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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: 1071339-SUD (Substance Use Disorder) Investigator(s): Deb Neubauer-Hoffman Suspected Maltreatment Reported: It was reported that a staff person (SP) engaged in sexual contact with two vulnerable adults (VA1 and VA2) and brought alcohol to the facility to share with another vulnerable adult (VA3). Date of Incident(s): Prior to July 18, 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 two interviews conducted with a facility staff person (P1) and one vulnerable adult (VA2). Multiple attempts were made to contact VA1 and VA3 via telephone and mail; however no responses were received. A certified letter and an email were each sent to the SP; however, s/he did not respond. VA1-VA3 resided at the facility between April and July 2022. VA1’s was admitted to the facility on two occasions in 2022 and was diagnosed with substance use disorder, anxiety, and depression. VA2 and VA3 were each diagnosed with depression, anxiety, and substance use disorder. P1 and the facility’s internal review provided the following information: · On July 17, 2022, a client (C) told P1 that the SP had a sexual relationship with VA1 and VA2 and also said the SP brought alcohol to the facility and drank the alcohol with VA3. · The C did not provide specific dates that the incidents occurred. However, according to P1, the SP no longer worked at the facility after the first week of July 2022; therefore, the incidents occurred prior to that date. The C said that all three of the incidents occurred during the “overnight” shift. · The C shared a bedroom with VA1 and VA2 at different times. When the C shared the room with VA2, the SP came into their room and the SP and VA2 went into the bathroom where they engaged in sexual contact. The C was “not sleeping and heard everything.” · The C also said that VA1 and the SP had an “obvious flirtatious relationship” and “one night” the SP and VA1 engaged in sexual relations in an “empty room.” No additional information was provided. · According to the C, VA3 told the C that the SP brought alcohol into the facility and drank it with VA3. No additional information was obtained. · The C said that s/he did not tell anyone about the incidents until after VA1-VA3 were discharged and the C was preparing to be discharged. P1 believed the C was truthful. Multiple attempts were made by this investigator to contact the C to obtain additional information; however, the C was not located. VA1 was interviewed via telephone by this investigator and provided the following information: · VA1 was at the facility twice within five months and the second time, the C was his/her roommate. · VA1 said that s/he was on a “behavior contract” for smoking in a bathroom. An unidentified staff person discussed the behavior contract and told VA1 if s/he did not engage in sexual contact with him/her, VA1 “could get kicked out” of the facility. · One unidentified staff person kissed VA1 in an office and grabbed VA1’s “privates.” · On another occasion an unidentified staff person stayed in VA1’s room all night “massaging my body and trying to get me to have sex.” · According to VA1, several staff persons were aware of the incidents and “didn’t do nothing” and/or “covered it up.” VA1 said that s/he had letters and text messages from three different staff persons as “proof” these incidents occurred during the evening, overnight, and morning hours. There was another client that knew about the incidents; however, VA1 did not want to identify that client by name. VA1 was not willing to provide additional information, names, or his/her “proof” to this investigator until s/he consulted with a lawyer. (Attempts were made via telephone and mail by this investigator to contact VA1 again after giving him/her time to consult with a lawyer. VA1 did not contact this investigator.) · Regarding alcohol brought into the facility, VA1 said that a staff person identified by gender only, brought “vodka” into the facility for VA2. (Note: The C said the alcohol was brought in for VA3.) VA1 did not see anyone drink the alcohol and only saw the bottle. Again, VA1 refused to provide the staff person’s name and stated, “What is this going to do for me? It is not going to do nothing” and VA1 would “like to be compensated somehow.” The facility’s Staff Personal Relationships policy stated that employee contact of any kind with facility patients was prohibited for two years. Staff persons, including the SP, were trained regarding the employee handbook, ethics in the workplace, policies and procedures, and the Reporting of Maltreatment of Vulnerable Adults Act. Conclusion: On July 17, 2022, the C told P1 that the SP had a sexual contact with VA1 and VA2 and also said that the SP brought alcohol to the facility and drank the alcohol with VA3. No additional information was provided and attempts to contact the C were unsuccessful. VA2 and VA3 were not located and/or did not return this investigator’s attempts to obtain information, therefore it was not known what if any of the reported incidents involving them occurred. Likewise, the SP did not respond or provide any information. As a result, only information from VA1 was obtained. VA1 said that sexual contact occurred between him/herself and more than one staff person, and that a staff person brought alcohol into the facility for VA2; however, VA1 declined to provide any additional information. Due to lack of corroborating information, there was not a preponderance of the evidence whether sexual contact between the VA1 and a staff person occurred, or sexual contact between VA2 and a staff person occurred or whether there was a failure to provide care or services that were reasonable and necessary to obtain or maintain VA1-VA3’s physical or mental health or safety. It was not determined whether sexual abuse or neglect occurred (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 and/or 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 reporting policies and procedures were adequate and were followed and there was no need for additional training. The SP no longer worked at the facility. Action Taken by Department of Human Services, Office of Inspector General: No further action taken.
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