Glen Mills Schools Serious Incident Report NOTE: A and a Serious Incident Report are two separate reporting processes. The HCSIS is rcquirld by the state and the Serious Report Is requested by Probation. when a serious Incident occurs, both reports must be suhmitted within 24 hours. A serious incident report is required (or (but not limited to) the following reasons: an arrest, a child lino tor sexual abuse, physical abuse, an Injury from a restraint, an injury requiring medical treatment, a medical condition requiring hospital treatment or an incident of self -harm. Date 8r Time: July 20. 2016 at 9:32 AM Location: Johnson Hall Employee Name: Jim Lindouist Supervisor Name: Sean Cosgrove Title/Position: Team Leader. Johnson Hall Description of incident: At 3:05 PM on Thursday, July 2013, resident_ Philadelphia. DOB- was sitting on a couch and arguing with several siudents during 3 Guided Group interaction session in the lower recreation area of Johnson Hall. Counselor/Teacher Chris Medina verbally times to lower his voioe and be respectful to his peers. ignored the directives to stop arguing. Counselor/Teacher Chris Medina then stood up and slapped several times on the back of his head. Counselor/Teacher Chris Medina then picked up-. lified him over the rear oi the couch and restrained him on the floor for approximately five minutes. The rulraint was assisted by Counselor/feathers Anthony Smith and Art Sanders as-became resistive. Medical Treatment Provided (it necessary): At 1:15 PM on 7/20/18. Was given a roll physical examination at the Glen Mills Health Center by Doctor John Munshowercomplained oi mid back pain, and had a minor abrasion on his righi cheek, lei: cheek, and below the chin. was given 600mg of ibuproren and was told id keep abrasions clean with soap and water, Philadelphia Youth lnvolvad: -- - Philadelphia Action to be taken (check all that apply): at Safety Plan ChiidLine Called Cl Removal from Agency El Police Involvement Parent Notification El other Explain in detail all actions taken: After interviewing resident Counselor/Teacher Chris Medina, Counselor/Teacher Anthony Smith and Counselor/teacher An Sandora and reviewing video looiage of the previous incident, Team Lezderllm Lindquist made a Chiidline tall at 9:32 AM on mom: to report an incident ofsuspected abuse by Counselor/Teacher chris Medina. Team Leader Jim Lindquist spoke with Lisa, operator number 352. Philadelphia Admissions Supervisor Anthony Meadows was notified by Team Leader Jim Lindquist at 9:43 AM on 7/20/13 by mother was notified by Team Leaderiim Lindquist at 10:25 AM by phone. Ray Pazdunliiawicz, Human Services Program Administraror. was notified by Team Leaderiim Lindquisi at 10:50 AM on 7/20/18 by phone Counselor/Teacher Chris Medina's employmenz was terminated by Team Leaderjirn Lindquist on 7/20/13 lor going outside of established Glen Mills Schools Behavioral Intervention Techniques. Chief otiwenlle Probation Faustino Castro-lime was contacted by Team Laaderlim Llndouist at 2:15 pm on July 20, 2019 by phone, An ongoing internal investigation is being conducted id ensure sare practices, policies and procedures are (allowed, By signing- this abutment, you acknowledge that. if additiana! informatibn becomes availabie it Shoul? be) sent in an amended apart to the .Gh'i'ef, Deputy Chief, 335 Deputy Commis?aner, at the D?putv 'frectdr, the PD, and both Probatian LV- ?x?~wmw_ Employtee '??natlife Supervis?nature 7 25.7. ?6 . Date Date en?