Serious Occurrence Initial Notification Report/Avis Initial dIncident

grave
Region/Rgion

Service Provider Year-to-Date SO Total:

1 (one)

Central-West Region
Date/Time of Occurrence:

January 25, 2016

Date of Notification/
Date et heure de
lavis

Time

January 26, 2016

9:00 a.m.

4:58 p.m.

Service Provider/Fournisseur de services

Reported by (name/position):

TheraCommune

Kenzie Foster

Agency-operated residence, if
applicable:

Phone #:

Program
Supervisor/Advisor/Superviseur(e)
du programme/conseiller(re)

Debashis Dutta

(519) 893 7526 x.275

N/A
Name of Client(s) Involved (First Name and Initial of Surname)/Nom du (de la) client(e) ou des clients en cause (Prnom
et lettre initiale du nom de famille):
Age/Birth Date:
Raquel H. (23)
Type of Serious Occurrence (circle):
1. Death: coroner notified: - Y or N - By whom:
2. Serious Injury: (a) by service provider (b) accidental
including water quality
(c) self-inflicted/unexplained treatment reqd
re: client
3. Alleged abuse / mistreatment
4. Missing client

5. Disaster on premises specify:

6. Complaint about service standard
7. Complaint made by or about a client, or other SO
8. Use of Physical Restraint

Summary of Occurrence/Rsum de l'Incident

Raquel has been a resident of TheraCommune Group Home since December 2015. On January 25, 2016, Raquel became
increasingly agitated with me as I was conducting a group therapy session on the topic of hoarding. When discussing with
her the reasons why it is unacceptable to own thirty snowy owls, Raquel began insisting that I was incorrect and that she
could own as many owls as she wished upon leaving the group home. When I reinforced the concept that owning so many
was, in fact, hoarding, Raquel began yelling and the situation escalated, despite attempts made by myself and co-workers
to calm her down. Raquel proceeded to grab her chair and throw it at the window, breaking it. She then pushed me to the
ground and attempted to run away, screaming owls are my life, and you cant change me! Myself and another co-worker
pursued Raquel, who was uttering death threats, until we were able to put her in handcuffs and escort her back to her
room.
Action Taken/Mesures prises

First aid was administered

A new psychological evaluation was ordered for the client
A counsellor was contacted to provide other members of the group home assistance with coping with witness-toviolence issues

Who has been Notified/Personnes avises

Waterloo Regional Police

Further Action Proposed by Service Provider/Autres mesures proposes par le fournisseur de services

Purchase of a DVD season of TLCs Hoarding: Buried Alive for educational use
Purchase of a new window for TheraCommune
Purchase of a stun gun

Direction, if any, provided by Ministry/Directives donnes par le Ministre, le cas chant

Completed By (Signature)/Prpar par (signature)

Completion Date/Date de

preparation

January 26, 2016

1939(09/02)