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MALTREATMENT INVESTIGATION MEMORANDUM Minnesota Statutes, section 260E.01, paragraph (a), “The legislature hereby declares that the public policy of this state is to protect children whose health or welfare may be jeopardized through maltreatment.”
License Number and Program Type: 802333-CCC (Child Care Center) Investigator(s): Anna Parkin Suspected Maltreatment Reported: It was reported that a staff person (SP) bit an alleged victim (AV) on his/her right shoulder. Date of Incident(s): September 22, 2022 Nature of Alleged Maltreatment Pursuant to Minnesota Statutes, section 260E.03, subdivision 18, paragraph (a), and subdivision 23, paragraph (a): "Physical abuse" means any physical injury, mental injury, or threatened injury, inflicted by a person responsible for the child's care on a child other than by accidental means. "Threatened injury" means a statement, overt act, condition, or status that represents a substantial risk of physical or sexual abuse or mental injury. Summary of Findings: Pertinent information was obtained during a site visit conducted on September 29, 2022; from documentation at the facility; and through four interviews conducted with a supervisory staff person (P1), a facility staff person (SP), and two of the AV’s family members (FM1 and FM2). According to the AV’s enrollment information, the AV was four years old and enrolled in the star (preschool) room at the time of the incident. The star room was on the lower level of the facility and had a bathroom along a hallway. Consistent information was provided that during the incident, another staff person (P2) was also in the star room but did not witness the incident because s/he was preparing for lunch. According to the AV’s Individual Child Care Program Plan, the AV benefited from “significant assistance for expressing” how s/he feels “safely and regulating” him/herself. The AV also benefited from a “calming space” and visual supports for regulation. The SP provided the following information: · On September 29, 2022, at approximately 11:40 a.m., P2 and the SP brought 17 children, including the AV, inside from the playground. P2 was in the star room preparing for lunch while the SP assisted the children lined up in the hallway and inside the bathroom. · The AV started “amping up” by crawling around on the floor and running down the hallway. During that time, the SP tried to redirect the AV by physically moving him/her to another spot in line with the other children and by ignoring the AV but the AV continued the behavior. The AV then bit the SP on the leg. The SP told the AV that it hurt and verbally redirected the AV not to bite. The AV laughed and then bit the SP two more times. The SP felt that the AV was not listening to the SP, so s/he picked up the AV and bit the AV on the right shoulder and told the AV to stop biting because it hurt. · The AV began crying so the SP carried him/her around the corner and then sat with the AV on the stairs until the AV calmed. The SP again explained to the AV that s/he could not bite people. Once the AV was calm, s/he returned to the bathroom and washed his/her hands for lunch. The AV was “fine” the rest of the day. · Historically the AV had difficulties with transitions and the SP used redirection and removing the AV from a situation. The SP stated that biting the AV was not in line with his/her training. P1 provided the following information: · On September 22, 2022, at approximately 2:40 p.m., the SP came to P1 “distraught” and crying. The SP told P1 that earlier in the day, the AV bit the SP on the leg multiple times. The SP tried redirecting the AV and the third time the AV bit the SP, the SP bit the AV on the right shoulder. The SP was “devastated” by his/her actions. P1 had the SP repeat what took place because s/he had a “hard time believ[ing] it” and suspended the SP pending the investigation. · P1 then went to the star room where the children, including the AV, were napping. P1 looked at the AV and saw a red bite mark, on the AV’s right shoulder and took a picture of it. P1 went to his/her office and called FM2 about the incident. · The SP worked at the facility for approximately 21 years and was an “excellent” staff person. P1 did not have prior concerns with the SP’s interactions with the children. FM1 and FM2 preferred that the incident did not happen but were “surprised” because they knew the SP “well” and it was unlike the SP to bite a child. FM2 saw the bite mark on the day of the incident and said it was a red mark that did not break the skin. On September 29, 2022, FM1 and FM2 each stated there was still a “tiny” red outline of the mark but “very minimal.” FM1 and FM2 each stated that the SP was a “good” staff person who had a “bad moment” and would “hate” to see the SP lose his/her employment. According to the facility’s Behavior Guidance and Discipline Policy, staff persons modeled and affirmed positive behavior and recognized positive behavior. For unacceptable behavior, staff persons provided clear and directly related consequences while ensuring the safety of all children. Staff persons provided reasons and explanations for why a child should do something and if the child did not comply, staff persons redirected the child to an activity or behavior by providing an alternate choice. As a last resort, staff persons removed the child from the situation. Facility documentation showed that the SP and other staff persons interviewed in this investigation received training on the facility’s Behavior Guidance and Discipline Policy and the Maltreatment of Minor’s Act prior to the incident.
Conclusion: A. Maltreatment On September 22, 2022, after the AV bit the SP three times, the SP bit the AV on his/her right shoulder. The SP’s action was not accidental; was inconsistent with the standards of a professional caregiver in a program licensed by the Minnesota Department of Human Services; and were violations of facility policies and procedures. Given that the SP bite the AV on the shoulder causing a red mark, there was a preponderance of the evidence that a person responsible for the AV’s care inflicted an injury on the AV other than by accidental means. It was determined that physical abuse occurred ("Physical abuse" means any physical injury, mental injury, or threatened injury, inflicted by a person responsible for the child's care on a child other than by accidental means. "Threatened injury" means a statement, overt act, condition, or status that represents a substantial risk of physical or sexual abuse or mental injury). B. Responsibility pursuant to Minnesota Statutes, section 626.556, subdivision 10e, paragraph (i): When determining whether the facility or individual is the responsible party, or whether both the facility and the individual are responsible for determined maltreatment in a facility, the investigating agency shall consider at least the following mitigating factors: (1) whether the actions of the facility or the individual caregivers were according to, and followed the terms of, an erroneous physician order, prescription, individual care plan, or directive; however, this is not a mitigating factor when the facility or caregiver was responsible for the issuance of the erroneous order, prescription, individual care plan, or directive or knew or should have known of the errors and took no reasonable measures to correct the defect before administering care; (2) comparative responsibility between the facility, other caregivers, and requirements placed upon an employee, including the facility’s compliance with related regulatory standards and the adequacy of facility policies and procedures, facility training, an individual’s participation in the training, the caregiver’s supervision, and facility staffing levels and the scope of the individual employee’s authority and discretion; and (3) whether the facility or individual followed professional standards in exercising professional judgment. The SP was trained on the Behavior Guidance Policy and the Reporting of Maltreatment of Minor’s Act. The SP was responsible for maltreatment of the AV. C. Recurring and/or Serious Maltreatment: The Office of Inspector General is required to evaluate whether substantiated maltreatment by an individual meets the statutory criteria to be determined as “recurring or serious.” Individuals determined to be responsible for recurring or serious maltreatment are disqualified from providing direct contact services. Minnesota Statutes, section 245C.02, subdivision 16, states: “Recurring maltreatment” means more than one incident of maltreatment for which there is a preponderance of evidence that maltreatment occurred and that the subject was responsible for the maltreatment. Minnesota Statutes, section 245C.02, subdivision 18, states: "Serious maltreatment" means sexual abuse, maltreatment resulting in death, neglect resulting in serious injury which reasonably requires the care of a physician whether or not the care of a physician was sought, or abuse resulting in serious injury. For purposes of this definition, "care of a physician" is treatment received or ordered by a physician, physician assistant, or nurse practitioner, but does not include diagnostic testing, assessment, or observation; the application of, recommendation to use, or prescription solely for a remedy that is available over the counter without a prescription; or a prescription solely for a topical antibiotic to treat burns when there is no follow-up appointment. For purposes of this definition, "abuse resulting in serious injury" means: bruises, bites, skin laceration, or tissue damage; fractures; dislocations; evidence of internal injuries; head injuries with loss of consciousness; extensive second-degree or third-degree burns and other burns for which complications are present; extensive second-degree or third-degree frostbite and other frostbite for which complications are present; irreversible mobility or avulsion of teeth; injuries to the eyes; ingestion of foreign substances and objects that are harmful; near drowning; and heat exhaustion or sunstroke. Serious maltreatment includes neglect when it results in criminal sexual conduct against a child or vulnerable adult. It was determined that the substantiated physical abuse for which the SP was responsible did not meet statutory criteria to be determined as recurring because it was a single incident. However, it was serious maltreatment because although the bite mark did not break the skin, the mark was still present seven days after the incident. Pursuant to Minnesota Statutes, section 260E.35, subdivision 6, paragraph (c) all investigative data maintained in this report will be kept by the Department of Human Services for at least ten years after the date of the final entry in the report. Action Taken by Facility: The facility completed an internal review and determined that policies and procedures were adequate but not followed. All staff persons with the exception of the SP were retrained on the behavior guidance policy and discipline policy. The SP was suspended pending the investigation. Action Taken by Department of Human Services, Office of Inspector General: The SP was disqualified from a position allowing direct contact with, or access to, persons receiving services from programs, organizations, and/or agencies that are required to have individuals complete a background study by the Department of Human Services as listed in Minnesota Statutes, section 245C.03. The determination that the SP was responsible for maltreatment and the disqualification of the SP are each subject to appeal. Certification: The information collection procedures followed in this investigation were pursuant to Minnesota Statutes, section 260E.30, subdivision 6, paragraph (c). All individuals that are subjects of data in this investigation have the right to obtain private data on themselves which was collected, created, or maintained by the Department of Human Services.
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