along with -, walked out of the house and off campus, leaving superwsion for several hours. Wimessing: Aaron Alston - Long-Term Runaway Annette Carbone Luanna Toney Incident Report 79804 (Reference #:79804 I. .II El.? ?1 . . Sapphire DTP 05/17/13 Front of Campus walked out of the house, ignoring prompts and proceeded to leave campus and out of supervision. CONFIDENTIALITY NOTE I 1 The documents accompanying this transmissron may contain information that is con?dential and/0r legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. if you are not the intended rectpicnt, you are hereby noti?ed that any disclosure, copying, distribution. or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this. telccupy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000219 FaeriesF?'st, Inc. 21001712?!) Street, Davis, CA 95616 24 Hr. CL Report Monday, May 20, 2013 The time period of this report is from 7:00 am. (prior of?cc working day) to 7:00 a.rn. (current of?ce working day) Luanna Toney - Long-Term Runaway Incident Report 79805 (Reference #:79805 Sapphire RTP 05/17/13 - Resource Center missed her 7 PM medication, due to not being on campus during this time. gem Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 79803 (Reference #:79803 Emnm Wooden: Sapphire RTP 05/17/13 Resource Center rief - refused to wake up and take her 7 AM dose of medication. When I approached her, she said she was not going to take her medication anymore. Several attempts were made, but- continued to refuse. Appropriate people were noti?ed. mm Beggrting: Julie Vice Med Error - Client Refused To Take Medition Assisting; David Waites Incident Report 79323 (Reference #:79828 BMW 2mm Wat Went Sapphire RTP 05/18/13 House had returned to campus, changed her clothes, and proceeded to leave campus. Incidentjta?t mummies; ggporting; Luanna Toney - - Law Enforcement Contact - Long-Term Runaway Incident Report 79829 (Reference #:79829 Sapphire RTP 05/18/13 - Resource Center missed her 7 AM and 7 PM medication, due to not being on campus during this time. mm mm Remitlng: Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 79827 (Reference #:79827 Wu: Emnmn Sapphire RTP 05/ 18/13 Kitchen made a statement, alleging that two other residents from campus had sexual intercourse while they were all out of sta?? supervision in the community of Davis, Ca. maximums: Witnessing: Christian Villela Other Reporting; Leola Taylor CONFIDENTIALITY NOTE 12 The documents accompanying this telecopy transmission may contain information that is con?dential and/or legally The information is intended only for the use by the indivtdual or entity names on this transmissxon sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying. distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this in error. please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000220 Fam'li'csFiI-st, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Monday, May 20, 2013 The time period 0! this report is from 7?00 mm. [pnor of?ce working day; to 7:00 of?ce working day, Incident Report 79851 (Reference #:79851 2mm WW Sapphire RTP 05/19/13 - Resource Center was not on campus to receive her 7 AM and 7 PM medications. Brenda Vermette - Med Error - Missed Dose at FamiliesFirst Incident Report 79832 (Reference #:79832 MW Emmi: Wooden: Sapphire RTP 05/18/13 - Field/Quiet Room was not following directions and began pushing into staff.- continued pushing into us, after the clear limit, so an escort containment was initiated. (3 min) Luanna Toney - Restraint Escort Ass-1mm; Marcos Almeida - Assault/Aggre55ion Incident Report 79831 (Reference #:79831 Sapphire RTP 05/18/13 Basketball Court was in containment for assaulting staff. (18 min) 3min; Ashley McLemore - Restraint Team Prone mm Jonathan Stone 0 - Amident/Injury to Child Standing Leola Taylor 0 - Assault/Aggression Incident Report 79850 (Reference #:79850 Emmn Adventurer RTP 05/19/13 Bedroom became upset over consequences and left through his window and ran off of campus. Remrting: Adrian Mendoza - Long-Term Runaway Jonathan Stone CONFIDENTIALITY NOTE 13 The documents accompanymg this telecopy transmission may (ontain information that con?dential anti/oi legally privileged. The information is intended only for the use by the individual or entity names on this transmissmn sheet. If you are not the intended recipient. you are hereby notified that any disclosure, copying. distribution. or the taking of any action in reliance on the contents of this iclei?opicd information is strictly prohibited. Ifytiu h:ch rt?t?Cth?tl this ielecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us :it no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000221 Fanu'ljesH'rs I, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Fn'day, 24, 201.3 TEK rum pun-d ul' Illh upon I: 7 00 .I pIIm nl'r?zcc \vurkmg dn' In (ill .I cunmu ullIu \uukmg Jul Incident Report 79989 (Reference #:79989 Wagner): Barnum Jade RTP 05/23/13 Resource Center When I called for to take her meducatron, was Informed that- was not on campus. I checked back several tunes and determrned that was off campus past noon trme. Appropriate people were notI?ed. Watt. 3:993:33; Julue Vrce - Med Error - Missed Dose at FamnlresFIrst Incident Report 79974 (Reference #:79974 I. ?.In .II I I. nun! Ranger DTP 05/23/13 Bldg/Parkang Lot was running around campus. chaos by Jumpan on the hoods of and cncouragmg other peer to get off task hum. TherefOre, we mutuated an escort to the Quret Room to prevent further drsruptnon. (16 mm) Erm - Restraint Escort gm Efren Sanchez-Delgado Other Quuet Room Kamlka Sherwood Othe' Incident Report 79981 (Reference #:79981 unit of Incident Emgnm . Iim; of Incident i Jade DTP 05/23/13 02.00PM House When I started my shIft at 2:00 was already gone. Felncua Thomas - Long-Term Runaway -) Incident Report 79972 (Reference #:79972 Winn! Adventurer RTP 05/23/13 Resource Center *attempted to attack peer, desmte staff deternng mm from dorng so. He contmued to charge after peer an as per walked out of the house wIthout As a result, Oscar and escorted hum. {1 mm) Sulc Ambaba - Restrarnt Escort 559$;an Oscar Lopez 0 - Assault/Aggressmn QuIet Room CONFIDENTIALITY NOTE I ll? unwnh .n I upy mm Inmam Ilm! tnII?rlt'nlnl .Iml/m legally pm?xlr gr hr Is only Mr IlIt- IN by (H I-nrm? mum-x rm Iransnusslun slut! ll yuu .lrt nu: Ilw tuprIt-nl, \ou arc hereby Imu?cd IlIut an} tlIstlosuru. comm?. distrIlIuru-n, or the ralung of lel?. .u mm In I'm tlu- (mm-ms of this ?lm rIpIr-rl Is pmlIIlIIlul l! Wu lt'tt'th?tl It It npy plant IIrIlIl'y Us by ll?lt'PllOnt wr can Ilu mum ml the rmgmal documents Io us :It nu cost l0 you Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000222 Fam'lt'esE'rst, Inc. 2100 Fifth Street, Da W's, CA 95616 24 Hr. CL Report Frida y, May 24, 2013 The [lmt' period of tllh? report is from ?00 a {prior ()l-l-iCc working day; to 7:00 a in ot't'iu: Working: day) Incident Report 79988 (Reference #:79988 ..In Jade RTP 05/23/13 - Resource Center When I distributed medication to Jade House, I called - to take her medication and she told Erin that she was refusmg. Several attempts were made and appropriate people were notified. Watt; mm Julie Vice - Med Error Client Refused To Take Medication Assisting: Erin Milligan Incident Report 79985 (Reference #:79985 ni Brogan] Ti Jade RTP 05/23/13 5th Street left campus at 12:15 PM. Repoging: FeliCia Thomas - Long-Term Runaway Incident Report 79987 (Reference #:79987 I. f1 . I I Adventurer RTP 05/23/13 Resource Center When I entered Adventurer House to distribute medications, I called. but he was sleeping and refused to c0me and get his medications. Several additional attempts were made and he continued to refuse. Therefore, he did not take his 7 AM dose. gem; Julie Vice - Med Error - Client Refused To Take Medication Assisting: Jose Garibay Incident Report 79975 (Reference #:79975 fIncid Emmi: MA?Lgdu?me of i Ranger RTP 05/23/13 Porch had already ran out of the house earlier today. Once he began to push into staff, we set his limit and directed him to uiet Room. Since he kept trying to get past his limits, we went ahead to gmde then escorted him to the Quiet Room. (4 min) Inc-mm]; Stan. lasing]: Ixng- int Witnessing: Kelsey Blissett - Restraint Escort 33mm Efren Sanchez-Delgado - Assault/Aggression QUiet Room Oscar Lopez CONFIDENTIALITY NOTE 2 The documents accompanying this may contain informanon that is con?dential and/or legally The Information is intL?Ilde only l-Ul' the use by llIL' individual or clitin namcs on this initismissmn SlK?tl? Hi you are not this intended recipient. you are hereby notified thzit any disclosure, copying, disrrihutioii, or the taking of any action in reliance on the contents of this tcli'copit?tl information is strictly prohibncd. lfymi lmvt' rt'Ci-ii't-tl this crmr. plea?st Hullh' us by iinintdinit-ly so that wc can arrangi- {or the return of (llt' original documents to u< at no cost to you 'l?hnnk you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000223 Fam'lies?'tst, Inc. 2100 Fi?/1 Street, Dan's, CA 95616 24 Hr. CL Report Friday, May 24, 2013 The time period of this report 15 from 7:00 an]. (prior office working day) to 7:00 a.m. (current office working day) Incident Report 79983 (Reference #:79983 2mm Jade DTP 05/23/13 Living Room was pushing into staff. (7 min) 3mm; Felicia Thomas - Restraint Standing Johnny Tillis - Assault/Aggression Incident Report 79990 (Reference #:79990 Emnmn Jade RTP 05/23/13 Resource Center When I went to Jade House to distribute medications, I called- to take her? medications and she told Erin that she was not coming to take them. She again refused her noon medication. Both time frame, several attempts and noti?cations made. Julie Vice - Med Error - Client Refused To Take Medication Erin Milligan Theresa Murchison Incident Report 79979 (Reference #:79979 WW Emma: Sapphire RTP 05/23/13 Front of House began elbowing me in the stomach. I prompted her to stop yelling and assaulting me but she continued, so I initiated an escort with Logan. She would not cooperate with the escort, so we released. She continued assault, team prone placed. (5 min) Mug; Aaron Alston - Restraint Escort Logan Hess 0 - Assault/Aggression Team Prone Annette Carbone Incident Report 79976 (Reference #:79976 WW anagram Voyager DTP 05/23/13 House - After snack, walked out of the front door of the house. He was shadowed until he left campus; at which time the police were notier . 11153551119; Dean Valencia - Law Enforcement Contact Dianna Wade - Long-Term Runaway Brett Atwood Witnessing: Efren Sanchez-Delgado 3mg; Logan Hess CONFIDENTIALITY NOTE 3 The documents accompanying this transmission may contain Information that is confidential and/ or legally The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that my disclosure, copying. distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this telecopy to error, please notify us by telephone Immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000224 FamilieSE'rst, Inc. 2100173712!) Street, Davis, CA 95616 24 Hr. CL Report Friday, Ma 24, 2013 The time period of this report is from 7:00 a.rr1. (prim of?ce working day) to 7:00 a.m. (current of?ce working day} CONFIDENTIALITY NOTE 4 The documents accompanying this telecopy transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you PBS Front Line PRA Request?(201 3-2011 Incident Reports) 000225 FaHu'IJ'csE'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24Hr. CCL Report Thursday, May 30, 2013 The time period of this report is from 7:00 run. (prior of?ce working day) to 7:00 am. (current of?ce working day) Incident Report 802.06, (Reference'maozoe .Ranger RTP 05/29/13 Resource Center was not on campus to receive his 3 PM and 7 PM of medication. laminating; Repo?ing: Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 80205 (Reiercnee #:80205 Wm Emmn Ranger RTP 05/29/13 - Resource Center was not on campus to receive his 7 AM and 12 PM doses of medication. Rerrting; Julie Vice - Med Error - Missed Dose at FamiliesFirst Incident?eport 80207 (Reteme?tsozo7 ..I . Elan Ranger RTP 05/29/13 - Quiet Room A peer stated that he has watched his peer?s having sexual Intercourse. Ming; Adrian Mendoza Other Incident Report 8.0224 (Reference #480224 Wooden: anagram WW Sapphire RTP 05/29/13 - Resource Center was not on campus during 7 PM medication time frame. 3mm; Angela Lira - Med Error - Missed Dose at FamiliesFirst madam Report's: 30231 . (Reference #:80231 1 WM Brogan: Widen: Jade RTP 05/29/13 Resource Center was not on campus to receive her 7 PM medication. Therefore, she missed her 7 PM medication. mm mm; Angela Lira - Med Error - Missed Dose at FamiliesFirst CONFIDENTIALITY NOTE 1 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original BRAc?eqaes?Mrl 3-201 1 Incident Reports) 000226 t, Inc. 2100 Street, Dan's, CA 95616 24 Hr. CCL Report Thursday, May 30, 2013 The time period of this report is from 7:00 a.m. (prior of?ce working day) to 7:00 a.m. (current of?ce workng day) Incident Report a: 80230 (Reference #:sozso in i I i Brennan: Jade RTP 05/29/13 Resource Center indicated that she did not want to take her medication and even after several attempts and encouragement, she ec ed to refuse her 7 AM dose of medications. Noti?ed appropriate people. Inde?nite; Julie Vice - Med Error - Client Refused To Take Medication Incident Report it: 80225 (Reference #:8022 Emntam Sapphire RTP 05/29/13 Resource Center was not on campus, therefore she [hissed her 7 PM medication. Ming; Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident (Reference ?3:30:91. Went anagram We: WM Ranger DTP 05/29/13 - House le?: supervision by running off campus. Bene?ting; Claudia Vazquez - Long-Term Runaway Edgar Zamora Incident freezer.) I Reportinunmnsident Brennan Walden: immense: Ranger RTP 05/29/ 13 Resource Center was not on campus to receive his 3 PM and 7 PM medication. msidentnne: Mug; Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report at 30203 (Refgrenoe #189203) 4 mutant mm Ranger RTP 05/29/13 House was not on campus to receive his 7 AM dose or 12 PM medication. Noti?ed appropriate house supervisor, social worker, and - Reporting: Julie Vice - Med Error - Missed Dose at FamiliesFirst CONFIDENTIALITY NOTE 2 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original 3-201 1 Incident Reports) 000227 FannYiesFirst, Inc. 2100 Street, Dan's, C4 95616 24 Hr. CL Report Thursday, May 30, 2013 The time period of this report is from 7:00 rim. (prior of?ce working day) to 7:00 am. (current of?ce working day) Incident Report at: 80204:. (Reference #:80204) . MW Bantam WW minim; Ranger RTP 05/29/13 Quiet Room A peer stated that he has watched his peers having sexual intercourse. Reporting: Adrian Mendoza Other Incident? Repo'rtif: 80200; (nuisancesmso?oo P_r?29r_em WM Ranger RTP 05/29/13 Front of Campus continuously was running into traf?c and stating that he wanted to go get hit by a car. (19 min) gem Kyle Garlick - Law Enforcement Contact Team Prone Eduardo Villalobos - Restraint Standing Assisting; Imelda Davila - Accident/Injury to Staff Brett Atwood - Suicidal Ideation Other Other sacrum-t Riepor-t #:1301957 (Reference #380195) . I Wanna: Emsram Adventurer RTP 05/29/13 Quiet Room A peer stated that she has had sexual intercourse with him as other peers watched. 3312931119; Adrian Mendoza Other Incident Reportf#: 80238 (Reference mesa-as . . WW Brennan: WSW Pioneer RTP 05/27/13 - House called Pioneer House while he was assaulting her. Renaming; Kyle Garlick 0 - Assault/Aggression Other Incident Report sores #:aoiss anagram WW Pioneer RTP 05/29/13 House became extremely upset with a peer and began escalating. He began to hit his head with extreme force. He was also assau ve towards staff. min) CONFIDENTIALITY NOTE 3 The documents accompanying this telecop}r transmission may contain information that is confidential and/ or legally leV'llEged. 'lhe information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied infOrmation is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original qu?m? 3-201 1 Incident Reports) 000228 Fann'li'esFi'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Thursday, May 30, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 (current office working day) Repgging: Zorobabel Pruneda - Restraint Escort Assam Shamiya Ali 0 - Assault/Aggression Other Incident Report #:30219 (Reference #:80219 i Email: WW Voyager RTP 05/29/13 Quiet Room A peer stated that they had sexual intercourse and at time other peers watched. mm; Adrian Mendoza Other -- Incident Report-it": 80233- (Reterenca 49:30:33) WW anagram Jade RTP 05/29/13 Resource Center missed her 7 PM medication, due to not being on campus during this time. Insidentlm: Wing; Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report 80232 - (Reference #:80232 . ".lu.ll plan Jade RTP 05/29/13 Resource Center When I went to distribute medication to Jade House, I called ford- and was informed that she was not on campus. She did not return in time to take her 7 AM dose of medications. Noti?e appropriate people. Julie Vice - Med Error - Missed Dose at FamiliesFirst Incident Report it: 80234 (Rem-once #:80234 Jade RTP 05/29/13 Quiet Room stated several statements about having sex With her peer and other adults in the community. Also, how some of her peers watched her having sex. Adrian Mendoza Other Incident Report 3: 80198 (Reference #:soiso Dan-earthen llnu- n? Turbines. Drone-am "at. 9. Tim. ?5 Tnn??onO I unable-n a! You-Edna.- CONFIDENTIALITY NOTE 4 The documents accompanying this telccopy transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original ERAiEeqaasde?rl 3-2011 Incident Reports) 000229 Fam'lies?'rst, Inc. 2100 Fifth Street, D3 vis, CA 95616 24 Hr. CL Report Thursday, May 30, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 am. (current of?ce working day) Adventurer DTP 05/29/13 Bedroom #3 made a statement about havmg sexual contact With individuals from this campus, but was not speCIfic as to who. In Reporting: Islam Hassanein Other Incident Report 80189 (Reference #:80189 ?in i 2119:1111 Jaguars DTP 05/29/13 Classroom Erief Desgijpgign: had an unidenti?able ill on him in class. He also made statements when uestioned olice officers, that he ha a riend by the name ah in the community. She lives Wlth?. In PatrICia Button - Law Enforcement Contact am Imelda DaVila Other Other Incident Report 80193 (Reference #:80193 ELegLam Time of Incident Widen; Adventurer RTP 05/29/13 Resource Center was not on campus to receive his 3 PM and 7 PM medication. Reporting: Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 80192 (Reference #:80192 Adventurer RTP 05/29/13 Resource Center i was not on campus during distribution of 7 AM medications and did not return before the time in which he was able to ta the, had expired. Therefore, he did not take his 7 AM dose of medication. Incident Stg?; In 1 MT e: Reporting. Julie Vice - Med Error - Missed Dose at FamiliesFirst Incident Report 80194 (Reference #:80194 r?n 1' In i 2mm mm Adventurer RTP 05/29/13 Room A peer stated that they have had sexual intercourse and that she fears him, due to his temper. She also stated how he is phy5ically abusrve to others. _en_m_Incid e: Repgging- Adrian Mendoza Other CONFIDENTIALITY NOTE 5 The documents accompanying this transmission may contain Information that is con?dential and/or legally privileged. The information is intended only for the USC by the individual or entity names on this transmission sheet. lf you are not the intended recipient, you are hereby noti?ed that any disclosure, copying. distribution, or the takzng of any action in reliance on the contents of this telecopied information is strictly prohibited If you have received this Iclecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000230 FamiliesFirs I, Inc. 2100 Street, Davis, CA 95616 24 Hr. CL Report Thursday, Alay 30, 201.3 permd of this report ts {mm 70414.2? tut?ICC wurkmg day; tn 7 CO .I :(uxu'ili ufttu- dos" Incident Report 80209 (Reference #:80209 Emanm Ranger DTP 05/29/13 04 00PM House made threats to hort another peer and pushed Into staff, therefore he was escorted to the house Qwet Roam to keep ourse was and another citent safe. (5 mm) Etrcn Sanchez-Delgado - Restraint Escort Ryan Banks 0 - Assault/Aggressnon Qutet Room Incident Report 80237 (Reterence #:80237 Ranger RTP 05/25/13 04 15PM Front of Campus returned from a runaway and stated that a peer had burned him repeatedly a lighter. - ran away wtthuut supermsuon agam. Marcos Almelda - Law Enforcement Contact Assisting Andrea Chtles - Long-Term Runaway - Accudcnt/lnjury to Chuid - Susptaon of Abuse - Child to chuld Other Incident Report at: 80208 (Reference #:80208 2mm Ranger DTP 05/29/13 - 03 30PM House was throwmg toys around the house, attempting to tun out of the house. When physucaily detemng he pus ed staff outSIde, therefore he was esc0rted to the Qwet Room. (13 mm) Ryan Banks - Restraint Escort Efren Sanchez-Delgado - Accudent/Injury to Room Claudia Vazquez - Assault/Aggressmn Incident Report 80227 (Reference #:80227 Emmi: Jade DTP 05/29/13 03.00PM Off/On Campus left and returned to campus and gave statements Patnck Oleson-Wheeier - Long-Term Runaway - Suncndal Ideatlon Incident Report 80228 (Reference #:80228 Donne-Nun ?0 .- 73m. A. I 00-anue n6 Vac-5A-". CONFIDENTIALITY NOTE 6 'l'hr durumt'nt: .trcompanymg may runtam that ts rnn?dt'ntial .md/ut prtx'iltgt~ti. 111C. mfmnuttun Is illic?dt?d only for the use by the ur natntw tm transmissmn sheet. If you are the Intended you an: hereby noti?ed that out disclmuw, taming. or iht? taking of any tn nn fht? of ts strictly PIOhith?l'. It you have It'ccivct] this lulu-copy crtut. plexu- noltfy us by so that can arrangt fur the return of documents to us at no rust yuu. 'l'hunk yutt. PBS Front Line PRA Request (2013-2011 Incident Reports) 000231 Fann'liesEr-st, Inc. 2100 Fifth Street, Data's, CA 95616 24 Hr. CCL Report Thursday, May 30, 2013 The time period of this report is from 7:00 a.m. (prior of?ce working day) to 7:00 a.m. (current of?ce working day) Jade RTP 05/25/13 Living Room made a statement about a staff. 105W 11M 0" e: Patricia Button Other Incident Report: a: 30229 (Reference means .) Jade RTP 05/29/13 Resource Center did not take her 7 PM medication due to possiny being under the in?uence. Reggm'gg: Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Assisting: Patrick Oleson-Wheeler Incident Report it: 80225 (Reference #:8022?6 1-. I. Elan II . . Jade RTP 05/29/13 Resource Center missed her 7 AM dose of medication, due to not being on campus during this time. Incidemm?. Insulating: Julie Vice - Med Error - Missed Dose at FamiliesFirst Incident Report 86235 i . I. DIED [I'll I I. Jade RTP 05/26/13 Living Room made a statement about staff and then punched peer in the nose with a closed ?st. Patricia Button 0 - Assault/Aggressio Other Incident Reports: 80236 (Reference #:80236 . BMW anagram Jade RTP 05/29/13 Resource Center - When I went to Jade House to distribute medications, I called- to take her medications and she told Erin that she was not coming to get them, because she was too tired. Several attempts and noti?cations made. Maritime. 352mm; Julie Vice - Med Error - Client Refused To Take Medication Erin Milligan Incident Report at: 80221 (Reference CONFIDENTIALITY NOTE 7 The accompanying this tclecopy transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmissmn sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original 3-2011 Incident Reports) 000232 Familieerst, Inc. 2100 Fifth Street, Data's, CA 95616 24 Hr. CL Report Thursday, May 30, 2013 The time period of this report is from 7:00 a.m. (prior office working day) to 7:00 am. (current of?ce working day) Sapphire DTP 05/29/13 Front of Jade House became assaultive by pushing staff into a door. (43 min) Witnessing; Felicia Thomas - Restraint Team Prone Reporting; Aaron Alston - Suicidal Ideation Standing Assisting: Marcos Almeida - Assault/Aggression Assisting: Nicholas O'Dowd Other Incident Report 80222" (Reference#:80222 Sapphire DTP 05/29/13 NPS Quiet Room pushed into me and spit on Dave and then continued to attempt to assault me. (55 min) Witnessing: Ashley McLemore - Restraint Quiet Room Felicia Thomas - Assault/Aggression Quiet Room mam; Annette Carbone Ammo; Dave Clark Andrew Enright Incident Report macros (Reference #:80196 Adventurer DTP 05/29/ 13 Front Porch left supervision after having to do time on the front porch and not being able to get a fruit. Miriam Adrian Mendoza - Long-Term Runaway "mm #:2501519: -- ammonia: amount WM Adventurer RTP 05/29/13 Resource Center was not on campus to receive his 7 PM medication. Reporting; Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report #2 80218 (Reference #:80218 I. .II El In .ll Voyager RTP 05/29/13 Front of Campus was contained after repeatedly and forcefully punching me in the face with a closed ?st. (26 min) \Alifnneeinn- have Plan-Ir .. Dart-rain? Cot-n.4- CONFIDENTIALITY NOTE 8 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original 3-2011 Incident Reports) 000233 Famjll'esE'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Thursday, May 30, 2013 The time period of this report is from 7:00 run. [prior of?ce working day) to 7:00 rim. (current of?ce working Clay) John (Nick) Mon?ana 0 - Accident/Injury to Child Team Prone Marcos Almeida - Assault/Aggression Standing Incident Report #2 80239 (Reference #2an I. l! i! I . I Voyager DTP 05/28/13 5th Street Brief Description: Shortly after entering the house after school, lel?t supervision of staff off campus and continued down 5th Street. Multiple attempts to tie-escalate, but was not success I. Witnessing: Nicholas O'Dowd - Long-Term Runaway mm; Dan'us Randall Incident Report is: @0214 (Reference #:802142) . WM Brennan: We: Voyager RTP 05/29/13 - Resource Center Winn; After several attempts, - refused his 7 PM medication. Angela Lira - Med Error - Client Refused To Take Medication incident mm 80211 (same; menu WM Voyager RTP 05/29/ 13 Resource Center When I was distributing 7 AM medication! was not on?campus during the time frame he could take his 7 AM dose of medication. Several attempts were made an appropriate people noti?ed. Incident?tam Insulating; Banning; Julie Vice - Med Error - Client Refused To Take Medication Incident import it: 392167 (nerorenge. meme WW anagram Went Voyager RTP 05/29/13 Quiet Room A peer made a statement that- watched her having sexual intercourse. Incident?tam maximums: Reporting; Adrian Mendoza Other o? - Incident Report ?it: 80220 Reference #180220 WW 2mm Sapphire RTP 05/29/13 Resource Center was not on campus to receive her 3 PM medication. CONFIDENTIALITY NOTE 9 The documents accompanying this telecopy transmission may contain information that is con?dential and or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this tclecopied information is strictly prohibited. If you have received this telecopy in error, please notify us by tclE?h?me immediately so that we can arran for the return of the ori $3131 I mill-in?gmt?g?u??hxg?? -2011 Incident Regg?lts) 000234 Families?'rst, Inc. 2100 Street, Davis, CA 95616 24 Hr. CL Report Thursday, May 30, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 am. (current of?ce working day) Kenning; Angela Lira - Med Error - Missed Dose at FamiliesFirst CONFIDENTIALITY NOTE 10 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original ?86!va macadath 3-201 1 Incident Reports) 000235 Familics?'rs t, Inc. 2100 Fifth Sweet, Davis, CA 95616 24 Hr. CL Report Friday, May 31, 2013 The time period of this report is from 7:00 3 mi (prior office working day) to 7:00 am. @urrent office working day) Incident Report 80247 (Reference #:80247 Id Wooden: Ranger DTP 05/30/13 House/Front of Campus ran out to the front of campus; due to his recent history of out into the community, we prevented him from eavmg campus and escorted him to the Quiet Room. (16 min) witnessing: Lanai O'Brlan - Restraint Escort Efren Sanchez-Delgado - Assault/Aggression Qunet Room Other Incident Report 80264 (Reference #:80264 WW mum WW Ranger RTP 05/30/13 Resource Center was not on campus to receive his 7 PM medication. meme. . Reporting; Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incldent Report it: 80269 (Reterence #:80269 2mm Mum In I Jade RTP 05/30/13 Resource Center After several separate attempts, - refused her 7 PM medication. Reporting: Andrea Chlles - Med Error - Client Refused To Take Medication Incident Report 80257 (Reference #:80257 Wm 2mm MW Jade RTP 05/30/13 Resource Center I was not on campus to receive her 7 AM medication and had not returned in time to take her 7 AM dose of medications. oti?ed appropriate people. 33mm Julie Vice - Med Error - Missed Dose at FamiliesFirst Incident Report 80255 (Reference #:80255 89W Emmi: Sapphire DTP 05/30/13 House CONFIDENTIALITY NOTE 1 'lhe documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally The information is intended only for the use by the indivxdual or entity names on this transmission sheet. if you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or the taking of any action in reliance on the contents oftlus telecopicd information is strictly prohibited. if you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you 'lhank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000236 Familieers I, Inc. 2100 Fifth Street, Dz w's, CA 95616 24 Hr. CL Report Friday, May 31, 2013 The time period of this report is from 7:00 .i.m (prior of?ce working day) to 7:00 a.m. (current of?ce working day) packed her bags and started to leave campus. Staff attempted to convince her to stay, but- left and staff couldn adow because of the lack of staf?ng. Immune: Annette Carbone - Long-Term Runaway Wing; Aaron Alston Incident Report 80267 (Reference #:80267 Wat Emmi: Window: Sapphire RTP 05/30/13 Resource Center was not on campus, therefore she missed her 7 PM medication. Incident?a?. Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 80265 (Reference #180265 Bmdinn?niuunsinent Emma: Winn: Ranger RTP 05/30/ 13 - Resource Center was not on campus to receive his 7 PM medication. mum; Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 80243 (Reference #:80243 2mm Widen: Adventurer RTP 05/30/13 House left campus supervision. Bengt-313g; Rachel Fader - Long-Term Runaway Assisting: Sule Anlbaba Incident Report 80261 (Reference #:80261 Emmott: Winn: Adventurer RTP 05/30/13 Resource Center missed his 7 PM medication, due to not being on campus during this time. Incldent?a?. Andrea Chlles - Med Error - Missed Dose at FamiliesFirst Incident Report 80242 (Reference #:80242 2mm Adventurer RTP 05/30/13 Resource Center CONFIDENTIALITY NOTE 2 The documents accompanying this telecopy transmission may contain information that is confidential and/ or legally The information is only for the use by the indiwdual or entity names on this txansmissron sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited, If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you PBS Front Line PRA Request (2013-2011 Incident Reports) 000237 FamiliesE'rs t, Inc. 2100 Fifth Street, Dan's, CA 95616 24 Hr. CL Report Fu'da y, May 31, 2013 The time period of this report is from 7:00 mm. {prior of?ce working day) to 7:00 u.m. (current of?ce working day) refused his 7 AM dose of medication, because he was "too tired" to get up. He had been off campus most of the rug t. Noti?ed appropriate people. Incident?a?; Julie Vice - Med Error - Client Refused To Take Medication Incident Report 80246 (Reference #:80246 Widens 2mm Pioneer DTP 05/30/13 House assaulted staff, threw himself against the wall with force. (14 min) Felicia Thomas - Restraint Standing Anthony Aispuro-Sanchez - Assault/Aggression Other Incident Report 80270 (Reference #:80270 MW WW Jade RTP 05/30/13 Resource Center missed her 7 PM medication, due to not being on campus during this time. InsidentSte?. mounting; Andrea Chiles - Med Error Missed Dose at FamiliesFirst Incident Report 80258 (Reference #:80258 Wooden: 2mm Jade RTP 05/30/13 - Resource Center When I distributed medication to Jade House, I called- to take her medication and she told Erin that she was refusing. Several attempts were made and appropriate people were notified. Emmy; Julie Vice - Med Error - Client Refused To Take Medication Assisting; Erin Milligan Incident Report 80262 (Reference #:80262 Adventurer RTP 05/30/13 - Resource Center was not on campus to receive his 3 PM and 7 PM medication. Reporting; Andrea Chiles - Med Error - Missed Dose at FamiliesFirst CONFIDENTIALITY NOTE 3 The documents accompanying this transmuision may Contain information that is con?dential and/ or legally privileged. The information is Intended only for the use by the indiVidual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you PBS Front Line PRA Request (2013-2011 Incident Reports) 000238 Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Friday, Ma 31, 2013 The time period of this report is from 7:00 a.m. (prior of?ce working day) to 7:00 a.tn. (current other: working day) Incident Report 80244 (Reference #:80244 Eastern Widens Magnesium: Adventurer RTP 05/30/13 Resource Center WI went to Adventurer House to distribute 7 AM medications. I called for his medications and he refused to get up and take his medications. I attempted to encourage him several times. refused his 7 AM medication. Julie Vice - Med Error - Client Refused To Take Medication Incident Report 80271 (Reference #:80271 Jade RTP 05/30/ 13 - Resource Center missed her 7 PM medication, due to not being on campus during this time. Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 80273 (Reference #:80273 I. . . Jade RTP 05/30/13 - Resource Center missed her 7 PM medication, due to not being on campus during this time. modem Insulating; Remus]; Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 80259 (Reference #:80259 ?reman: Was-liens Jade RTP 05/30/13 Resource Center When I went to Jade House to distribute medications, I called to take her medications and she told Erin that she was not coming to take them, because she was too tired. Severe attempts and noti?cations were made. Julie Vice - Med Error - Client Refused To Take Medication Assisting: Erin Milligan Incident Report 80256 (Reference #:80256 anagram Wu: Sapphire RTP 05/30/13 - Side of Field lunged at me and attempted to put her hands on my neck. (35 min) Varied-n5 anldoni Tunas nacho-inf Tun-- CONFIDENTIALITY NOTE 4 The documents accompanying this transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this sheet. If you are not the intended recipient. you are hereby noti?ed that any disclosure, copying, disuibuuon, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. lfyou have received this in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000239 Famz'lr'esFirst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Friday, May 31, 2013 The time period of this report is from 7:00 am. (prior of?tc wot king day) to 7:00 am. (current office working clay) 33mm Annette Carbone - Restraint Team Prone Dave Clark 0 - Assault/Aggression Standing Aaron Alston Incident Report 80245 (Reference #:80245 2mm Adventurer DTP 05/30/13 Front of Campus walked out of his room without permission and sat on the porch for a few minutes. After seeing a peer off task, he fol owe and ran off campus at 3:53 PM. Bryce Lumbard - Long-Term Runaway Brian Blanco Liming; Sule Anibaba Incident Report 80263 (Reference #:80263 WW Brennan: MAW Went Adventurer RTP 05/30/ 13 Resource Center was not on campus to receive his 7 PM medication. Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 80250 (Reference #:80250 2mm Wm Voyager DTP 05/30/13 - House left with his bag packed and ran around campus for a bit, before leaving campus. Kyle Garlick - Long-Term Runaway Logan Hess Incident Report 80266 (Reference #:80266 _i;eg_e__P in Voyager RTP 05/30/13 Resource Center was not on campus to receive his 7 PM medication. Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 80248 (Reference #:30248 Widen: 2mm Written: Voyager RTP 05/30/ 13 Resource Center CONFIDENTIALITY NOTE 5 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000240 FanliliesFirst, Inc. 2100F1'fth Street, Davis, CA 95616 24 Hr. CL Report Fn'da y, Ma 31, 2013 The time period of this report is from 7:00 v.1.ml (prior of?ce working day) to 7:00 aLmi (current of?ce working day) When I was distributing 7 AM medications,- was not on campus during the time frame he could take his 7 AM dose of medication. Several attempts were made and appropriate people were noti?ed. Renaming; Julie Vice - Med Error - Client Refused To Take Medication Incident Report 80254 (Reference #:80254 Bantam Sapphire DTP 05/30/13 Front of Campus - was outside not following staff directions and noticed a peer running off of campus, so she decided to join her peer and run 0 campus. Beaming; Aaron Alston - Long-Term Runaway Incident Report 80268 (Reference #:80268 Bantam MW Sapphire RTP 05/30/13 Resource Center was not on campus to receive his 7 PM medication. Andrea Chiles - Med Error - Missed Dose at FamiliesFirst CONFIDENTIALITY NOTE 6 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000241 0 LI.- Inc. 2100 Street, Davis, CA 95616 24 Hr. CL Report Monday, farm 03, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 am. (current of?ce working day) Incident ?Report 80293 (Reference #:30293 MW Eastern Wu: Voyager RTP 05/31/13 Voyager House began to wander around the house and wipe away boards and throw objects. This escalated to assaulting staff with lC and punches, and climbing on coutners to assault, leading to containment. remrting: Logan Hess - Restraint Team Prone Marcos Almeida Team Prone mm; Eric Benoit Oscar Lopez Incident Report 80276 (Reference #:80276 Widen: Weldon: Jade RTP 05/31/13 Jade House left campus and staff supervision from Jade House. Theresa Murchison - Long-Term Runaway Assisting; Eduardo Villalobos Incident Report 80291 (Reference #:80291 i Voyager RTP 05/31/13 Resource Center refused to wake up and take his 7am medication. Several attempts were made. Appropriate people were noti?ed. Indium Insidentlue. [em Julie Vice - Med Error - Client Refused To Take Medication -) Incident Report 80289 (Reference #:80289 Ranger RTP 08/31/13 Resource Center was in class but refused to wake up to take his 12pm medication. I attempted to wake him up several times and each time he stated that he was not taking his medication.Noti?ed appropraite house supervisor, social worker, and Incidentjn?: Incidentlitnei Mug; Julie Vice - Med Error - Client Refused To Take Medication CONFIDENTIALITY NOTE 1 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. if you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. lfyou have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original emacm Reqileslt x201 3-201 1 Incident Reports) 000242 Fan??cerst, Inc. 2100 Street, Davis, CA 95616 24 Ht. CL Report Monday, lune 03, 2013 The time period of this report is from 7:00 a.rn. (prior of?ce Working day) to 7:00 a.m. (current office working day) Incident Report 80282 ?(Reference #:80282 WM mini mum Adventurer RTP 05/31/13 Adventurer A peer stated that- had sexual intercourse with a gin while off of campus. Police contact. Incidentita?: Beaming; Brooke Piasecki - Law Enforcement Contact - Suspicion of Abuse - child to child Incident Report 80281 (Reference #:80281 33W Emmi: Wooden: Adventurer RTP 05/31/ 13 Adventurer was not on campus to take his 7am medications and was unwilling to take his medication when he returned. Several attempts made. Noti?ed appropriate people. Julie Vice - Med Error - Missed Dose at FamiliesFirst Incident Report 80283 (Reference #:80283) MW Brennan: WW Adventurer RTP 05/31/ 13 Basketball Court was riding a skateboard and when a peer approached him, she ran off campus and he followed after her on his skate oard. InsidenLSIa?: Ming; Whitney Shettler - Long-Term Runaway Assisting: Johnny Incident Report 80290 (Reference #:20290 4 Trailblazer RTP 05/31/ 13 Resource Center le? on his home visit without taking his 3pm medication. reporting; Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incldent Report 80287 (Reference #:80281) anagram Wm Adventurer RTP 05/31/ 13 - Resource Center missed his 7pm medication, due to not being on campus during this time. mm mm remixing; Andrea Chiies - Med Error - Missed Dose at FamiliesFirst CONFIDENTIALITY NOTE 2 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this in error, please notify us by telephone immediately so that we can arrange for the return of the original ninecPRA Midwest 3-201 1 Incident Reports) 000243 FamiliesE'rst, Inc. r?q? N) 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Monday, lune 03, 2013 'lhe time period of this report is from 7:00 am. (prior of?ce Working day) to 7:00 a.m. (current office working day) Incident Report 80286 (Reference #:80286 Adventurer RTP 05/31/13 Resource Center missed his noon dose of medication, due to not being on campus during this time. Insulating. Lemming; Julie Vice - Med Error - Missed Dose at FamiliesFirst Assisting; Imelda Davila Incident Report 80285 (Referenoer#:80285 Winn: mam Adventurer RTP 05/31/13 Resource Center was not on campus to receive his 3pm and 7pm medication. momma. Repomng: Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report it: 80-284 (Reference #:80284 DIEI. . Adventurer RTP 05/31/13 Resource Center was not on campus during the distribution of 7am medications and did not return before the time in which he was able to take them had expired. Therefore he did not take his 7am dose of medication. Incidentlimei 3m Julie Vice - Med Error - Missed Dose at FamiliesFirst -) Incident'Report- 80275 (Reference #:30275 . Jade RTP 05/30/13 Jade House I evaded- swinging her closed ?st punches. - continued to come towards me swinging her ?st toward my face. I could no longer evade. Zach and I inititated an escort. Renaming; Eduardo Villalobos - Restraint Escart Zachariah Fromm - Assault/Aggression Incident Report 80292 (Reference #:80292 WW Emram Widen: Voyager RTP 05/31/13 Resource Center Wig]; When I was distributing 7am medications,-was sleeping and refused to wake up to take his medications. Several attempts were made and appropriate people were noti?ed. CONFIDENTIALITY NOTE 3 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original departments Itinech Re?ll-39! (Q01 3-201 1 Incident Reports) 000244 Fanu'lz'cerst, Inc._ 2100 Fifth Street, Davis, CA 95616 24 Hr. CCL Report Monday, junc 03, 2013 The umc period of this report is from 7:00 am. (prior of?ce working day) to 7:00 am. (current of?ce Working day) mugging; Julie Vice - Med Error - Client Refused To Take Medication CONFIDENTIALITY NOTE 4 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. I you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original domnmm L'il??ecm wedded! $201 3-201 1 Incident Reports) 000245 Farm'IiesE'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CCL Report Tuesday, lune 04, 2013 The. time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 a.m. (current of?ce working day) Incident Report 80323 (Reference #:80323 WM Widens Adventurer RTP 06/02/13 Resource Center was not on campus to receive his 7 AM and 7 PM medication. Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report it: 80377 (Reference #:80377 WEI W01 W03 Adventurer RTP 06/03/13 House W. Aw0Led. Reporting; Antonio Galvan - Long-Term Runaway Incident Report 80378 (Reference #:80378) W0: Brogan: WM Adventurer RTP 06/03/13 Resource Center was not on campus to receive his 7 AM and 7 PM medication. Repo?ing; Angela Ura - Med Error - Missed Dose at FamiliesFirst - Incident Report:#: 80358 (Reference #:80358 Wm Emeram WM Adventurer RTP 06/02/13 Off Campus left superwsion off of campus. Ming; Patrick Oleson-Wheeler - Long-Term Runaway Incident Report #1 80357 Widen: 2mm WW Jade RTP 06/02/13 Resource Center missed her medications due to not being on campus during this time. Reporting; Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report 80409 (Reference-#50409 Emma: WW Jade RTP 06/02/13 EMQFF CONFIDENTIALITY NOTE The documents aCCompanying this telecopy transmission may contain information that is con?dential and/ or legally The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this in error, please notify us by telephone immediately so that we can arrange for the rcturn of the original 3-2011 Incident Reports) 000246 FainI'IJ'esE'rs I, Inc. 2100 Street, Davis, CA 95616 24 Hr. CL Report Tuesday fume 04, 2013 The time period of this report is from 7:00 (prior of?ce working day) to 7:00 a.m. (current of?ce working day) left supervision off campus. mummies; reporting: Eric Benoit - Long-Term Runaway assisting: Patrick Oleson-Wheeler Incident (Reference #:80373 plan . Jade RTP 06/03/13 Jaguar's Classroom made statements regarding peers and their activities while off campus this last weekend. Peers involved -, and Mitt. Reporting: Imelda Davila Other madam Report at: 80367 (Reference #30307 a Emma WM Trailblazer RTP 06/03/13 Jaguar?s Classroom made statements -, -, and while at play?elds this weekend. modem Rggorting; Imelda Davila Other Incident Report #00310. Emma: Wu: Ranger RTP 06/01/13 - Front of Campus was sitting at the benches by the basketball courts, exchanged negative words with a peer and I was unable to physica eter him from running off campus, so he did. Watt: mm Reporting; Rachel Fader - Long-Term Runaway Assiging: Marcos Almeida Incident Report it: 90335 (Reference #:80335 Emnm WW Ranger DTP 06/02/ 13 Resource Center was not on campus to receive his medication. mm mm Reporting: Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report it: 80390 (Reference #:80390 W03 Emeram Wm Ranger RTP 06/03/ 13 - Resource Center CONFIDENTIALITY NOTE 2 The documents accompanying this telecopy transmission may contain inibrmation that is con?dential and/ or legally privileged. The information is intended only {or the use by the individual or entity names on this transmission sheet. If you are not the intended recipient. you are hereby notified that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telceopicd information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original . . . 3-2011 Incident Reports) 000247 FamiliesFirst, Inc. 2100 Fifth Smear, Davis, CA 95616 24 Hr. CL Report Tuesday, lune 04, 2013 The time period of this report is from 7:00 a.rn. (prior of?ce working day) to 7:00 a.m. (current of?ce working day) was not on campus to receive his 7pm medicationAngela Lira - Med Error - Missed Dose at FamiliesFirst Incident (Reform #:80389- BMW 2mm Wm: Widens Ranger RTP 06/03/13 Off campus - Covel Blvd. Wm made multiple statements of events that occurred on his runaway and also stated that his peer - showed him his Dic mama; Islam Hassanein Other John (Nick) Moriana Incident Report #:00312 Widens Emnm Wander]: Wm Adventurer RTP 06/01/13 House became frustrated when more clients from Voyager came to Adventurer. He left the house without permission and left campus with a peer, going west on 5th Street. Reporting: Brian Blanco - Long-Term Runaway 555mm; Rachel Fader Andrea Chiles Incldont?eport s: @321 (Reference #:80321- Widens anagram Adventurer RTP 06/02/ 13 Living Room came out of his room and left the house. Adrian Mendoza - Long-Term Runaway Rachel Fader (mromremoszz RENEW 2mm Adventurer RTP 06/02/ 13 Resource Center was not on campus to receive his medication. mm mm Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Reportah 80379 (Reference #:80379 WW anagram WEEDS Adventurer RTP 06/03/ 13 Resource Center was not on campus to receive his 3 PM and 7 PM medication. CONFIDENTIALITY NOTE 3 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original dDle?omLinvP?AtqutiBsth 3-2011 Incident Reports) 000248 FamiliesE'r-st, Inc. 2100171121: Street, Dan's, CA 95616 24 Hr. CL Report Tuesday, June 04, 2013 The time period of this report is from 7:00 am. (prior office working day) to 7:00 a.m. (current of?ce working day) Incidentm Insulating. gm Angela Lira - Med Error - Missed Dose at FamiliesFirst Incldont Report #2 30295 (Reference #:sozss . Emmn WW LEW Voyager DTP 05/31/13 House wandered to the living room and tore down the wand for the blinds, hitting the W, and eventually staff with it. He tried to pull us onto the couches and onto the ?oor; leading to containment. (26 min) Noel Salazar - Restraint Team Prone Felicia Thomas - Assault/Aggression Team Prone Logan Hess Eric Benoit Matthew Brown Inddent?lteport #:80392 Widen: Emeram Wm Madden: Voyager RTP 06/03/13 Voyager Emma; Nicholas O'Dowd - Restraint Team Prone Assisting; John (Nick) Moriana 0 - Assault/Aggression Kristan Warren Other a_ss_i??mg; Darius Randall assisting; Dean Valencia Incident ReporttitrBOBSZ Sapphire RTP 06/02/13 Resource Center was not on campus during 7 AM ad 7 PM medication time frame. Bending; Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report it: 80399 (Reference #:80399 Emram Sapphire DTP 06/03/13 Front of campus left staff's supervision and ranaway from campus. gagging; Ashley McLemore - Long-Term Runaway Incident Report at: 80406 (Reference menace CONFIDENTIALITY NOTE 4 The documents accompanying this telecopy transmission may contain information that is confidential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original 3-2011 Incident Reports) 000249 FamiliesE'rst, Inc. 2100 Street, Davis, CA 95616 24 Hr. CL Report Tuesday, june 04, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 am. (current office working day) ni In Widen; Sapphire RTP 06/03/13 Resource Center was not on campus during 7pm medication time frame. Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report-1.9: 80332 (Reference #:80332 Brennan: LEW Pioneer RTP 06/02/13 House made statements about killing staff and peers with a knife and killing himself. 10mm 10mm; Bending; Adriana Escobar Other Incident Report it: 89310? (Reference #380810 )1 Emma: WM Jade DTP 05/31/13 Resource Center was not on campus to receive her 7 PM medication. Therefore, she missed her 7 PM medication. Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report at: 80362 WW Widens Jade RTP 06/02/13 Resource Center was not on campus to receive her 7 AM and 7 PM medication. Indium mm Renaming; Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident-Report #:2813303. (Re?nance Widens: Emram 2333mm Jade RTP 06/02/13 Off Campus left supervision off of campus. Remus]; Patrick Oleson-Wheeler - Long-Term Runaway Adrian Mendoza Incident Rep'ort'a?t: 80404 (Reference #:80404) anagram Widen: Jade RTP 06/03/ 13 Resource Center was not on campus to receive her 7pm medication. CONFIDENTIALITY NOTE 5 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally The information is intended only for the use by the individual or entity names on this transmisston sheet. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telccopied information is strictly prohibited. If you have received this in error, please notify hone immediately so that we can arran for the return of the or ial -2011 Incident Regions) 000250 Farm'IiesFit-s I, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Tuesday, lune 04, 2013 Thy timc of this rr-pnrt is from 7:00 am. (prior of?ce Working day) to 7:00 am. (current ot'licc working day) Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report 80348 (Reference #:80348 'n Emmi) w?m In i Wow Voyager RTP 06/02/13 - Resource Center was not on campus to receive his 7 PM medication. nci ff: mm Reporting: Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report 80350 (Reference #:80350 Emmi: WW Incident Voyager RTP 06/02/13 07-46PM House/5th Street ?rtgf left staff and was gone for over 4 hours. [geportingz Islam Hassanem - Long-Term Runaway A55isting: Adrian Mendoza Incident Report 80396 (Reference #:80396 manna mm or In ident Voyager RTP 06/03/13 07.00PM Resource Center was not on campus to receive his 7pm medication. reporting Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report 80304 (Reference #:80304 In Emma: Wm WM Sapphire RTP 05/31/13 01.30PM House A peer stated that- had sexual intercourse With a boy while off campus. Police contacted. 339mm Brooke Piasecki 5 Suspucnon of Abuse - child to child Incident Report 80318 (Reference #:80318 Emmi: Sapphire RTP 06/01/13 Back Bedroom reported to me that when she was oft campus on an AWOL, her peer forced her to have sex. COQW- Yuridon? Tun.- CONFIDENTIALITY NOTE 6 The dot. accompanying this transmission may contain information that is con?dential and/or log-ally 'l'ht- information is intended mil) tor the: usc by the mdivtdual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying. distribution, or the taking of any action in i'cliancc on the contents of this information is strictly prohibited. If you hth~ this ti-lccopy in {-rror? please notify us by immediately so that we can nrrangc for the return of the origin-.11 documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000251 FamiliesFirst, Inc. 2100 Fifth Street, D2 w's, CA 95616 24 Hr. CL Report Tuesday, june 04, 2013 The iimi period of this rtpori is from 7:00 a.m. (prim of?cc working day) to 7:00 (Clix rent working day) Repomng' Annette Carbone - SuspICIon of Abuse - child to child Incident Report 80329 (Reference #:80329 i Emma: Dates?W In Ranger RTP 06/02/13 Outside was Sitting outSide f0r a couple of hours until he ran off campus. __?_t?_1ncid aff: M1191: Reporting: Adrian Mendoza - Law Enforcement Contact Assisting: John (Nick) Moriana Assisting: [slam Hassanein Am Claudia Vazquez Incident Report 80328 (Reference #:80328 Bengging Unit of Incident Date 8: Time of Incident Ranger RTP 06/02/13 07 00AM Resource Center was not on campus to receive his medication. Reporting: Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report 80391 (Reference #:80391 Bantam Tim 1' In i Ranger RTP 06/03/13 O3 00PM resource Center was not on campus to receive his 3pm and 7pm medication. ide Incident Tyne: reporting: Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report 80327 (Reference #:80327 Adventurer RTP 06/02/13 Resource Center missed his 7 PM medication, due to not being on campus during this time. Incident Staff: Incident Type: Reporting. Angela Lira - Med ErrOr - Missed Dose at FamiliesFirst Incident Report 80384 (Reference #:80384 We: Emma: Went Adventurer DTP 06/03/13 05.44PM Bedroom Child became assaultive which at that pomt we initiated a standing. Tad-Edna. Inc-Edna. Terna- CONFIDENTIALITY NOTE 7 The accompanying this may Contain information that is confidential and/or legally privileged. The information is illtt?lltlul only for the use by the individual or cntiry names on this transmission Slit'l'l If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on contents of this information is. strictly. prohibited. lfynu have this tilt-copy in error, please notify us by teleplionc immediately so that we can arrangc for the return of the original documents to us at no Cost to you. 'l'hcmk you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000252 FamilicsE'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Tuesday, june 04, 2013 The time period of this report is from 7:00 a.m. (prior working day) to 7:00 a.m. (current of?ce working day) Reporting: Adrian Mendoza - Restraint Assisting; Islam Hassanein - Assault/Aggression Incident Report 80385 (Reference #:80385 WW 2mm: Wm Adventurer RTP 06/03/13 2nd Bedroom made several allegations about his peers. CRC and Clinical on-call were notified. Mumps; gem; Islam Hassaneln Other Adrian Mendoza Incident Report 8,0387 (Reference #:80387 Adventurer RTP 06/03/13 Resource Center missed his 7pm medication, due to not being on campus during this time. reporting; Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report 80368 (Reference #390358 WNW Emam Adventurer RTP 06/03/ 13 - Jaguar's Classroom made statements regarding and while at playiields this weekend. Imelda Davila Other -- Incldent- Reports: 80335; (Reference memo I . . . Wu: Emmi: Wanna: Trailblazer RTP 06/02/13 Resource Center - stayed on his home visit longer then expected and his medication was not prepped appropriately and medication doses. InsidonLSh?. Reporting; Angela Lira - Med Error - Missed Dose at Home Incident Report 80337 (Reference macaw WW 2mm MW Trailblazer RTP 06/02/ 13 Resource Center - stayed longer on a home visit than expected and his medication was not prepped appropriately and medication doses. He returned with more medlcation than he should have. CONFIDENTIALITY NOTE 8 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone Immediately so that we can arrange for the return of the original W?ontminw?mtkoqt?s?m 3-2011 Incident Reports) 000253 FamiliesFirs t, Inc. 2100 Street, Dan's, CA 95616 24 Hr. CL Report Tuesday. june 04, 2013 The time period of this report is from 7:00 1m. (prior office working day) to 7:00 a.m. (current office working day) Angela Lira - Med Error - Missed Dose at Home Incident, apartments? (Reference #:esosoo . Emmi: Wmuunsidm Wm Jade RTP 05/31/13 - House stated that two of her peers had sexual intercourse while off of campus. Brooke Piasecki - Suspicion of Abuse - child to child Incident Report #189307 (Reference #:80307 WW 2mm Widens Jade RTP 05/31/ 13 Resource Center missed her 7 PM medication, due to not being on campus during this time. Insident?a?: mum Banning; Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Went-Riv?wejmbt' 9 WW Bantam Wilt Jade RTP 05/31/13 Resource Center When I went to distribute medication to Jade House, I called for! and was informed that she was not on campus. She did not return in time to take her 7 AM dose of medicatioins. Noti?e appropriate people. Incident?n?. Reporting; Julie Vice - Med Error - Missed Dose at FamiliesFirst Incident Report it: 80359 (Refer-one. #:80359?) Jade RTP 06/02/13 Resource Center missed her 7 AM and 7 PM medication, due to not being on campus during this time. Repgging: Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report a: 80360 (Reference #:soaeo. ?rearm WM Jade RTP 06/02/13 on Campus left supervision off of campus. Patrick Oleson-Wheeler - Long-Term Runaway Incident We: sows (neurone. #:sms) D-nnr?lnn Ila? a. Duran-I?m nan.- In ?In- Yul-Edna.- I Ina-.680? a. in?ll-n. CONFIDENTIALITY NOTE 9 The documents accompanying this tclecopy transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the rctum of the original 3-2011 Incident Reports) 000254 Fanat'lz'eerst, Inc, 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Tuesday, june 04, 201.3 'lhe time period of this report is from 7:00 am. (prior office working day) to 7:00 a.m. (current of?ce working day) Jade RTP 06/03/13 Resource Center missed her 7pm medication, due to not being on campus during this time. Insident?ta?. mooning; Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report it: 80326 (Reference #:80326 WW Emram We: Adventurer RTP 06/02/13 Resource Center was not on campus to receive his 7 PM, and 7 PM medication. mpg; Angela Lira - Med Error - Missed Dose at FamiliesFirst incident Import at: 80375 (Reference #:80376 WW anagram Wanna: Adventurer RTP 06/03/13 Bedroom #3 Wagon; made statements about being ?high? last night and also statements about having sexual contact with girls and his peer Incidentjta?; mixing; Islam Hassanein Other Incident Report at: 30309 (Reference #:1303959 WW Emeram WW Adventurer RTP 06/03/ 13 Jaguar's Classroom made statements regarding- -, and while at play?eids this weekend. Wag; Imelda Davila Other Inddont?neport 8037-1 (Reference #:80370 2199:3111 Adventurer RTP 06/03/ 13 Jaguar?s Classroom made statements regarding peers and their activities while off campus this last weekend. Peers involded and Reporting; Imelda Davila Other Incident 80325 (Reference #330375 2mm Wat Adventurer RTP 06/03/13 Off Campus peers made a statement against him. CONFIDENTIALITY NOTE 10 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. If you have received this tclecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original MMLianthuame 3-2011 Incident Reports) 000255 Farnilieers t, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Tuesday; fume 04, 2013 The time period of this report is from 7:00 :Lm. (prior of?ce working day) to 7:00 a.m. (current of?ce working day) Islam Hassanein Other John (Nick) Moriana Incidentilleport 30324 (Reference #:330324- Adventurer RTP 06/02/13 Resource Center was not on campus to receive his medication. Insiden?'xne. mug; Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report 80325 (Reference #180325). Adventurer RTP 06/02/13 School Quiet Room stated that he was intoxicated yesterda while he was a runaway from the facility. He also charged the door and the Quiet Room door containment was initiated. also left supervision. (3 min) Islam Hassanein - Restraint Quiet Room Assisting; Adrian Mendoza - Assault/Aggression Other Incident Report at: 80381. Went 2mm WW Adventurer RTP 06/03/13 Resource Center was not on campus to receive his 3 PM and 7 PM medication. Angela Lira - Med Error - Missed Dose at FamiliesFirst Incidentnepo?tieisossz (Meade-#280382) . mourn Wanna: Adventurer RTP 06/03/13 Bedroom #2 mm Multiple statements were made about. from his peer- in regards to sexual activity and physical abuse. Wing; Islam Hassanein Other Incident Report 80383 (Reterence #180383 Winn: Emnmm Widens: Widen: Adventurer RTP 06/03/ 13 West Wall of Campus threw a butane lighter at my feet and the lighter exploded; the debris my leg. - Wing; John (Nick) Moriana - Law Enforcement Contact Assisting: Andrew Enright - Assault/Aggression CONFIDENTIALITY NOTE 1 1 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally privdeged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this telec0py in error, please notify us by telephone immediately so that we can arrange for the return of the original Incident Reports) 000256 FanziliesFirs t, Inc. 2100 Fifth Street, D3 Vis, CA 95616 24 Hr. CL Report Tuesday, farm 04, 2013 The time period of this report is from 7:00 2111. (prior of?ce Working day) to 7:00 a.m. (current of?ce working day) Incident Report 80380 (Reference #280380 ?rearm Wm Adventurer RTP 06/03/13 Jaguar?s Classroom made statements regarding peers and their activities while off campus this last weekend. Peers involved were -, and I 3mm Imelda Davila Other Incident Report 80333 (Reference #:80333 8W ?rearm Ranger RTP 06/02/13 Resource Center was not on campus, therefore missing his 7 AM and 7 PM medication. Incident?a?. Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report 80322 (Reference #180372 Brennan Ranger RTP 06/03/13 Jaguar?s Classroom made statements regarding peers and their activities while off campus this last weekend. Peers involded and Imelda Davila Other Incident Report 80406 (Reference #:80406 Jade RTP 06/03/13 Parking lot. attempted to leave supervision off of campus resulting in a restraint. (28 min) Lemming; Eric Benoit - Restraint Escort Patrick Oleson-Wheeler Other Team Prone Standing - Incident Report it: 80320 (Reference #:80320 WEI Brennan: Widens Jade RTP 06/01/13 Hallway went into the kitchen while escalated and the stove was in use. (19 min) CONFIDENTIALITY NOTE 12 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. If you have received this in error, please notify us by telephone immediately so that we can arrange for the return of the original meemneuheipm?nemi?et'tzm 3-2011 Incident Reports) 000257 FamiliesFirs Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Tuesday, june 04, 2013 The time period of this report is from 7:00 a.m. (prior of?ce working day) to 7:00 a.m. (current of?ce working day) Mum; Johnny Tillis - Restraint Escort Regorting: Felicia Thomas - Assault/Aggression Team Prone Patricia Button Incident Report 80308 (Reference #:80308 Emmi) Wooden; Jade RTP 05/31/13 Resource Center missed her 3 PM and 7 PM medication, due to not being on campus during this time. m9; Andrea Chiles - Med Error - Missed Dose at FamiliesFirst - madam Report-it: 80369 (Reference #:aosoo 2mm Jade RTP 05/31/13 - Resource Center missed her 7 PM medication, due to not being on campus during this time. Mg; Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report?rt: 80319 mammograms? 2mm Widen: magnum Jade RTP 06/01/13 Sutter Medical Center stated that her peers that she with, were abusive after consuming alcohol. gem Antonio Galvan Other Incident Report 80355 (Refer-once #:80355 WW anagram Jade RTP 06/02/13 Porch was contained for assault to staff. (24 min) Angela Lira - Restraint Team Prone Renaming; Patrick Oieson-Wheeler - Assault/Aggression Standing Adrian Mendoza Assisting; Eric Benoit Incidont Report 80356 Jade RTP 06/02/13 House was contained for assault to staff. (20 min) CONFIDENTIALITY NOTE 13 The documents accompanyng this telecopy transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that We can arrange for the return of the original MinnhtinaRMtquuEsbuM 3-2011 Incident Reports) 000258 Fam'liesFI'r-st, Inc. 2100 E'fi?lz Street, Da W's, CA 95616 24 Hr. CL Report Tuesday, lune 04, 2013 The time period of this report 15 from 7:00 sun. (prior office working day) to 7:00 a.m. (current of?ce working day) witnessing: Jesus Zamudio - Restraint Team Prone gem Patrick Oleson-Wheeler - Assault/Aggression Wall-Assisted ?33139; Claudia Vazquez Eric Benoit Incident Report-4t; 50354? I unit of 8:2ng mm Maximum Jade RTP 06/02/13 Resource Center W- did not receive her 7 AM medication. Instdenums; mains; Angela Lira - Med Error - Missed Dose at FamiliesFirst Incomith 80407 . (Reference #:00407 Bantam Jade RTP 06/03/13 Jade House Hallway stated a peer .) and an older man gave her vodka that tasted like vanilla while she was off campus this weekend. Mm; Theresa Murchison Other Incld'eritlieportilitrsodos (Reference #100408) 1? . . g. WW 2mm Jade RTP 06/03/13 Adventurer House There was a statement made about- from her peer-. Lemming; Islam Hassanein Other Incident Rotter! it: 80374 (Rererenee #:80374 Jade RTP 06/03/13 - Jaguar?s Classroom made statements regarding-, -, and while off campus at play?elds. Repgging: Imelda Davila Other Incident Report it: 80303 (Reterence #380303 Brogan: . Sapphire RTP 05/31/13 Behind School was placed in a team prone restraint for assaulting staff. (25 min) Danna-inf? Achlau Mal omnva f? - Dart-rainf Taam Dun-u: CONFIDENTIALITY NOTE 14 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopicd in formation is strictly prohibited. If you have received this tclecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original CPBSI?oWLiherAtmuas?eKm 3-2011 Incident Reports) 000259 Inc. 2100 Fifth Street, Data's, CA 95616 24 Hr. CL Report Tuesday, lane 04, 2013 The time period of this report is from 7:00 in). (prior of?ce Working day) to 7:00 a.m. (current of?ce working day) Keana West 0 - Accident/Injury to Staff 0 - Assault/Aggression Incident (Reference moo-401) anagram Sapphire DTP 06/03/13 Field, Outside QR wandered around campus and attempted to get her peers off task so we designated a safe area for her to be in. She eventually pushed into us so we escorted her to the outside quiet room. Incident?a?; mm mg; Andrew Enright - Restraint John (Nick) Moriana - Assault/Aggression assisting; Dave Clark Other Incident 89395 (Reference #:80395 MW Bantam Wm Widen: Voyager DTP 06/03/13 Campus attempted to leave staff supervision by going out through his window. - began to assault and throw items at sta which lead to containment and restraint in his room. witnessmg: Julia Braun - Restraint Team Prone John (Nick) Moriana - Assault/Aggression Lemming; Darius Randall Other Nicholas O'Dowd Kristan Warren - Inelth (Reference #:80339 We]: 2mm WW Voyager RTP 06/02/13 House was contained for pushing into staff. min) gem Nicholas O'Dowd - Restraint Escort Assisting; Angela Ura - Assault/Aggression Team Prone mm; Darius Randall - Assault/Aggression Standing made-imam 30341 (Reference #:1303450 a I. E11 Voyager RTP 06/02/ 13 Play Structure was contained for pushing into staff. (2 min) Reporting; Nicholas O'Dowd - Restraint Escort Assigjng: Eric Benoit - Assault/Aggression Other CONFIDENTIALITY NOTE 1 5 The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally privtleged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original mweuJ?siwmi 3-2011 Incident Reports) 000260 Fann'liesE'rst, Inc. 2100 Street, 03 W's, CA 95616 24 Hr. CCL Report Tuesday, june 04, 2013 The time period of this report is from 7:00 a.m. (prior of?ce working day) to 7:00 a.m. (current of?ce working day) Incident Report #1 $0294 . (Reference #:8021341 I - I.?.lu.ll DIED Sapphire RTP 05/29/13 Resource Center was not on campus to receive her medication. Reporting: Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report 80298 (Reference #180298)- I. ".lu.ll u.ll I I. ?.ll Sapphire RTP 05/31/13 Resource Center was not on campus to receive her 3 PM medication. Insidenr?tatt. Incidenmne: Reporting; Andrea Chiles - Med Error - Missed Dose at FamiliesFirst Incident Report it: 80296- (Referenoe #:80296Sapphire RTP 05/31/13 Resource Center had been off campus all night and was sleeping when I arrived to distribute medication! refused to wake up to ta her medications. Several attempts were made and still refused. Noti?ed appropriate sta . 34.3mm Julie Vice - Med Error - Client Refused To Take Medication Incident?nepodtr: 8631.6 #:80316. ll plan . Sapphire RTP 06/01/13 - Front of Campus left the house without permission and beg an to wander campus. I encouraged her to stay on campus, but she did not take my advice. She left campus and due to the lack of staf?ng, I could not shadow her. Reporting; Aaron Alston - Long-Term Runaway Incident Report #280402 (Reference #:80402 Emeram WW Sapphire DTP 06/03/13 Field was placed in a team prone restraint for forcefully pushing into staff. m9; Ashley McLemore - Restraint Escort Patricia Button Team Prone Standing Incident Report #2 8038;. (Reference mousse CONFIDENTIALITY NOTE 16 The documents accompanying this telecopy transmission may contain information that is confidential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original 3-2011 Incident Reports) 000261 Farm'II'esE'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CCL Report i Tuesday, june 04, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 a.m. (current of?ce working day) Brennan: Widen: Widens Pioneer DTP 06/03/13 Pioneer House Dining Room - was not getting what he wanted so he became angry, aggressive, and assaultive. We Initiated a standing restraint per is needs and services due to him continuing to assault staff past his clear limit. mixing; Rosa Retzer - Restraint Standing Adriana Escobar 0 Assault/Aggression CONFIDENTIALITY NOTE 17 The documents accompanying this telccopy transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original 3-2011 Incident Reports) 000262 FaIm'II'esFirst, Inc. 2100 Fifth Street, Dan's, CA 95616 24 Hr. CL Report - . Wednesday, fume 05, 2013 l'hr time (ll this upon ham 7'0? a (print working day" to 7:00 am (current rift-ice Working day} Incident Repair 80413 (ashram #:80413') Emotam WW Adventurer RTP 06/03/13 - Resource Center was not on campus to receive his 7 AM medication and had not returned in time to take his 7 AM dose of medications. otified appropriate people. Julie Vice - Med Error - Missed Dose at FamiliesFirst ?identRepo? 80428.(Reference #180428) . ni Balsam mm adventurer RTP 06/04/13 Resource Center was not on campus to receive his 7 PM medication. ?g?grting: Angela Lira - Med Error - Missed Dose at FamiliesFirst E_%pcident Report 80427 2mm adventurer RTP 06/04/ 13 - Resource Center was not on campus to receive his 7 AM medication and had not returned in time to take his 7 AM dose of medications. Noti?ed appropriate people. i Reporting: Julie Vice - Med Error - Missed Dose at FamiliesFirst Incident Report 8046]. (Reference #:80461 . Widen: Emma: Lions RTP 06/04/13 Classroom reported that she had sex the last 3 days and that her stomach hurt because of it. 105mm ?1 8: Reporting: Zachariah Fromm Other - Incident Report 80439 Reference #:80439) . ngangn Inglgent Emsnm Ranger DTP 06/04/13 Campus n: was attempting to leave and when staff provided support to deter him from leavmg campus,- punche staff multiple times. (14 min) Donhr?nn- CHI-tar 7-:mnra - Doc?raink Team Dr'an CONFIDENTIALITY NOTE 1 The documents accompanying this it'lccopy transmissmii may contain information that is con?dential rind/0r legzilh privileged. The is intended only fur the use by llH? or entity names on this trunsrnissmn sheet. if you are not the intended reapient. you are hereby notified that :1in disclosure, copying (?llStIlbllIlUlL (H the taking (ii any action in reliance on the contents of this telecnpietl information is strictly prohibited. lfymi have received this iclewpt' erriin please mitily us by telephone immediately so that we can arrange for the return of the original documents tn us at no (?mi in you. 'l'hank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000263 FamilicsFirst, Inc. 2100 Fifth Street, D3 W's, CA 95616 24 Hr. CL Report I .f . Wednesday, func 05, 2013 The ?Hit: period at this report is from ?00 im {prior Working (LIV) to 7:00 am. (current day) Assisting: Angela Lira - Assault/Aggression Standing Assisting: Leon Jones Other Assisting: Erin Milligan . Incident (Reference #:80438) Ranger RTP 06/04/13 Therapy made a statement about threatening a boy while he was absence without leave. Reporting: Amy Mild Other Incident ?gm 80415 (Reference #:80415 I 3mm Tim 1? Adventurer RTP 06/03/13 Resource Center missed his 7 AM his 12 PM dose of medication due to not being on campus during this time. Incident gaff: Insigeng Type: Reporting: Julie Vice - Med Error - Missed Dose at FamiliesFirst Incident Report #:280430 (Reference-#30430 . magnum Adventurer RTP 06/04/13 Resource Center was not on campus to receive his 3 PM and 7 PM medication. Incident Staff: Incident Type: Reporting; Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report 80429 (Reference -#:so42? )j Wm WM Adventurer RTP 06/04/13 Resource Center missed his 7 AM and 12 PM dose of medication, due to not being on campus during this time. Incide i an Repggting; Julie Vice - Med Error - Missed Dose at FamiliesFirst Incident Report 80435. (Reference #:80435.) Pioneer RTP 06/04/13 07535PM Hallway was contained after aggressively charging towards a peer after havmg forcefully pushed that peer. (14 min) anidonir Tuna. Dachaan Tun-- CONFIDENTIALITY NOTE 2 ?l?hr- accompanying this transmission may contain information that is con?dential ind/or The information is only tor the use by the individual or entity names on this transmission shut ll- )1 are not the intended recipient, you are hurt-by noti?ed that any disclosure. copying, distribution, or the taking of any action in i?clinnt't' on the contents of this information is prohibited. If you have rt'Cl?th?d this tcluopi' in error. plunsu notify us by telephone immediately so that we can arrange for the tcturn of Uflg?hll documents to us at no cost to You Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000264 Farm'II'esFirst, Inc. 2100 Fi?h Street, Dan's, CA 95616 24 Hr. CL Report Wednesday, june 05, 2013 The unit period of this upon is from 7.00 .uti. (illice day; ll) 7.0031?. current ?it'l'iee working day) 33m; John (Nick) Moriana - Restraint Escort Rosa Retzer - Assault/Aggression Team Prone Standing Incident Report 80412 (Reference #:8041?2 . .l I IIEI. .II I . [1.ll Voyager RTP 06/03/13 Therapy made a statement about his absence from campus. Incident Staff: Incident Type: Reporting: Amy Mild Other Incident Report 80443 (Reference 3:80443 Voyager RTP 06/04/13 Resource Center After several separate attempts,- still refused his 3 PM medication. Watt: Incidentlust Angela Lira - Med Error - Client Refused To Take Medication Incident Report #5 80445 (Reference #:80445, ni 2mm Tim Voyager DTP 06/04/13 Kitchen W- was contained after repeatedly and forcefully bent and tWisted my little ?nger. (29 min) Witnessing: Noel Salazar - Restraint Team Prone Reporting: John (Nick) Moriana - ACCident/Injury to Staff Oscar Lopez 0 - Assault/Aggressmn Incident Report 80446 (Reference #:80446 t) WW Emma: Wight Voyager DTP 06/04/13 - Hallway was contained after repeatedly and forcefully pulling me to the ground. (14 min) ?iuLIncIdent e: Mnessmg: Andrew Enright - Restraint Team Prone Mug; John (Nick) Moriana - Accident/Injury to Child Team Prone Assisting: Oscar Lopez 0 - Assault/Aggression Incident Report 80419 (Reference #:80419 Emsnm Sapphire RTP 06/03/13 - Resource Center CONFIDENTIALITY NOTE 3 The documents atcompunymg this telecopy transmissian may contain information that is con?dential :mtl/nr legally The information is intended only for the use by the individual or entity names nn this sheet. If you ure not the intended tecipient. you are hereby noti?ed that any disclosure, copying. distribution, or the taking of any iit'ttiin in reliance on the contents of this telectipietl in formation is strictl)l pmhihitetl. lfynu lL'lVl? received this telectipt- in error. please notify us by telephone immediately N) that we can arrange for the return the tirigiiml documents to us at no cost to mu. 'l'liank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000265 Fam'lz'esFirs t, Inc. 2100 Fifth Street, Davis, CA 95616 7 . 24 Hr. CCL Report . Wednesday, june 05, 2013 The time period of this report is from 7:00 am. (prior of?ce working day} to 7:00 am. (current office working day) was not on campus during the distribution of 7 AM medication and did not return before the window to take the medication ad passed. Therefore, she did not take her 7 AM dose of medication. momma Reporting: Julie Vice - Med Error - Missed Dose at FamiliesFirst David Waites IncidentI'Report?: 80451 'Emma: Moms we nof nt Sapphire RTP 06/04/13 Resource Center Brief - was not on campus during 7 PM medication time frame. Reporting: Angela Lira - Med Error - Missed Dose at FamiliesFirst giInci'd?ent'Repiort #1 sodsoxrriierefrehce #:sou's'oj. . Uni of In ldent Program Dag; 5 Time of Incident Sapphire RTP 06/04/13 Resource Center was not on campus during the distribution of 7 AM medication and did not return before the window to take the medication ad passed. Therefore, she did not take her 7 AM dose of medication. Mm; Julie Vice - Med Error - Missed Dose at FamiliesFirst Assisting: Waites Incident Report #30421 . . Wm mun of. Incident Jade RTP 06/03/13 Resource Center was not on campus to receive her 7 AM medication and had not returned in time to take her 7 AM dose of medications. Noti?ed appropriate people. Remrting; Julie Vice - Med Error - Missed Dose at FamiliesFirst I Incident Report-m 8049151: (Reference 7-: I: . . . unit of Incident Date 3 Time of Incident WM Jade RTP 06/03/13 House I verbally directed - to go to school. She refused and continued to walk out of the house.- proceeded to walk off of campus. Reporting; Eduardo Villalobos - Long-Term Runaway Theresa Murchison Incident ?Perth-80454 #8045". j" Jade RTP 06/04/13 Resource Center CONFIDENTIALITY NOTE 4 The documenls accompanying this telecopy may contain information that is confidential and/m legdlli? privileged. The information is intended only for the use by the individual or entity names on this trunsmissnm sheet. ll you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the. taking of any action in reliance on the Contents of this telecopied Information is strictly prohibited. If you have received this Ielecopy in error. please notify us by telephone immediately so that we can arrange For the return of the original documents to us .It no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000266 Fam'lies?rsr, Inc. 2100 Street, Davis, CA 95616 .. 24 Hr. CL Report Wednesday, func 05, 2013 'l?hc time period of [his IS from 7.0? um. {prior of?ce working day"; to 7:00 am. (current of?ce working day} was not on campus to receive her 7 PM medication. Incident Staff: Incident Type: Reporting: Angela Lira - Med Error - Missed Dose at FamiliesFirst Incidenrtrepdrt moons; (?congestion . Jade RTP 06/04/13 Resource Center was not on campus to receive her 7 AM medication and had not returned in time to take her 7 AM dose of medications. Noti?ed appropriate people. Incident Staff: Incident 1112c: Reporting: Julie Vice - Med Error - Missed Dose at FamiliesFirst Incident; gammaJade RTP 06/04/13 House called the house phone and gave statements. I Reporting: Patrick Oleson-Wheeler Other Assisting: Eric Benoit i Incident 80418 themes. #:80418 )5 cient 1mm M0 In fIni Voyager RTP 06/03/13 Resource Center refused to wake up and take his 7 AM medication. Several attempts were made. Appropriate people were notified. Insulating; Reporting: Julie Vice - Med Error - Client Refused To Take Medication itncidentneportai": 804,41 ranges-mom Elan II. Voyager RTP 06/04/13 Resource Center ?n?et was not on campus to receive his 7 PM medication. - Mg; Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident'Report #:89440 - 5 WW .__g._mPro ra Mamba Tim 0 I was?: Voyager RTP 06/04/13 Resource Center When I went to distribute medication to Voyager House, I called for- and was informed that he was not on campus. He did not return in time to take his 7 AM dose of medications. Noti?ed appropriate people. ?I?nridnnf 'nridonf Tun-- CONFIDENTIALITY NOTE 5 The accompanying this transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this trunsmissron sheet. If you are not the intended rcmpicnt, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action In on the contents of this information is strictly prohibited. If you havc rr-ccivcd this [dc-cop)- In error, please notify us by telephone immediately so that we can arrange {or the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000267 FamilicsFirst, Inc. 2100 Fifth Street, Dan's, CA 95616 I . 24 Hr. CL Report Wednesday, fans 05, 2013 The little til this icptirt is 7 00 a (prim tiff-ICC Working day, to 7200.1.m? of?ce working day, Reporting: Julie Vice - Med Error - Missed Dose at FamiliesFirst Incident Report 80434 (Reference-#580434) nioIn 2mm We: Pioneer DTP 06/04/13 Behind NPS attempted to leave supervi5ion and assaulted me hitting me with a good Sized stick and kicking me past the clear limit. 5 min) Repomng: Nolan Bradley - Restraint Escort Assisting; Dave Clark 0 - Assault/Aggression Other Incident Report 80417 Ranger RTP 06/03/13 Resource Center was not on campus to receive his 7 AM dose or 12 PM dose of medication. Noti?ed appropriate house supervisnr, social worker, and id 0 Staff: 1mm Reporting: Julie Vice - Med Error - Missed Dose at FamiliesFirst Incident Report 80437 (Reference #:80437. - Ranger RTP 06/04/13 - Resource Center was not on campus to receive his 3 PM and 7 PM medication. Insident?a?z i Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Remake-043i; (Reference #:80435) . WM Emma: Widens Ranger RTP 06/04/13 Resource Center - was not on campus to receive his 7 AM dose or his 12 PM medication. Notified appropriate house superVisor, social worker, and Reporting; Julie Vice - Med Error - Missed Dose at FamiliesFirst Incident Report-1t: 80433 CONFIDENTIALITY NOTE 6 The unit-ins Accompanying this Iclecopy transmission may contain information that is con?dential .?IntI/hl lcgtilly The information is intended only for the use by the individual or cntity iianics mi this SIICCI. ll. \?Ull arc not the intended recipient. you are hurt-In that :my disclusure, copying, (H tilting iil' :irtinii reliance on the cuntc'nts of fins information is strictly prohibited. lfynii haw this Kit-copy in error, please notify us by immediately so that we can arrange for the return (it (l?lt? original (ILKUHICUIS It) us lit nii Ctist tn you. 'l'hmik you PBS Front Line PRA Request (2013-2011 Incident Reports) 000268 Fam'li'esFirst, Inc. 2100 Fifth Street, D21 Vis, CA 95616 24 Hr. CL Report Wednesday, fune 05, 2013 The tlnu' pct-ind of this report is from "00 a (piim office working thy; to 7:00 mm, (current oft-ice workinby day) all]: ll Adventurer RTP 06/04/13 - Resource Center an}! missed his 7 PM medication, due to not being on campus during this time. Insident?a?. gem Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report #580462: (Reference Jaguars NPS 06/04/13 TimbenNolves Classroom ?rigf - shown up to school in brand new shoes fr0rn Target and house staff con?rmed that they were not his. mm Adrian Mendoza Other witnessing: Patricia Button Reporting: Genevieve Cames -) IncidentRepfort I 2mm Wm Jade RTP 06/03/13 Resource Center When I went to distribute medication to Jade House, I called for, and was informed that. was not on campus. She did not return in time to take her 7 AM dose of medications. Noti?e appropriate people. Reporting: Julie Vice - Med Error - Missed Dose at FamiliesFirst Incident Report 8645s '(Reference #39455); - Jade RTP 06/04/ 13 Resource Center When I went to distribute medication to Jade House, I called for. and was informed that she was not on campus. She did not return in time to take her 7 AM dose of medications. Notified appropriate people. 1gg?dgnt ?taff; mm Julie Vice - Med Error - Missed Dose at FamiliesFirst IncidentRepo-rtEmmim on; Jim: at Insidgng 2f Ing'gegt Jade RTP 06/04/13 House i woke up and proceeded to walk out of her room without permission. I verbally directed her to get her meds, she refused and proceeded to leave the house. began to leave campus. Erin Milligan - Long-Term Runaway 3392:9119; Kyle Gariick Assisting: Kamika Sherwood CONFIDENTIALITY NOTE 7 The documents accompanying this transmission may contain information that is (Oniidt?nll?l :ind/or li-gally The information is only for the use by the indiwdunl or entity namcs on this transmissmn Silct?i?. If you are not the tccipiciit. you an: hereby noti?ed that any Copying, distribution. or the taking of :1in action in l't'il?lit?t?, on the i'ontenis of this nth-copied information is strictly prolubitrd. Ifyoii haw tt'lccopy in error. please notify us by immediately so that we can tuning}. {in the icturn of original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000269 Fann'liesFirst, Inc. 2100 Fifth Street, Davis, CA 95616 . 24 Hr. CL Report Wednesday, junc 05, 2013 'l'lic timc pi-noil Hi. this Ii-poii is from 00 it in (print otlirc Working day', to 7:01) (current Un-Kt: working day) Incident Report 80416 (Reference #:80416) I. . . Adventurer RTP 06/03/13 Resource Center missed his noon dose of medication, refusing to wake up after having been off campus for several hours. mm mm Reporting: Julie Vice Med Error - Missed Dose at FamiliesFirst Incident Report 80431 (Reference #:8043131?) I I. . I Adventurer RTP 06/04/ 13 Resource Center missed his noon dose as he was off campus for several hours and did not return in time to take his noon dose of medication. Watt: gem Julie Vice - Med Error - Missed Dose at FamiliesFirst Assisting: Imelda Davila -- Incident Report 80414} (Reference #:80414 Emmi]! Adventurer RTP 06/03/13 - Resource Center was not on campus during the distribution of 7 AM medications and did not return in time in which he was able to take em had expired. Therefore he did not take his 7 AM dose of medications. mm Regomug; Julie Vice - Med Error - Missed Dose at FamiliesFirst Incident Report 80425 (Reference #380035) WW Enema lm Adventurer RTP 06/04/13 Resource Center refused to get up after several attempts to receive his 3 PM medication and he was not on campus to receive his 7 PM medication. I mm Angela Lira - Med Error - Missed Dose at FamiliesFirst Incident Report#: 80426 (Reference #:80426 Widen: Adventurer RTP 06/04/13 Front of Campus/Off 5th Street left campus out of supervision after multiple attempts to verbally de-escalate him. He was gone for over 4 hours. Incidentlme: Donnr?nn- [clam ?arcanoin f? - I ann_Torm Diinaui:u CONFIDENTIALITY NOTE 8 The documents accompanying this telecopy transmissum may contain information that is confidential Ind/or legally priVIk-gt-d. The information intruded only for the use by the individual or Ullin names on this iraiismismon slitct. It you are not the intended recipient. you are hereby noti?ed that any disclosure, Copying, distribution, or the inking of nny union in reliance on the Loiiti-nts (ii?this tcli'mpicd mfnnimiion is strictly Ifyou haw ri ccivcd this in error. picnsc notify us by tulcphonc immediately so that we can arrange for flit return of the original documents to us at no Cost to will. l'hnnk you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000270 Fann'II'eSFirst, Inc. 2100 Fifth Street, Daw's, CA 95616 24 Hr. CL Report Wednesday, june 05, 2013 The llmt? of this report is from 7:0? ant. (prior office working day, to 7:00 am (current office working day) Assisting: Adrian Mendoza Assisting: Oscar Lopez gigging: John (Nick) Moriana Incidentk'eport #:8045'7 (Reference #:30457) Balsam maximum Jade DTP 06/04/13 Bedroom Both times,- was placed in restraint for forcefully assaulting staff in an attempt to leave staff supervision. (23 min) Wimgssing: Genevieve Carnes - Restraint Team Prone Banging; Jesus Zamudio - Sutcndal Ideation Team Prone Eric Benoit - Assault/Aggressuon Standing Assimng: Eduardo Villalobos Other Standing Incident Report 80458 (Reference #:80458 . . I. Jade RTP 06/04/13 Bedroom was contained for cutting herself. (12 min) 3m Patrick Oleson-Wheeler - Restraint Standing Assisting: Jesus Zamudio - Accident/Injury to Child Assisting: Andrew Enright - Sutcrdal Ideation - Assault/Aggressuon Other Inejdent- Reporter: 80459 Wm Emmi: Widen: Jade RTP 06/04/13 - House was contained for attempting to leave superwslon. (31 min) Watt: mm en Maintain; Witnessing: Noel Salazar - Restraint Standing Wimessmg: Islam Hassanein - Accident/Injury to Child Reporting: Patrick Oleson-Wheeler - Assault/Aggresswn Assisting; Aaron Alston Assisting: Eric Benoit Incident Report-1t: 80460 (Referenee #:80450') Widen: [mam Wm Jade RTP 06/04/13 Bedroom attempted self Injurious behaviors and became assaultive. (21 min) Mdent Rgpoging: Eric Benoit - Restraint Team Prone A??i?gngz Patrick OIeson-Wheeler - Assault/Aggression Other CONFIDENTIALITY NOTE 9 The documean accompanying this telecopy transmission may contain information that is con?dential and/or legally The information is intended only for the use by the individual or entity names (in this iransmissron sheet if you are not the intended recipient. you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on [hr contents of this telL-Copiul information is strictly prohibited. Ifyou have received this It-lecopy in error, please notify us by telephone so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000271 FarmliesFirst, Inc. 2100 Fifth Street, Data's, CA 95616 24 Hr. CL Report Wednesday, [um- 05, 2013 'llxc tunc (it this report 15 00' an) {prior nt?cc dzn'. tn 7 00.1.1?. Off-1C6 working day) Incident Report 80423 (Reference #:80423 .. WW Emma: We: Adventurer RTP 06/04/13 - Dinning Room became upset over an Outing ending early and began to assault staff. We initiated a supine restraint, which we then transitioned Into a team prone. (17 min) Mm; Adnan Mendoza - Restraint Team Prone 5mm; Islam Hassanein - Assault/AggreSSIon Team Prone Assisting: Noel Salazar Incident (Reference #:80447Voyager DTP 06/04/13 Field/Bushes began to run around the house when it became chaotic. He ran out the back door towards the back parking lot. His space was limited to av0id him from running off campus. He began to assault staff and was contained. (29 min) Witnessing: Bryce Lumbard Restraint Team Prone Mm; Kristan Warren - Accudent/Injury to Staff Aim; Christopher Bryce - Accrdent/Injury to Child Darius Randall - Assault/Aggression Assisgng: Brooke Piasecki Incident Report 80448 (Reference #:8044831) . I. I'll. i .I Voyager DTP 06/04/13 House was instigating peers and assaulted staff. (11 min) Reporting; Nicholas O'Dowd - Restraint Team Prone Assisting: Bryce Lumbard - Assault/Aggression Assisting: Darius Randall Incident Report 80449 (Reference #:80449 Rem??Ln Unit of Incid nt 2mm mm Voyager RTP 06/04/13 Resource Center After several separate attempts, - refused to wake up to take his 7 PM medication. Angela Lira - Med Error - Client Refused To Take Medication CONFIDENTIALITY NOTE 10 'l?lu- ilntumi-nh accompanying this tI-lct'npy may inl'nrmmiun than Is :Iml/m lI-gall) prwilrgt d. 'I'lu- information is tumult-d for the use by the individual or entity names (in this Sllt'tf. If you are not the intended rcupx?nt. you are hereby noti?ed that any disclosure, copying, or the tail-(mg ul- nny On tht~ (if lhis trlI-rnpicd is strictly prohibited If you have n-u-ivul [llh? in cm"; please minty us by immediately so that wc can arrangr Fur the rt-tum of the nrigmul documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000272 FarmZI'esE'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24111: CCL Report ,2 Wednesday, junc 05, 2013 The time period of this upon is from 7:00 am, (prim nil?lee working day} tn7100 mm. {current of?ce working day) Incident 'Report 80420 Jade RTP 06/03/13 - Resource Center '0 had been off campus all night and was sleeping when I arrived to distribute medication. refused to wake up and take her medications. Several attempts were made and still refused. Noti?ed appropriate sta . 1mm?: Julie Vice - Med Error Client Refused To Take Medication CONFIDENTIALITY NOTE 1 1 The dntumenta .ii telet?npy transmission may contain ininrmmion that is :inrl/nr legally privxlegc-d. The information iS intended only For the use. by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking ?if any in relizmu- on the contents of this telecopicd information is strictly prohibited. If you have received in error, please notify us by telephone immediately that we can arrange for the return of the original documents Ii) us at no cost to you. 'l'hzink you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000273 Fam'li'esE'rst, Inc. 2100 Fifth Street, D3 W's, CA 95616 24111: . Fnday, junc 14, 201.3 The time period of this report is from 7.00 am. (prior office working day} to 7:00 mm. (current of?ce. Working day) -) Incident Report 80650 (Reference #:80650 unit 9! Insider]; 21:99:31]] Date 35 limg 9t Incidgng i en Jade RTP 06/13/13 Therapy Room 4 Brief was interviewed by an officer of PD. "3 Reporting: Wayne Cottle - Law Enforcement Contact Incident Report 80649 (Reference #:80649 . . .l i. E: .l I. .l Jade RTP 06/13/13 - Resource Center After several separate attempts,- refused her 7 PM medication. In on ff: Incident Type: Regorting: Andrea Chiles - Med Error - Client Refused To Take Medication Incident Report 80648 (Reference #:80648 Jade RTP 06/13/13 Resource Center Brief Description: - indicated that she did not want to take her medication and even after several attempts and encouragement, she dPl?lde?i to refuse her 7 AM dose of medications. Notified appropriate people In i ff: Ingigeng Type: Reporting: Julie Vice - Med Error - Client Refused To Take Medication Erin Milligan Incident Report 80651 (Reference #:80651 Emigrant Widens Location of Incident Voyager RTP 06/10/13 Livmg Room repeatedly postured as if to punch me in the face and spit directly ln my face repeatedly. (1 min) - attempted se era times to leave supervismn after making statements that he intended to leave campus. (23 minWitnessmg: Misaki Curtis - Restraint Escort Mm; Patriaa Button 0 - Assault/Aggression Escort Witnessmg: Sarah Tingey Other Standing witnessmg: Cristina Mendoza?Sanchez Qmet Room Witnessmg: Anthony Gonzales Witnessmg: Brett Atwood Witnessing; Zachariah Fromm Dianna Wade Reporting: Zachariah Fromm A55isting: Hilary Sleuter Kyle Garlick CONFIDENTIALITY NOTE I The documents accompmying this lulccopy may contain information that is con?dential and ?or legally privileged. Tilt information is intended only for use by the individual or untin names on this transmission sheet, If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the. taking of my action in rcliancc on the contents of this information is strictly prohibited. If you have this ll?l (?ffof? notify us by immediately so that we can arrange. for the rcnirn of the original documents to us. at no cost to you. Thank you, PBS Front Line PRA Request (2013-2011 Incident Reports) 000274 Fanlilies?'rs t, Inc. 2100 Fifth Street, Da W's, CA 95616 24 Hr. CCL Report Friday, fune I4, 2013 The time period of this report 15 from 7 00 item. (prior off-Ice working day} to 7:00 a.m. '\eurrent working day) Incident Report 80652 (Reference #:80652 . HI. .l int Pioneer RTP 06/14/13 Administration Davus police came to ask that someone contacted? In regards to her-. Meg Regomng: Coronda Carter 5 - Law Enforcement Contact Incident Report 80646 (Reference #:80646 Bengm?ng Unit of Incident Tim 1? In i Ranger DTP 06/13/13 Bedroom #2 stabbed staff In the left leg With a broken pencnl. (12 mm) Ingiggnt ?taffz Igcigent Tygg: 3951mm; 719g; Christopher Bryce - Restraint Team Prone Ryan Banks 0 - Assault/Aggressmn CONFIDENTIALITY NOTE 2 The documents accompanying this teleeopy transmission may tontnm int?mmntion that is con?dential and/or legally privileged. 'I'he formanon is intended only tor the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in ielinnee on the contents of this telet opted information is strictly prohibited. lfyou have this telecopy in error. please noti fy us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000275 FamiliesE'rs t, Inc. 2100 Street, Dz: Vis, CA 95616 24 Hr. CL Report Monday, junc 17, 201.3 The time period of this report is from 7:00 tun. [prior office working day) to 7:00 mm. (current of?ce working day) Incident Report 80661 (Reference #:80661 WWI): Mam Ranger RTP 06/16/13 Car informed me of an incident that occuned on a previous AWOL, concerning his peer -), a former EMQFF client. Insidentlme; Reporting; Claudia Vazquez Other mum (Nick) Moriana Incident Report 80655 (Reference #:80655 Emanm Widen: Voyager RTP 06/14/13 Adventurer House - Bedroom #1 made a statement about doing something to a peer Indientjta?: Incidentlimm mm Christopher Bryce Other Bugging; Kristan Warren Incident Report 80656 (Reference #:80656 MW Voyager RTP 06/14/13 Of?ce was given notice and will be discharged on 9/16/13 by 7 PM, due to alleged sexual assault. Wing; Lisa Robertson Other Assisting; Julia Braun Incident Report 80657 (Reference #:80657 Emigrant WW Wooden: Voyager DTP 06/14/13 - Front Porch of Ranger House CPS emergency response social worker and CSW from Fresno responded to reparts made on 6/6/13 by agency. They conducted an interview with child in his room with the door closed. Afterwards, they reported ?ndings to us and contacted Davis PD. Rgpo?ing: Julia Braun - Law Enforcement Contact Assisting; Lisa Robertson Incldent Report 80658 CONFIDENTIALITY NOTE 1 The documents accompanying this telccupy transmission may contain information that 15 con?dential and/ or legally The information is intended only for the use by the individual or entity names on this transmissuon sheet. if you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. lf you have received this tclecopy in error? please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000276 Fam'liesE'rst, Inc. 2100 Fr'??b Street, Davis, CA 95616 24 Hr. CL Report Monday, june 17, 2013 The time period of this report is from 7:00 a.rn. (prior office working day) to 7:00 a.rn. {current of?ce working day) i In Tim gf Insider}; Voyager RTP 06/ 14/13 House/Off Campus left campus without permission, assaulted staff, and ran into Oncoming traffic. (5 min) Rego?ing; Nicholas O'Dowd - Law Enforcement Contact Team Prone Assisting: Bryce Lumbard - Restraint Assisting: Christopher Bryce - Assault/Aggression Assisting: Brian Blanco Other Assisting: Anthony Aispuro-Sanchez Assisting: Kristan Warren Incident Report #1 80659 (Reference #:80569 worm M?me of I Motion?91.1mm Voyager RTP 06/15/13 House left the house through the back door and attempted to leave supervision by running off campus. While off campus, said want to kill myself" and began walking closer to the street. I used physical deterrence to prevent any danger. Reporting: Aaron Alston Other Assisting: Nicholas O'Dowd Other Assisting: Logan Hess Incident Report 80660 (Reference #:80660 BMW Bream Sapphire RTP 06/15/13 House reported to me that she was really depressed and wanted to die. Reporting: Annette Carbone Suicidal Ideation Incident Report 80662 (Reference #:80662 Sapphire RTP 06/16/13 Bedroom #1 made a statement while on the phone with her mother that she wanted to kill herself. Watt; Reporting: Ashley McLemOre - Suicidal Ideation Other Incident Report 80663 (Reference #:80663 in i ?nd _L.q_eti1P Widen; fIn' Sapphire RTP 06/17/13 House Brief At 7:10 AM on Monday June 17, 2013, - stated that she wanted to kill herself so she could be with her Dad. luggith Staff; I Dannrfinn- lanl: Tau'nr Cilirirlal Trinal'inn CONFIDENTIALITY NOTE 2 The documents accompanying this telecopy transmission may contain in formation that is con?dential and/or legally privileged. The information is intended only for the use by the indivrdual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000277 Fam?'es?kst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Mondays fame I7, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 a.m. (current office day) David Waites Other CONFIDENTIALITY NOTE 3 The documents accompanying this relecopy transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the indiVidual or enciry names on this transmit-salon sheet, If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000278 FamiliesE'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CCL Report Thursday, [une 20, 2013 The time period of this report is from 7:00 (prior of?ce working day) to 7:00 (current office working day) Incident Report 80676 (Reference #:80676 Mum Widens Voyager RTP 06/19/13 Campus became assaultive and disrespectful to staff after staff informed him that he could not be In the kitchen at the time. assaulted, went into a food bin without permission, left staff supervision, and was escorted to the Quiet Room. (1 min) NW Incidentms; Witnessing: Angela Lira - Restraint Escort Witnessing: Gary Volchanksy 0 - Assault/Aggression Standing Nicholas O'Dowd Other Regorting: Darius Randall Assiging: Adrian Mendoza Brian Blanco ECEIV BY: CONFIDENTIALITY NOTE I The documents accompanying this telecopy transmission may contain information that is con?dential and/ or legally privileged The information is intended only for the use by the indiVidual or entity names on this transmission sheet. If you are not the intended rCCipicnt, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this telecopy in error, plcuc notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000279 Fann'liesFirst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CCL Report Monday, lune 24, 2013 2 I, The time period of this report is from 7:00 Jim. iprior ?like working day) to 7:00 am. (current of?ce Working day) Incident Report 80688 (Reference #:80688 Emmi: Jade RTP 06/05/13 Sutter Hospital of Davis BY: was taken to Sutter Hospital to be Medically cleared come back to campus after she been out of supervision. Witnessing: Kirsten Loar Other Reporting: Johnny Tillis Jesus Zamudio Incident Report 80684 (Reference #:80684 I. E: .II plan I I. .l Voyager DTP 06/06/13 House left the house Without permission. Reporting; Nicholas O'Dowd - Long-Tenn Runaway Incident Report a: noose (Reference #:89686 2mm Trailblazer RTP 06/23/13 - Resource Center Winn; While on a home visit, - missed 2 separate dosages of his medication. Andrea Chiles - Med Error - Missed Dose at Home Incident Report 80685 (Reference #:80685 WW WEEDS Sapphire RTP 06/22/13 Dinning Room Child made a statement about wanting to kill herself. Bene?ting; Felicia Thomas - Suicidal Ideation CONFIDENTIALITY NOTE The documents accompanying this telecopy transmission may contain information that is confidential and/or legally priVilcged. The information is intended only for the use by the iridn'idual or entity names on this transmission sheet. If you are not the intended recipient. you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. lfyou have received this teleuipy in error, please notify us by telephone immediately so that we can arrange for the return of the original 3-2011 Incident Reports) 000280 Families?'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Monday, fune 24, 2013 The time period of this report is from 7002111. (prior of?ce working day) to 7:00 J.m. (current ot??cc working day) Incident Report 80688 (Reference #:80688 MW Emma: Widen: Jade RTP 06/05/13 - Sutter Hospital of was taken to Sutter Hospital to be Medically cleared come back to campus after she been out of supervision. Kirsten Loar Other 3:293:33; Johnny Tillis Jesus Zamudio Incident Report 80684 (Reference #180684 8mm Voyager DTP 06/06/13 House left the house Without permission. Wm: 3mm; Nicholas O'Dowd - Long-Tenn Runaway Inddent Report ems (Reference unit of Ing?dgng anagram WM Trailblazer RTP 06/23/13 Resource Center While on a home missed 2 separate dosages of his medication. In i - Reporting: Andrea Chiles - Med Error - Missed Dose at Home -) Incident Report at: 80685 (Reference #780685 MW Emnm WM Sapphire RTP 06/22/13 - Room Won; Child made a statement about wanting to kill herself. - Suicidal BY: JUN 25 20l3 CONFIDENTIALITY NOTE 1 The documents accompanying this transmission may contain information that is con?dential and/or legally The information IS intended only for the use by the indmdual or entity names on this transmissum sheet. If you are not the intended recipient. you are hereby noti?ed that any disclosure, copying, distribution, or tht? taking of any action in reliance on the contents of this information is strictly prohibited. if you have this in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you Thank ycw. PBS Front Line PRA Request (2013-2011 Incident Reports) 000281 Wednesday, lane 26, 2013 Fam'lies?'rs Inc. 3 2100 Fifth Street, Davis, CA 95616 0 . 24 Hr. CL Report lhe period of this report is from 7:00 a.m. (prior of?ce working day) to 7:00 a.m (current of?ce working day) Incident Report 80693 (Rotor-once #:80693 .l . I Voyager RTP 06/25/13 - Resource Center returned with less medication than he should have. Bene?ting; Angela Lira - Med Error - Missed Dose at Home CONFIDENTIALITY NOTE 1 The documents accompanying this talc-copy transmission may contain information that is con?dential and/or legally The Information is intended only {or the use by the individual or entity names on this transmismon sheet. If you are not the intended recipient. you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any actu in reliance on the contents of this telecopied information is strictly prohibited, If you have {CCt?th?tl this tclecopy to error, please notin us by telephone immediately so that we can arrange for the rctum of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000282 FamiliesFirst, Inc. 2100 Fifth Street, D3 W's, CA 95 CCL Report Thursday, june 27, 2013 2 7 The time period of this report is from 7:00 mm. 11 of?ce working day) to 7:00 a.mi (current of?ce wo y) 3? Incident Report 80690 (Reference #:80096 Emmi: Wm WM Pioneer RTP 06/12/13 House continued punching staff with extreme force on the stomach area. (14 min) Anthony Aispuro-Sanchez - Restraint Standing Adriana Escobar - Assault/Aggression Other Incident Report it: 80697 (neurone. #:00697 I. ".lu.ll plan n.l Voyager RTP 06/26/13 Davus Community made a statement. Eric Benoit Other Jason Wade Bugging Edgar Zamora Incident Report 80635 (Reference #:80695 "i 2mm Tim 1" WM Pioneer DTP 06/ 12/13 Davus was attempting to provoke peers and he was assaultlve toward staff. (20 min) mm I e: Reporting: Anthony Aispuro-Sanchez - Restraint Team Prone Assisting: Johnny Tillis - Assault/Aggressnon Standing John (Nick) Moriana CONFIDENTIALITY NOTE 1 The documents accompanying this telecopy transmission may contain information that is confidential and/or legally privxlegcd. The information is intended only for the use by the indivxdual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied in formation is strictly prohibited. If yOu have received this In error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you Thank y0u. PBS Front Line PRA Request (2013-2011 Incident Reports) 000283 FannZiesE'rs t, Inc. 2100 Fifth Street, w's, CA 95616 24 Hr. CL Report Frida y, june 28, 2013 The time period of this report is from 7:00 am. (print working div) to ":00 a.m. {current of?ce working day) Incident Repart 80703 (Reference #:80703 . .t Adventurer RTP 05/19/13 OutSIde Qunet Room A peer Indicated that she had given- a "hickey." Incident Sgg?: Incident Tyge: Reporting: John (Nick) Moriana - Allegation Incident Repart 80702 (Reference #:80702 8mm 9 unit 91 Insld?ns mm 23!; lime 9t Insider]: nt Adventurer RTP 05/19/13 Front of Campus grief Description: - ran away from campus and was out of super-VisuonJohn (Nick) Moriana - Law Enforcement Contact - Long-Term Runaway -) Incident Report 80698 (Reference #:80698 I .ll.?.ll EIEI. Pioneer RTP 06/27/13 Resource Center missed his 7 AM medication due to an error from the new pharmacy. Incident gaff: Incident Type: Reporting: Cristina Mendoza-Sanchez - Med Error - Missed Dose at FamiliesFirst - Incident Report 80699 (Reference #:80699 Bgng?i?g Lani; of Incident Ezggram Date Time of Incident Trailblazer RTP 06/27/13 ResourCe Center missed his 7 AM medication due to an error from our new pharmacy. Incident Staff: Incident Type: Reporting: Cristina Mendoza-Sanchez - Med Error - Missed Dose at FamiliesFirst Incident Report 80700 (Reference #:80700 Regg?ing Unit of Incident 393mm page 5 Time of Incident Locatlgn of Incident Trailblazer RTP 06/27/13 07 00PM Resource Center grief Description: - missed ms 7 PM medication due to an error from the new pharmacy. I . Et- . I Reporting. Andrea Chiles - Med Error - Missed Dose at FamiliesFirst CONFIDENTIALITY NOTE 1 The documents accompanying this telecopy may contain infommtion that is con?dential and/or legally privileged. The information is intended only for the use by the indmdunl or entity names on this transmisston sheet. If you are not the Intended recipient, you are hereby notified that any disclosurc, copying, distribution, or the taking of any action in reliance on the contents ofthis telecopietl information is suictly prohibited. Ifyou have received this [elm-copy In error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us .it no (ust to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000284 Farmlies?rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Fu'da y, func- 28, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 am. (current of?ce working day) Incident Report 80713 (Reference #:80713 I. ".lu .II DIEI. I I. Jade DTP 05/09/13 5th Street and Pole Line Rd. - was in her room asleep, she was awake due to a peer making a lot of noise. - went to the bathroom, got up, and went out the front d00r and left staff supervision going toward 5th Street. CRC was contacted and made police report. Reporting; Johnny Tillis - Long-Term Runaway Assisting: Marcos Almeida Incident Report 80705 (Reference #:80705 Emma) Adventurer RTP 05/19/13 Outside Quiet Room Wm A peer stated that she gave. a "hickey." Watt; Reusing; John (Nick) Moriana - Allegatlon Incident Report 80704 (Reference #:80704 WW EtogLam Wm Adventurer RTP 05/19/13 Front of Campus left campus without permission and was out of supervision for an extended period of time. With Wing; John (Nick) Moriana - Law Enforcement Contact - Long-Term Runaway - Incident Report 80708 (Reference #:80708 MIMI WM Jade RTP 05/19/13 - Outside Quiet Room A peer indicated that she had engaged in sexual conduct with- and had given- a "hickey." Reporting; John (Nick) Moriana - Allegation o- Incident Report 80701 (Reference #:80701 i .I . I Voyager RTP 06/27/13 Resource Center CONFIDENTIALITY NOTE 2 The documents accompanying this transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the mdivtdual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this tclecopied information is strictly prohibited. lfyou have received this telecopy in error, please notify us by telephone immediately so that WC can arrange for the return of the original doBBSr?ont ItinecPRA Req?eslt ((201 3-201 1 Incident Reports) 000285 FarmYJ'eers t, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Fn'da y, june 28, 2013 The time period of this report is from 7:00 a.m. (prior working day) to 7:00 am. (current of?ce Working day) missed his 7 AM medication due to an error from the new pharmacy. Imam Reporting: Cristina Mendoza-Sanchez - Med Error - Missed Dose at FamiliesFirst Incident Report 80711 (Reference #:80711 WWI): Emsnm Wooden; Went Jade RTP 05/24/13 - Resource Center missed her 3 PM and 7 PM medication, due to not being on campus during this time. Insidentjta?i Insidenllimez mm; Andrea Chiies - Med Error - Missed Dose at FamiliesFirst Incident Report 80712 (Reference #:80712 Widens 11an Went Jade RTP 05/24/13 Play Fields's Park, Davis Ca Won; Police of?cers located after she had run away from campus. One of -'s peers made a statement indicating a physical altercation etween_ and her peer. IncidenLSIatf: mixing; John (Nick) Moriana - Law Enforcement Contact "is 'n Antonio Garibay - Allegation Incident Report 80710 (Reference #:80710 anagram Widens Jade RTP 05/24/13 Front of Campus had run away from campus and was located Davis Police Of?cers. She also made statements regarding an incident at appened between her and a peer during? runaway episode. - was also attacked by a peer. Ming; John (Nick) Moriana - Law Enforcement Contact Antonio Garibay - Long-Term Runaway - Accident/Injury to Child - Allegation Incident Report 80707 (Reference #:80707 Widen: 2mm Sapphire RTP 05/19/13 Front of Campus was located in Rio Linda by SaCramento County Sheriff Deputies and was transported back to campus by them. Tun-- CONFIDENTIALITY NOTE 3 The documents accompanying this telecopy transmissmn may contain information that IS con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmissnon sheet. If you are not the intended you are hereby notified that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original duRBiSnanont Linecm Bequest??M 3-201 1 Incident Reports) 000286 FamiliesE'rst, Inc. 2100 Fifth Street, Da W's, CA 95616 24 Hr. CL Report Friday, lune 28, 2013 The time period of this report is from 7:00 a.m. (prior office working day) to 7:00 am. (current of?ce working day] Reporting; John (Nick) Moriana - Law Enforcement Contact Incident Report 80709 (Reference #:80709 WW 2mm mm mm Sapphire RTP 05/24/13 Play Fields?s Park, Davis Ca had run away earlier in the day and was located by Davis Police Officers. Wag; John (Nick) Moriana - Law EnfOrcement Contact Assisting: Antonio Garibay - Long-Term Runaway Incident Report 80706 (Reference #280706 Brennan: WW Sapphire RTP 05/19/13 Front of Campus i made several statements regarding alcohol consumption and sexual activity with her peers. She also had marks on her neck that were consistent with a bite. Incident?a?i Reporting; John (Nick) Moriana - Law Enforcement Contact Felicia Thomas - Accident/Injury to Child - Allegation Incident Report 80714 (Reference #:80714 WW anagram Voyager DTP 06/27/13 House assaulted staff repeatedly and was placed in a standing to a team prone restraint. (19 min) Adrian Mendoza - Restraint Team Prone Remains]; Marcos Almeida - Accident/Injury to Staff Standing Egpg?jm; Gary Volchanksy - Assault/Aggression Aaron Alston Assisting; Brian Blanco CONFIDENTIALITY NOTE 4 The documents accompanying this telecopy transmission may contain information that is confidential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied in formation is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original 3-2011 Incident Reports) 000287 Fam'liesE'rs Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Monday, july 01, 2013 The time period of report is ?01117.00 am. (piior office ?orking day} to 7:00 min. (current oft?ice working' day) Incident Report 80727 (Reference #:80727 i I. H. EIEI. .I . .I Trailblazer RTP 06/11/13 O7T4SPM House was upset and closed himself in the laundry room, holding the door shut then went to room and put a cord over his neck and looked for a place to tie lti Int Staf: Reporting: Whitney Shettler - Sutcndal Ideation A??l?fl?gi John (Nick) Moriana Other Incident Report 80724 (Reference #:80724 Jam?q?_?_R In Unit 01? Incid nt Emma: Incident. Jade DTP 05/15/13 02 02PM 5th Street and Pole Line Rd Brief Description: was wandering ar0und campus when I arrived to my shift and school staff asked me to swutch them out. I asked if she was okay, we walked around campus and checked-in. She agreed to that then she left supervusuon and staff shadowed her. - i Mtnessmg; Thomas - Long-lerm Runaway Witnessmg: Marcos Almeida Regomgg; Johnny Incident Report 80715 (Reference #:80715 Beggrting Unit of Incident Program Date Time of Incident Location of Incident Pioneer RTP 06/28/13 07 00AM Resource Center missed his 7 AM medication due to an error from our new pharmacy. Incident Reporting: Cristina Mendoza-Sanchez - Med Error - Missed Dose at FamiliesFirst Incident Report 80721 (Reference #:80721 I Mm fInl Trailblazer RTP 06/30/13 Resource Center caretaker forgot his medication at home. Incident Staff: Incident Type: Reporting: Ashley McLemore - Med Error - Missed Dose at Home CONFIDENTIALITY NOTE The documents nrt'onipanymg this (claim)! may (rmtzun information that is and/or legally privileged The information is intended only for the use by the indmdual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that :my disclm?urc, copying, distribution, or the taking of an}: action in reliance on the (mitt-tits of this telecopit-d information is strictly prohibited If you haw this telecopy in error. please notify us by telephone imiilediutel)? so that we can arrange for the return of the original domunt-ms to us no Cost til you Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000288 Fam'liesE'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Manda y, july 01, 2013 Tlu' tum~ period of this report is from 7 00 rim. (prior of?ct- working day) to ":00 (current (it-lice workingr day) Incident Report 80716 (Reference #:80716 I i. E.l . .n Trailblazer RTP 06/28/13 Resource Center missed his 7 AM medication due to an error from our new pharmacy. Incident gaff: i . Reporting: Cristina Mendoza-Sanchez - Med Error - Missed Dose at FamiliesFirst Incident Report 80723 (Reference #:80723 Reporting Unit of Incident Program Date Time of Incident MW Adventurer RTP 04/27/13 07.55PM Outsnde Qwet Room returned from being AWOL and began provoking and threatening peers. (40 min) Incident Staff: Incident Type: Restraint Type: Reporting Brian Blanco - Restraint Escort Reporting: Marcos Almeida - Assault/Aggrc55ion Quuet Room Assisting: Jared Hungerford Incident Report 80720 (Reference #:80720 Wander): anagram WW Location of Incident RTP 06/30/13 12 00PM Resource Center While on a home vrSIt, - missed an entire day of his medications due to not havmg them at the time Inci nt 1? Ashley McLemore - Med Error - Missed Dose at Home Incident Report 80726 (Reference #:80726 . l! .l . I I Hiram Iim: 9t nt Jade RTP 05/25/13 5th Street and Pole Line Rd grief Description: - woke up and asked for the time. When staff told her the time, she responded by saying ?on shitl I am late." When staff asked - what she was late for, she responded by saying was suppose to meet my friend at the park." - left supervnsuon. Ln__ecld mt Insulating; Rgporting; Johnny Tillts - Long-Term Runaway Incident Report 80717 (Reference #:80717 CONFIDENTIALITY NOTE 2 The documents accompanying this transmission may tt?mtmn information that is con?dential and/oi legally The information is intt-ndc'd only tor the use by the individual or names on this transmismon slit-ct. If you are not the intended recipient, you are hereby noti?ct?l that any disdosurc, Copying, distribution, or the taking, of any action in reliance on the contents of this ti'lccopicd information is strictly prohibited. If you received this copy in error, please notify us by immuliuicly so that we can arrange for the return of the original documents to us at no cost to you. 'l'hmik you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000289 Fann'liesE'rst, Inc. 2100 Street, D3 W's, CA 95616 24 Hr. CL Report Monday/111}! 01, 2013 The time period of this report is from 7.00 an). (prior of?ce working day} to 7:00 am. (current of?ce. working dayVoyager RTP 06/28/13 - Resource Center missed ms 7 AM medication due to an error from our new pharmacy. In i eff: Insident Type: Reporting: Cristina Mendoza-Sanchez - Med Error - Missed Dose at FamiliesFIrst Incident Report 80725 (Reference #:80725 Reporting Unit of Incident Program Date 8: Time of Incident Jade RTP 05/25/13 5th Street and Pole Line Rd woke up and went to the bathroom to take a shower then went towards the front door. Staff attempted to re-dlrect er to the house, but she refused and repeatedly said that she had somethan to do off campus. Repo?ipg: Johnny - Long-Term Runaway Incident Report #2 80722 (Reference #:80722 Reportingumt of Incident Program Date Timeot Incident Locationounsjdent Sapphire RTP 06/30/13 05 45PM Bedroom asked to speak to me privately, after which she asked If she could be hospitalized because she felt like killing herse . also proceeded to talk about mcndents that happened in her past. Incident 5gp: Incident Type: John (Nick) Moriana - SUICldal Ideatton Claudia Vazquez Other Andrew CONFIDENTIALITY NOTE 3 The drxtummls accompanying this tilt-copy transrriissinn may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individqu or entity names on this transmission sheet. ll- you are not the. intended recipient, you are hereby noti?ed that any disclosure, copying, distribution? or the taking of any action In reliance on the contents of this Iclccopicd information is strictly prohibited. lfynu havu received this in error. please notify us by immediately so that we can arrange. for tlii: ?turn of the original documents to us at no cost in you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000290 FamiliesFimt, Inc. 2100 Street, Davis, CA 95616 24 Hr. CL Report Tuesday, july 02, 2013 'lhe time period of this report is from 7:00 am. (prior otTICe working day) to 7:001Lm. (current of?ce working day) - Incident Report 80732 (Reference #:80732 Brown Voyager RTP 07/01/13 - Resource Center returned with less medication than he should have. Insidentjtam Reporting; Angela Lira - Med Error - Missed Dose at Home Incident Report 80734 (Reference #:80734 83W Bantam Jade RTP 05/29/13 - House left campus without permission and left staff's supervision. Witnessing: Eduardo Villalobos - Law Enforcement Contact Reporting; Kyle Other Stephen Lee Incident Report 80731 (Reference #:80731 WW 2mm Went Widen: Voyager DTP 07/01/13 House made a statement. Reporting: Edgar Zamora Other JUL 32 2013 .-.7 CONFIDENTIALITY NOTE 1 The documents accompanying this transmission may contain information that is con?dential and/ or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended you are hereby noti?ed that any disclosure, copying, distnbutioa, or the taking of any action in reliance on the contents of this telecopted information is strictly prohibited. If you have received this in error. please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000291 Fatm'IiesE'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Wednesday, july 03, 2013 The time period of this report is from 7:00 am. (prior of?ce working day) to 7:00 n.m. {current office working day) 95 38/3 Incident Report it: 80744 (Reference #:80744 2mm Sapphire DTP 05/14/13 - House left the house wuthout superviswn and began to walk toward the front of campus. I attempted to verbally de-escalate er by asking what was wrong and how I could help, but she refused my help and left campus. Incidenslum Reporting; Aaron Alston - Long-Term Runaway Incident Report 80745 (Reference #:80745 Sapphire DTP 05/29/13 - Activity Center While participating in a recreation actiwty,- left the center and campus with several of her peers. mm Aaron Alston - Law Enforcement Contact Egpg?mg; Andrew Enright JOhn (Nick) Moriana Incident Report it: 80747 (Reference #:80747 Widen: Emigrant Wat Ranger DTP 05/30/13 - Outside Basketball Court was placed on 24 hour stop by dinical.- left Ranger House Without permission and attempted to leave campus with other peers. (10 min) Matthew Bettencourt - Restraint Team Prone David Waites - ACCIdent/Injury to Child Standing Nicholas Rhodes 0 - Assault/Aggression Witnessing; Kamika Sherwood witnessing; Hilary Sleuter Reporting; Kyle Gariick Assisting; Stephen Lendzion Melissa Van Sambeek Assisting: Erin Incident Report 80743 (Reference #:80743 Bantam Sapphire DTP 04/29/13 House was attempting to get involved with two peers who were already in restraints in the same room. CONFIDENTIALITY NOTE The documents accompanying this transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet, If you are not the intended you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. lf you have received this telcc0py in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000292 Farm'IiesFirst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Wednesday, july 03, 2013 The time period of this report is from 7:00 a.m. (prior officc working day) to 7:00 a.m. (current of?ce working day) Mug; Kyle Garlick - Restraint Team Prone Eduardo Villalobos - Accident/Injury to Child Standing Oscar Lopez 0 - Assault/Aggression 5151M Mlsaki Curtis CONFIDENTIALITY NOTE 2 The documents accompanying this transmission may contain information that is con?dential and/ or lcgally privileged. ?le information is intended only for the use by the Indiwdual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. if you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000293 Fam'lies?rs t, Inc. 2100 Fifi]: Street, Davis, CA 95616 24 Hr. CL Report Monday, july 08, 2013 The time period oftliis iepoit is from 7.00 an). (prior office working day) to 7:00 am. (Curient office working day) Incident Report 80813 (Reference #:80813 332mm i ofIn id Brogan Widen: Pioneer RTP 07/07/13 Bedroom #3 Child was contained after repeatedly and forcefully, throwmg hard plastic and metal objects, and forcefully scratching me. Child sustained minor redness to pre-existing abraSion. Basnc First-Aid (antibiotic Ointment) applied. (23 min) Reporting: John (Nick) Moriana - Restraint Team Prone A?Sistingz Adnana Escobar - ACCIdent/Injury to Child Standing 0 Assault/Aggressnon Incident Report 80804 (Reference #:80804 unit of Incident Em gage Time 9! i Sapphire DTP 07/05/13 Livmg Room Brief Description: During community meeting, - told me that she was haying SUlCldal thoughts. witnessmg Gary Volchanksy Other Annette Carbone Incident Report 80807 (Reference #:80807 I. ?.lu.ln! u.ln Sapphire RTP 07/06/13 Bedroom #1 grief On Saturday July 6, 2013 at 1 47 AM, informed me that she did not actually take her evening medications. She instead pretended to take them, and later rough them in the trash. Leola Taylor Other Incident Report 80812 (Reference #:80812 Mum Tim In i Went Sapphire 07/06/13 House walked out of the house without permissmn. - stated that if she didn't go to the hospital; that she wou .i herself. Witnessing: Annette Carbone Other Mm Christian thlela Other ?itgessing: Logan Hess Reporting: Marcos Almeida ASSisting: Gary Volchanksy A?Sistingz Martin Melgoza CONFIDENTIALITY NOTE The documents accompanying this telecopy may contain information that is confidential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. lfynu have received this tilt-copy in error, please notify us by telephone immediater so that we can arrange for the return of the original documents to us at no cost to you. 'l'hzmk you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000294 Fann'liesFirst, Inc. 2100 Fifth Street, Davis, CA 95616 241-11: CCL Report .. 7 Tuesday, fuly 09, 2013 The time period of this report is from 7:00 am (prior of?ce working day) to 7:00 am. (current of?ce working day) ?fncident Report 80826 (Reference #:80826 Emmi]: Mom i In i Pioneer RTP 07/08/13 - House was hitting the Window, pushing staff, and throwmg objects at staff's face. (19 min) i ff: I Reporting: Adriana Escobar - Restraint Team Prone ASSIsting: Edgar ZamOra - Assault/Aggresson Standing Other Incident Report 80827 (Reference #:80827 Emmi; Widen: Location of Insigth Voyager RTP 07/08/13 09.55PM Bedroom #4 Brief Description; Child was contained after repeatedly and forcefully hitting and kicking me. Child sustained redness and soreness to both arms and left knee. First-Aid (Ice) offered and refused. (44 min) Ingiggng ?t?ff: Ingidgng Type: Witnessmg; Eric Benont - Restraint Team Prone Reporting: John (Nick) Monana - to Child Standing ASSisung: Adrian Mendoza - Assault/Aggressuon CONFIDENTIALITY NOTE The documents accompanying this transmission may contain information that is con?dcntial and/or legally privileged. The information is only for the use by the individual of unity names on this transmission sheet. If you arc not the intendt?d recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in on the of this iclccopicd information is strictly prohibited. If you havc this in error, please notify us by immediately so that we can arrange for the rctum of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000295 FarmliesFirst, Inc. 2100 Fi?/1 Street, Davis, CA 95616 24 Hr. CL Report Wednesday, july 10, 2013 The time period of this rcpt)? is from 7:00 a m. {prior office working day) to 7:00 am. (Current oft-ice working day) Incident Report 80835 (Morean #:80835 Emma: Wm Voyager NPS 07/09/13 - Program Break Room made a statement about staff. Indium Michelle Glicksman - Allegation David Waites Incident Report it: 80834 (Reference #:80834 Wm Bantam Ti Lions NPS 07/09/13 Timberwolves was hitting, kicking, and spitting on staff until they could no longer evade in the NPS hallway. (8 min) Matthew Bettencourt - Restraint Team Prone Leon Jones 0 - Accident/Injury to Child Kyle Garlick 0 - Accident/Injury to Staff Assisting: Brett Atwood - Assault/Aggression Eduardo Other A??is?ingz David Waites ECEIVE JUL 2 206 CONFIDENTIALITY NOTE 1 The documents accompanying this telceopy transmissmn may contain information that is con?dential and/or legally The information is intended only for the use by the indivxdual or entity names on this transmission sheet. If you are not the intended you are hereby notified that any disclosure, copying, distribution, or the taking of any action in reliance on the. contents of this information is strictly prohibited. If you have received this telecopy in error, please notin us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000296 Farm'II'esE'rs t, Inc. 2100 Fifth Street, D3 Vis, CA 95616 24 Hr. CCL Report Manda y, july 15, 2013 'l?hc timc pcriod (iltliis rcpoit is from 7:00 (prior of?cr working day} to 7:00 (current ofl'icc working day) Incident Report 80850 (Reference #:80850 . l! .l . I I Eng?m Dam In?: 9! Inm?ggn; id Pioneer RTP 07/14/13 Bathroom #2 sprayed his mouth wuth Axe body spray and threw up. Peison Control was notified and they informed us that would be fine and not reqUIre further medical care. 1 Reporting Nolan Bradley 0 - Acetdent/Injury to Child A55isting: Angela Lira Other Incident Report #2 80851 (Reference #:80851 in Unit In Bantam Tim of I i Pioneer RTP 07/14/13 - Bedroom #3 Brief Description: kicked his bedroom Window forcefully With his shoes on, past clear limit to stop because the wmdow could break. asked to have his gauze and tape redone on his left arm. Go home he tore off a Band-Aid that meshed to his skin. (13 min) Wlohn (Nick) Moriana - Restraint Standing Witnessmg Onna Juarez - ACCIdent/lmury to Child Reporting: Nolan Bradley 0 - Assault/Aggressmn A55isting' Edgar Zamora Other Incident Report 80845 (Reference #:80845 ?n nit of In i Date Time of Incident WM Sapphire RTP 07/12/13 In Front of the Resource Center Child stated that she didn't want to go to school today because of feeling smcidal. In i aff: 15mm Reporting: PatriCIa Button Other Incident Report 80848 (Reference #:80848 Emmi: w?m In mammogram Sapphire RTP 07/13/13 House approached me and said "These v0ices in my head keep telling me to kill myself." I asked - how long this has been 90an on and she replied "they always tell me to do it." 141?129." i ent Reporting: Aaron Alston Other Assisting: Lanai O'Brian Incident Report 80852 (Reference #:80852 D-nnrfinn 'Inil- n5 Brant-am g. 13mg n? anidnn. I nesOinn n' CONFIDENTIALITY NOTE The documents accompanying this iclccopy transmission may contain information that is con?dential arid/or lcgally privilt-grcl. The information is intended only tor the use by indn'idual or cntity names on this transmissmn Sllt'Cf. If you arc not the intended rt'itipicnt, you :irc noti?ed that any disclosure, copying, distribution. or the taking of any action in reliance on the contcnis of this lClt'COPlL'tl information is strictly If you have received this in error, plcasc notify us by telephone immediately so that we can arrange for the return of the original to us at no Cost to you. 'l?hank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000297 FamiliesFirst, Inc. 2100 Fi?h Street, D3 W's, CA 95616 24 Hr. CL Report Monday, fuly 15, 2013 The time period ofthis report is from 7'00 am. (print office working day) to 7:00 am. (current oft-Ice workingr day) Sapphire RTP 07/14/13 Room stated that she was hearing vomes, telling her to harm herself. nt ff: Regorting: John (Nick) Monana Other Incident Report 80853 (Reference #:80853 WW Emmam mm mm: Sapphire RTP 07/14/13 Dinning Room grigg peggringign: - stated that she was raped for 4 years Reporting: Onna Juarez Other CONFIDENTIALITY NOTE 2 The documents accompanying this transmission may contain information that is Confidential and/ or legally privileged. The information is intended only for the use by the Indiwdual or entity names on this transmission sheet If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or the taking of any action In reliance on the contents of this tcleropicd information is strictly lfyou have received this lL'lccopy in ertor, please notify us by telephone immediame so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000298 Familicerst, Inc. 2100Fi1'tb Street, Dan's, CA 95616 24 Hr. CL Report Frida y, ?lly I9, 2013 The time period of this report is from 7:00 am. (print of?ce working day} to 7:00 am. (current of?ce workingy day) Incident Report 80869 (Reference #:80869 2mm Voyager DTP 07/18/13 Gym/Front of Campus attempted to leave campus without permission and pushed into staff who attempted to deter him. mug; Bryce Lumbard - Assault/Aggression Nicholas O'Dowd Other Oscar Lopez Rebecca Jones Assisting: Christopher Bryce CONFIDENTIALITY NOTE 1 'l?hc documents accompanying l?lHS transmission may contain information that is con?dc'n?al andfor lr?gally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any copying, distribution, or the taking of any action in reliance on the Contents of this information is strictly proluhitcd. If you have this Iclccopy in error, please notify us by telephone immediately so that we can arrange for the rcturn of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000299 FamiliesE'rst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Monday, july 22, 2013 The umc perxod of this report IS from 7200.1.m. {prior of?ce working day) to 7:00 am. {current uf?cc workmg day; Incident Report #t 80874 (Reference #:80874') Wu! 2mm Widen: Voyager RTP 07/ 19/13 Resource Center missed his 7 AM medication due to insurance issues. Crustlna Mendoza-Sancnez - Med Error - Mussed Dose at FamiliesFIrst CONFIDENTIALITY NOTE I The documents accompanying (clccopy may cuntum that us con?denth and/m legally privileged The mformauon IS only for the use by the mdwudual or entity names on sheet. If you arc not the reapicnt, you are hereby noti?ed that any copying. distribution, or the taking of any action in (chance on the contents of this [ck-copied Information is smcu'y If you have thin telecopy In crror. please nonfy us by tolephonc so that wc can atrangc for the return of the ongmal documents to us at no cost to you Thank you PBS Front Line PRA Request (2013-2011 Incident Reports) 000300 FamzZiesE'rst, Inc. 2100 Fifth Street, D3 W's, CA 95616 24 Hr. CL Report Monday, fuly 22, 2013 'l?hc time period (if this rcport is from 7:00 a.m. (prior oft-ice working day) to 7:00 am. (Lurtunt of?cc working day] Incident Report it: 80874 (Reference #30874 2mm Voyager RTP 07/19/13 Resource Center missed his 7 AM medication due to insurance issues. mm Cristina Mendoza-Sanchez - Med Error - Missed Dose at FamiliesFirst CONFIDENTIALITY NOTE Th: accompanying this transmission may contain information that is confidential and/"or lcgally privileged. 'nic information is intended only {or the use by [lii? indiVidual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this tulecopicd information is Strictly prohibited. If you have received this In Cttor, plcasc notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000301 Inc. 2100 Street, Davis, CA 95616 24 Hr. CL Report Friday, fuly 26, 201.3 The tune permd of this report Is from 7:00 a In. (prior of?ce working day) to 7:00 am. (current of?cc working day) - Incident Report 80893 (Reference #380893 I. .II .II I I. fill I Voyager RTP 07/25/13 Around Campus punched and spit on staff. He also left the house without permission. Wag; Nicholas O'Dowd - Assault/Aggression Marcos Almeida Other Assisting: Gary Volchanksy A??i?ting: Brian Blanco CONFIDENTIALITY NOTE I The tlot uments accompanying thIs telecopy may contain Information that Is con?dential and/or legally The Inform-anon Is Intended only for the use by the or entity names on (Ms sheet. If you are not the Intended reciptent. you are hereby noti?ed that any copymg. dIstrIbutton, or the takmy~ of any action In on the contents of this It'lticnpletl Informanon is lt' you have recewed thIs Ielecopy in error, please notify us by telephone immediately so that we can arrange for the return of the documents to us at no eost to you. 'I'hnnk you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000302 Fam?iesFirst, Inc. 2100 Fifth Street, Davis, CA 95616 24 Hr. CL Report Monday, july 29, 2013 The time period of this report is from 7:00 am. (prior office working day) to 7:00 am. (current office working day) Incident Report 80900 (Reference #:80900 I. Elan I II Pioneer RTP 07/27/ 13 House Expecting a day visit from mom,- began a ritual where he strips naked before the visit. No hands on restraint took place or injury to client or staff. Shamiya Ali Other Witnessing: Anthony Gonzales mm; Anthony Aispuro-Sanchez - Incident Report 80901 (Reference #:80901 WW ?tment Widen! MW Voyager RTP 07/28/13 - House was hitting the glass on the TV, punching, and kicking staff. He continued kicking staff violently during the standing and we went into a team prone. (42 min) Nolan Bradley - Restraint Escort John (Nick) Moriana 0 - Assault/Aggression Team Prone RgmgIng: Adriana Escobar standing 555153133; Edgar Zamora CONFIDENTIALITY NOTE The documents accompanying this telecopy transmission may contain information that is con?dential an privileged The information is intended only for the use by the indiwdual or entity names on this transmis you are not the intended moment, you are hereby notified that any disclosure, copying, distribution, or any action in reliance on the contents of this ielecopied information is strictly prohibited. Ifyou have telecopy in error, please notify us by telephone immediately so that we can arrange for the return of ti documents to us at no cost to you Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000303 Inc. 2100 Street, Davis, CA 95616 24 Hr. CL Re art Tuesday, Ju1y30, ?13 I The time period of this report is from 7:00 am. (pm) office working day) to 7:00 am. (current of?ce workingiay - BY- Incident Report 80907 (Reference #:80907 I. I I Pioneer RTP 07/29/13 Living Room - reported to Leon Jones that a staff member hit him in the face with a door. 5mm Leon Jones 0 - Allegation Incident Report 80908 (Reference #:80908 2mm WW Pioneer RTP 07/29/13 Pioneer Hallway became argumentative and assaultive over not being able to brush his teeth cause another peer was using the bathroom. After being assaultive,- was phy5ically guided into a quiet room and the door was shut. witnessing: Eduardo Villalobos - Restraint Quiet Room David Waites - Assault/Aggression Wm; Kyle Garlick Other Incident Report #2 80905 (Reference #:80905 I. ?ilu.ll Elan. I I. Voyager RTP 07/29/13 Voyager House was hitting, kicking, and forcefully pushing into several staff members; he ran toward the front of campus, staff tried to physically deter him, and when he refused to stop pushing into us, we were forced to initiate containment. Patrick Oleson-Wheeler - Restraint Team Prone Rachel Fader - Accident/Injury to Child Standing Ryan Banks 0 - Assault/Aggression Islam Hassanein Other Assisting: Edgar Zamora Incident Report 80906 (Reference #:80906 Emram Voyager RTP 07/29/13 Child's bedroom Child was contained for forcefully punching staff, close-fisted, with a metal prong sticking out of his knuckles. John (Nick) Moriana - Restraint Team Prone Edgar Zamora - Assault/Aggression 3mm Patrick Oleson-Wheeler Ryan Banks CONFIDENTIALITY NOTE 1 The documents accompanying this talc-copy may contain information that is confidential and/or legally privileged The information is intended only {or the use by the or entity names on this If you are not the intended retipicnt. you arc hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original 3-2011 incident Reports) 000304 Famr'liesFirst, Inc. 2100 Fi?b Sweet, Davis, CA 95616 24 Hr. CCL Report Tuesday, fab! 30, 2013 The time period of this report is from 7:00 a.mr (prior of?ce working day) to 7:00 am (current office working day) Incident Report #2 80907 (Reference #:80907) 2mm Wooden: Pioneer RTP 07/29/13 Living Room reported to Leon Jones that a staff member hit him in the face with a door. mum Leon Jena 0 - Allegation Incident Report 80908 (Reference #:80908 Widens anagram WW Pioneer RTP 07/29/13 Pioneer Hallway - became argumentative and assaultive over not being able to brush his teeth cause another peer was using the bathroom. After being assaultive,- was physically guided into a quiet room and the door was shut. Mugging; Eduardo Villalobos - Restraint Quiet Room David Waites 0 - Assault/Aggression Kyle Garlick omer Incldent Report 80905 (Reference #:80905 WW Emsnm Voyager RTP 07/29/ 13 Voyager House was hitting, kicking, and forcefully pushing into several staff members; he ran toward the front of campus, staff tried to physically deter him, and when he refused to stop pushing into us, we were forced to initiate containment. Patrick Oleson-Wheeler - Restraint Team Prone Mpg; Rachel Fader - Accident/Injury to Child Standing Ryan Banks 0 - Assault/Aggression Islam Hassanein Other Edgar Zamora Incident Report 80906 (Reference #:80906 anagram Voyager RTP 07/29/13 Child's bedroom Child was contained for forcefully punching staff, close-fisted, with a metal prong sticking out of his knuckles. John (Nick) Moriana - Restraint Team Prone Witngsing: Edgar Zamora - Assault/Aggression 3922mm; Patrick Oleson-Wheeier Ryan Banks CONFIDENTIALITY NOTE The documents accompanying this telecopy transmission may contain information that is con?denti d/or lc lly privileged. The information is intended only for the. use by the individual or entity names on this trans ?sim?. [i you arc not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, ng of any action in reliance on the contents of this tclecopicd information is strictly prohibited. If you hav - in error. please notify us by telephone immediately so that we can arrangc {or the return 0 879* in documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000305 2100 Fifth Street, Davis, CA 95616 24 Hr. CCL Report 3, I . Fanu'liesFirst, Inc. Wednesday, 31, 2013 The time period of this report is from 7:00 a.m. (prior office working day) to 7:00 mm. (current of?ce working day) Bing/x Incident Report 80909 (Reference #:80909 . . Pioneer RTP 07/30/13 Game Room got upset over having to come out of the game room. He threw a Wii remote, tried to grab the batteries from staff, an grabbed staff?s left breast. Witnessing: Melissa Van Sambeek - Sexualized Behavuor Reporting: Sarah Tingey - Assault/Aggression Assisting: Eduardo Villalobos Incident Report 80915 (Reference #380915 - . I. .II EIEI II Sapphire DTP 07/30/13 Dinning Room stated that she was abused in the past, and mentioned that- was being abused. CRC and clinical on-call were noti?ed, and a. report was written. Claudia Vazquez Suspicion of Abuse - parent to child Bepgrting: Islam Hassanein - Allegation Andrew Enriglit CONFIDENTIALITY NOTE 1 The documents this telecopy transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission If you are not the intended recipient, you arc hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. It'ynu have received this in error, please notify us by telephone mmicdiatch' 50 that we can arrange for the return of the original 3-2011 Incident Reports) 000306 Fanu'liesE'rst, Inc. 2100 Fifth Sweet, Davis, CA 95616 24 Hr. CL Report Monday, August 05, 2013 The timc period of this report is from 7:00 am. (pnor office Working day) to 7:00 am. (current of?ce working day?- Incident Report it: 80929 (Reference #:80929 Bream Sapphire RTP 08/04/13 House Child stated that it would be easier if she were dead. Rggoning: Andrew Enright - Suicidal Ideation ECEIVE AUG 6 93:3 . H. 7 . CONFIDENTIALITY NOTE The documents accompanying this telecopy transmission may contain information that is con?dential and/or legally privileged. The information is intended only for the use by the indmdual or entity names on this transmissmn sheet. It you are not the intended reapient? you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this l?elecopied information is strictly prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you. 'l'hunk you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000307 FamiliesHmt, Inc. 2100 Fifth Street, Dams, CA 95616 24 Hr. CCL Report Tuesday, August 06, 2013 The time period of this repoit is from 7:00 a.m. (prior ot't'ice working clay) to 7:00 mm. (current of?ce Working day) Incident aosas i-(Rcference #:80938 a) Sapphire RTP 08/05/13 - Outside of Resource Center The child began wildly punching staff, so we initiated containment. (24 min) Witnessing: Kristan Warren - Restraint Team Prone Reggm'ng: Andrew Enright - Accident/Injury to Child Standing Islam Hassanein - Accident/Injury to Staff Assiging: John (Nick) Moriana - Allegation Assisting; Adrian Mendoza - Assault/Aggresscon Remnant Brennan: MW Sapphire RTP 08/05/13 Front of Campus Winn; Child attempted to run into traffic, which at that point we initiated an escort off the street. Once we got into the Sidewalk, we remained in a standing. She began to try to struggle out, which at that point we transitioned into a team prone. (35 min) In :idmn San. Inning?; In?; 353mm; 112;; Islam Hassanein - Restraint Escort Mug; Adrian Mendoza 0 - Assault/Aggression Team Prone Assisting: Ashley McLemore Other Standing Assisting: John (Nick) Moriana Remnant [imam WW Sapphire RTP 08/05/13 03 Bleachers - Following a containment, - stated that a staff member made comments about her body parts. She also stated that she hit this staff member multiple times and was struck in the during her assault to him. John (Nick) Moriana 0 - Allegation gem Courtney Ghilain Assisting: Andrea Guthrie 2mm Wooden: Sapphire RTP 08/05/13 Front of Campus Child hit staff in the face which we then initiated a standing. We then escorted her to the front of the Resource Center where we ended up in a standing. (28 min) Witnessing: Islam Hassanein - Restraint Escort Adrian Mendoza 0 - Accident/Injury to Staff Standing John (Nick) Moriana Other Standing Johnny Tillis CONFIDENTIALITY NOTE 1 The documents accompanying this telecop)? transmission may contain information that is Confidential legalh' The information is intended only for the use by the indiVidual or entity nan'ies on this transmission sheet. if you are not the intended recipient, you are hereby noti?ed that any disclosure. copying, distribution. or the taking of any action in reliance on the contents of this telempied tnforination is strictly prohibited, lt'i-oi: have received this teiecnpy in error, please notify us by telephone immediately so that we can arrange for the return of the original documents to us at no cost to you Thank you PBS Front Line PRA Request (2013-2011 Incident Reports) 000308 Inc. 2100 Street; D3 Iris, CA 95616 24 Hr. CL Report Tuesday, August 06, 2013 The time period of this: repurr is from 7:00 am. (prior rift-Ice working day} in 7:00 am {Current nil?ice working day} in of In Date Tim: of Incidgnt Locatign 9f Sapphire RTP 08/05/13 House Brig: Descripjjon: Child remitted statements that staff had been ieering at her inappropriately and asked for help in doing repair work with that staff. i an ff: In i Ryan Banks 0 - Allegation Aggi?ting: Ashley McLemore CONFIDENTIALITY NOTE 2 The diK?UH?IC?fi-?u acenmpenying this teleenpy [ransmih?smn min Contain Ililiimmnun that 151 Con?dential and/m" legally privileged. The infun?n?tnm is intended mil}: for [he use by the Individual nr entity names on this ?beer. lf you are not the intended recipient you are hereby notified that any tliselnsure, copying, nr the taking of. any action in reliance [m the contents of" this telempied infurirmtiun is strictly prnhil?nlied. ll'l?nu have. ieceived this teleeupy in eri'm. please until-y US by telephone ll?l?IITILTdizltle.? an that we can arrange fur the return nl? l'hc nfignml documents us at nu rust In you l"n:1nl< you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000309 Fann'IJ'esFI'rst, Inc. 2100 Fz?h Street, Davis, CA 95616 24 Ht. CL Report Monday, August 12, 2013 The timc pcriod of this rcpm?t is from .200 mm. (prior office working day) to 700 :i.m (current of?ce working day) Incident Report 80959 (Reference #:80959 . - . I: I I I. .l . Voyager RTP 08/09/13 Hallway forcefully threw hard objects, kicked and punched staff a standing containment was Initiated (1 min). - continue to struggle and kick staff so we tranSItIoned to a team prone (20 min). 1M I ff! Mn i w1tnessmg: Gary Volchanksy - Restraint Team Prone reporting: Rebecca Jones 0 Assault/Aggressmn Standing am Andrea Chiles assisting Christopher Bryce Incident Report 80960 (Reference #:80960 I. H. .II DIEI. .l int Voyager RTP 08/11/13 08 15PM Game Room became assaultive we then initiated a standing. he then began to struggle out and assault us which we then transntioned Into a team prone. (13 min) Incident gaff: i reporting: Adrian Mendoza - Restraint Team Prone Ryan Banks 0 - Assault/Aggressnon Standing ,3 Steven Sontag Incident Report 80961 (Reference #:80961 21:29am Tim of In i new Voyager RTP 08/11/13 - 10 13PM Voyager - began to bite, punch, grab, and lek us when he could not have cake, ice cream, and brownies. After multiple attempts to evade and repeated assaults, we Initiated a restraint. (15 min) Insiggn; sgg?- Iggiggnt Tyne: Begum; 119g; Witnessmg: Chl'lS Marshall - Restraint Team Prone wutnessmg: Marcel Game 0 - Assault/Aggressaon Standing $023109; H655 Adrian Mendoza CONFIDENTIALITY NOTE 1 'l?hc documents accompanying this transmiss'ion may contain information that is con?dential and/or legally privilcgul. The information is intended only for usc by the indn'iduul or entity names on this transmission slicct. lf you arc not the intended recipient, you are hereby notificcl that any disclosure, copying, distributu?m. or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have this tt'lccopy in error" please notify us by immediately so that we can arrange for the return of original documents to us .it no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000310 Familicsli'irst, Inc. 2100 Fifth Smear, Dan's, CA 95616 24 Hr. CCL Report Tucsda y, August 13, 2013 The time period of this report is from 7:00 a.m. (prior office working day) to 7:00 am. (current of?ce working day) Incident Report 80963 (Reference #:80963 Emma Voyager RTP 08/12/13 Front Porch Child became very assaultive and aggressive which at that point we initiated a standing. he then began to spit and try to break out of containment so we transitioned into a team prone. (19 min) witnessing; Islam Hassanein - Restraint Team Prone [gm Adrian Mendoza 0 - Assault/Aggression Standing Ryan Banks gigging; Andrew Incident Report 80964 (neremnce #:80964 mam Voyager RTP 08/ 12/ 1 3 Hallway Child became assaultive which we then initiated a team prone. (17 min) 1392mm; Adrian Mendoza - Restraint Team Prone assisting; Ryan Banks 0 - Assault/Aggression Andrew Enright ECEIVE CONFIDENTIALITY NOTE I The documents accompanying this telecopy transmission may contain information that is con?dential and/or legally privdcged. The information is intended only for the use by the indiwdual or entity names on this transmission sheet. ll' you are not the reapient, you are. hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this telecopicd information is strictly prohibited. lfyou have received this telecopy in error, please notify us by telephone immedialcly so that we can arrange for the return of the original documents to us at no cost to you. Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000311 FamiliesE'rst, Inc. 2100 Street, Dz Vis, CA 95616 24 Hr. CL Report Tuesday, September 03, 2013 The time period of this report is from ":00 a.m. (prior of?ce working day; to 7:00 am. (current working day) -) Incident Report 81030 (Reference #:81030 Eggoging Uni; of Ingiggng Erggram Timg of Incidgng MW Voyager RTP 08/31/13 Dining Room grief Qescription: Assault to staff and trying to hurt himself. Standing and Team Prone {30 minutes) lacing?: Staff. prg; In Wag; Brian Blanco - Restraint Team Prone reporting: Thomas - Suicidal Ideation Standing aSSisting: Aaron Alston 0 - Assault/Aggressmn assmtung: Christopher Bryce CONFIDENTIALITY NOTE The documents accompanying this telecopy transmission may contain information that is confidential and/or legally privileged. The information is intended only for the use by the individual or entity names on this transmission sheet. If you are not the intended recipient, you are hereby noti?ed that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this TL?lt?Ct)piL?tl information strictly prohibited. ?you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the return ofthe original documents to us at no cost to you Thank you. PBS Front Line PRA Request (2013-2011 Incident Reports) 000312