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MALTREATMENT INVESTIGATION MEMORANDUM Minnesota Statutes, section 626.557, subdivision 1 states, “The legislature declares that the public policy of this state is to protect adults who, because of physical or mental disability or dependency on institutional services, are particularly vulnerable to maltreatment.”
License Number and Program Type: 1095932-SUD (Substance Use Disorder) Investigator(s): Toni Puente Suspected Maltreatment Reported: It was reported that a staff person (SP) and a vulnerable adult (VA) engaged in a sexual relationship while the VA was receiving services at the facility. Date of Incident(s): On-going, prior to June 13, 2022 Nature of Alleged Maltreatment Pursuant to Minnesota Statutes, section 626.557, subdivision 9c, paragraph (b), and Minnesota Statutes, section 626.5572, subdivision 15, and subdivision 2, paragraph (c); and subdivision 17, paragraph (a): Any sexual contact or penetration between a facility staff person or a person providing services in the facility and a resident, patient, or client of that facility. Sexual contact is defined by Minnesota Statutes, section 609.341, as the intentional touching of the intimate parts with sexual or aggressive intent. 'Intimate parts' includes the primary genital area, groin, inner thigh, buttocks, and breast. The failure or omission by a caregiver to supply a vulnerable adult with care or services, including but not limited to food, clothing, shelter, health care, or supervision which is reasonable and necessary to obtain or maintain the vulnerable adult's physical or mental health or safety, considering the physical and mental capacity or dysfunction of the vulnerable adult and which is not the result of an accident or therapeutic conduct. Summary of Findings: Pertinent information for this investigation was obtained remotely, including documentation from the facility; and through seven interviews conducted with two facility staff persons (P1 and P4), a supervisory staff person (P2), an administrative staff person (P3), a consumer (C) who resided at the facility at the same time as the VA, and two community persons (CP1 and CP2) who worked at a sober house where the VA resided after leaving the facility. Attempts were made by mail, phone, and email to conduct an interview with the VA. The VA responded via voicemail that s/he would like to interview, but did not respond to subsequent attempts. The SP was scheduled to conduct an interview with this investigator, but later declined and provided written information to this investigator which is included below. The VA was diagnosed major depressive disorder and substance use disorders. Facility documentation showed that the VA began receiving services at the facility on December 6, 2021, and successfully discharged on March 7, 2022. Following discharge, the VA resided in sober housing and participated in an outpatient program. From June 2 to 5, 2022, the VA relapsed, and on June 6, 2022, s/he was arrested and court ordered to resume inpatient treatment at a different program. The VA’s Comprehensive Assessment Summary (CAS) stated that the VA displayed “high impulsivity” and lacked coping skills to prevent relapse despite consequences to his/her physical and mental health, legal involvement, housing, employment, relationships, and participation in meaningful activities. The VA’s Individual Abuse Prevention Plan (IAPP) stated that the VA had a history of emotional abuse and self-injurious behavior. Information from P2, P3, and P4 was consistent that the VA received services from the facility on multiple occasions, and during his/her most recent admission, there were four counselors, including P2, P4, and the SP, who typically worked during the daytime hours and maintained offices in close proximity to each other. Each counselor was assigned to a caseload of eight to nine consumers, and facilitated weekly group sessions, as well as individual sessions in their respective offices. From December through March 2022, the VA was assigned to the SP’s caseload, and facility documentation showed that the SP and the VA developed the VA’s IAPP, the CAS, and treatment plan goals. In addition, the VA was able to access the community during daytime hours as preferred for leisure activities. Facility documentation, including Simple Group Notes, showed that during weekly individual sessions, the VA and the SP typically met for an hour to discuss relapse prevention, internal motivation for change, and facility expectations pertaining to peer interactions and group participation. P1, P3, CP1, CP2, and the C; and facility documentation including the Internal Review; and Facebook Messenger screenshots of the SP’s conversation with the C, provided the following information: · P3 stated the SP was assigned to work with the VA from December 6, 2021, through March 7, 2022, when the VA successfully completed the program. The SP submitted his/her resignation and on March 25, 2022, the SP no longer worked at the facility. · Following the VA’s discharge from the facility, the VA resided in sober housing until June 1, 2022, when s/he moved into an apartment. Within a few days, the VA relapsed and was arrested as part of a Drug Court violation.
· The C stated that prior to June 7, 2022, s/he did not have contact with the SP outside of the facility. On June 7, 2022, the SP contacted the C via Snapchat or Facebook regarding the VA’s relapse and arrest. The C continued to exchange messages with the SP via Snapchat and Facebook Messenger. The SP told the C that for the past two years s/he used illegal substances on a daily basis and was involved in the VA’s relapse. The C was concerned about the SP’s use and how it affected the services that s/he provided to consumers at the facility. On June 13, 2022, the C contacted CP2 regarding his/her concerns and provided screenshots of his/her Facebook Messenger messages with the SP. · On June 13, 2022, CP2 notified CP1 about the C’s concerns and obtained screenshots of the Facebook Messenger messages that were exchanged between the C and the SP. CP2 forwarded the screenshots of the messages to CP1, who then sent them to P1 and P3. The screenshot messages showed the SP’s name and profile photo and correspondence between the SP and the C on June 9, 2022. The messages included the following exchanges: o The SP stated that on the previous Sunday, a person identified by the VA’s first name, brought a friend over to an unidentified location with the SP, and they used illegal substances. o The SP: “I’m not gunna argue lol. It is what it is. Getting sober made me more crazy. What’s the point? There is no purpose in my work after I hooked up with a client. Like and probably influenced [his/her] relapse. I’ll add you back on Snap if you want but I don’t like to be on this Facebook. . . . it’s my crackhead account.” o The SP: “Church doesn’t make people a better person. Just look at [the VA’s first name]. (smiling with a tear emoji). Sorry that wasn’t nice of me. [S/he’s] lucky I fucked up the address. I almost got my money back [s/he ripped me off Sunday (eyeroll emoji). But [s/he’ll] figure out I was trying I imagine [his/her] account got locked.” o The C: “Who?” o The SP: “[The VA’s first name].” o There were also several references to the SP’s use of illegal substances. · P1, P3, CP1, and CP2 were familiar with the VA due to his/her on-going participation in treatment, Drug Court program, and sober housing; but neither of them provided direct care services to the VA when s/he resided at the facility. It was unknown when or how the VA and the SP exchanged contact information and/or began communicating, if it was while the VA was receiving services at the facility or after the VA’s discharge. · The C stated that s/he was not aware of the VA and the SP engaging in any inappropriate or sexual conduct at the facility, adding that if there had been, the VA would have told the C. After the VA’s discharge from the facility, sometime in April 2022, the VA contacted the SP to request help with tax preparation. Then the VA continued to communicate with the SP, spend time with the SP, and ultimately developed a sexual relationship with the SP. · Prior to this allegation, there were no similar concerns or allegations involving the SP. P3 added that the SP performed his/her job duties, but there were concerns related to his/her attendance, mood changes, and interpersonal conflicts among the SP and other staff persons because the SP was “demanding” or preferred things to be done his/her way. P3 also heard some complaints from consumers that the SP was “mean” or “very strict.” The C added that the SP maintained professional boundaries with staff persons and consumers, but due to his/her frequent mood changes, the C and other consumers thought the SP was under the influence of substances. P2 and P4 provided the following information: · P2 had minimal information regarding the allegation with the exception that the VA’s relapse to substance use in June 2022, correlated with the timeline of when someone saw the VA under the influence of substance use at a religious service and the Facebook messages were exchanged between the SP and an unknown person. · P4 was not aware of the allegation involving the SP, but s/he added that the when s/he worked with the SP at the facility, the SP had negative interactions with staff persons and a “no fuck attitude.” · P2 and P4 each stated that they did not observe any inappropriate interactions between the VA and the SP. The SP may have engaged in conversation with some consumers, including the VA, more often than others which could be perceived as “favoritism.” P4 added that during staff meetings, P2 addressed any concerns of favoritism or professional boundaries with all staff persons. · P4 stated that shortly after the VA began receiving services at the facility, the SP talked to P4 about the VA because P4 was aware of the VA’s substance use and history from a previous stay at the facility. While they were talking, the SP stated that the VA was attractive, which P4 agreed, but added that the VA’s on-going substance use and treatment process, was not something to further pursue, which the SP laughed and agreed. · P2 recalled a couple of “teachable moments” when P2 addressed professional boundaries with the SP. On an occasion in February 2022, P2 heard the SP talking to P4 about the VA’s attractive attributes, like his/her “humor.” P2 interrupted their conversation and told them to “check this” and maintain professional boundaries. Then, a few weeks later, in early March 2022, P2 observed the SP and P4 sitting on either side of the VA prior to the start of a group session. Following the session, P2 again addressed how their interactions with the VA may be perceived by others as “favoritism.” · P2 and P4 each stated that SP often met with the VA for an hour, whereas most meetings with other consumers were about 30 to 40 minutes. During staff meetings, P2 advised that all staff persons, including the SP, address time management within their caseload. P4 added that the VA and the SP had similar personalities, which included joking or chit chatting. Since the VA was easy to talk to, the SP may have struggled with boundaries to end conversations with the VA. (Note: The C stated that s/he typically met with his/her assigned counselor twice a week, for about one hour one of the meetings and 40 minutes the next meeting.) · While the VA was receiving services at the facility and accessed the community during leisure time, it was possible that the SP saw the VA in the community. P4 added that the SP told P4 that s/he saw the VA at various locations in the community; but per facility policy, the SP nodded, waved, or did not acknowledge the VA. · P4 stated that shortly after the VA’s discharge from the facility, the VA called the SP’s office phone to discuss paperwork that was relevant to his/her treatment and recovery. P4 stated that s/he heard the conversation and asked the VA how s/he was doing. P4 did not have any concerns regarding the interaction since it was not uncommon for former consumers to reach out to their previous counselors. · P2 stated that following the VA’s discharge from the facility, the VA returned to the facility and met a mental health professional as part of his/her outpatient program. It was possible that on occasion, the VA may have went to the SP’s office to say “Hello,” which was not out of the ordinary for former consumers to do. (Note: Information provided by the C corroborated this information.) · P2 stated that the SP had “good” clinical skills, but there were concerns regarding the SP’s “aggressive” interactions with staff persons and consumers. P4 stated that the SP’s work performance was “poor” due to frequent absences or not completing his/her assigned tasks. The SP declined to be interviewed but provided written information which included the SP’s education and work histories and a response to two questions as follows (emphasis in original): Response to Allegations: 1) A staff person and a vulnerable adult engaged in a sexual relationship while the VA was receiving services at the facility (House of Hope). [The SP] never engaged in a sexual or inappropriate relationship with any of [his/her] clients while employed at House of Hope. 2) A staff person failed to maintain therapeutic boundaries and the staff person’s interactions with the VA were detrimental to the VA’s mental health and/or progress in his/her treatment. [The SP] never failed to maintain therapeutic boundaries with any of [his/her] clients while employed at House of Hope. The Merriam-Webster.com, online dictionary, stated that “hooked up” was a casual sexual encounter and meaning to become associated especially in a working, social, or sexual relationship. The facility’s Personnel Policy and Procedure stated that staff persons should avoid dual relationships and maintain professional relationships with clients. Staff persons shall not accept “friend” requests, follow, or allow clients (current or past) to follow them on any social media platform. Staff persons will not engage in any form of sexual or romantic relationship with any current or former client. The SP’s job description stated that the staff person was not to have any relationships with a client or other staff member other what was required by the job description. It was forbidden for any facility staff person to have a social, intimate, sexual, financial, or any other relationship with a facility client. Personnel files showed that all staff persons interviewed received training on the Reporting of Maltreatment of Vulnerable Adult Act and the facility’s policies and procedures prior to June 13, 2022. P2, P4, and the SP each received training on the VA’s program plans. Conclusion: Information from P1, P3, CP1, CP2, the C, and Facebook messages exchanged between the SP and the C on June 9, 2022, provided information that the VA and the SP used illegal substances together and likely engaged in a sexual relationship. The SP sent a message to the C that stated, “There is no purpose in my work after I hooked up with a client. Like and probably influenced [his/her] use.” Regarding sexual abuse: Although there were concerns that the VA and the SP engaged in a sexual relationship, there was no information provided that sexual contact occurred between the two while the VA was receiving services at the facility. Therefore, there was a preponderance of the evidence that the SP did not have sexual contact with the VA while the VA was receiving services from the facility. It was determined that sexual abuse did not occur (any sexual contact or penetration between a facility staff person or a person providing services in the facility and a resident, patient, or client of that facility. Sexual contact is defined by Minnesota Statutes, section 609.341, as the intentional touching of the intimate parts with sexual or aggressive intent. 'Intimate parts' includes the primary genital area, groin, inner thigh, buttocks, and breast.) Regarding neglect: Information was consistent that there were no concerns regarding the SP’s interactions with the VA while the VA was receiving services at the facility. However, P2 and P4 added that the SP’s interactions with the VA, including longer individual sessions, discussing the VA’s attractive traits, and/or engaging in conversation with the VA more often than others, could have been perceived as “favoritism.” During staff meetings, P2 addressed any concerns of time management, favoritism, or professional boundaries with all staff persons. The C stated that s/he was not aware of the VA and the SP engaging in any inappropriate interactions at the facility, adding that if there had been, the VA would have told the C. The C stated that sometime in April 2022, when the VA was no longer receiving services at the facility, the VA contacted the SP to request help with tax preparation. Then the VA continued to communicate with the SP, spent time with the SP, and ultimately developed a sexual relationship with the SP. P2 added that on one occasion, shortly after the VA’s discharge from the facility, P2 was present when the VA called the SP to discuss information pertinent to his/her treatment and recovery which was consistent with the SP’s duties. The SP denied that s/he failed to maintain therapeutic boundaries or engaged in any inappropriate relationships with any of his/her clients while employed at the facility. Given the information provided, it was likely that the SP and the VA interacted with each other in some capacity, including substance use, after the VA no longer received services from the facility and the SP no longer worked at the facility and that the SP was involved in the VA’s relapse, the SP’s conduct of having a relationship with the VA outside of the facility was inconsistent with the standards of a professional caregiver in a facility licensed by the Department of Human Services and the violation of the facility’s policies and procedures. However, without additional information from the VA and the SP it was not determined how or when the interactions began or when the relationship started. Therefore, there was not a preponderance of the evidence whether there was a failure to supply the VA with reasonable and necessary care or services. It was not determined whether neglect occurred (the failure or omission by a caregiver to supply a vulnerable adult with care or services, including but not limited to food, clothing, shelter, health care, or supervision which is reasonable and necessary to obtain or maintain the vulnerable adult's physical or mental health or safety, considering the physical and mental capacity or dysfunction of the vulnerable adult and which is not the result of an accident or therapeutic conduct.) Action Taken by Facility: The facility completed an internal review and determined that its policies and procedures were adequate but not followed when the SP engaged in a relationship with the VA. Although this was an isolated incident, supervisory staff persons were to remind all employees of the facility’s policies and ethics training. The SP no longer worked at the facility. Action Taken by Department of Human Services, Office of Inspector General: The SP was regulated by a health related licensing board and a copy of this report was forwarded to them for their review of possible board violations.
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