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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: 1000964-CCC (Child Care Center) Investigator(s): Tessa Ripka Suspected Maltreatment Reported: It was reported that a staff person (SP) dropped or threw an alleged victim (AV) which caused the AV to land on the floor and sustain a concussion. Date of Incident(s): September 8, 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 16, 2022; from documentation at the facility and medical records; and through four interviews conducted with two staff persons (P1 and P2) a supervisory staff person (P3), and the AV’s family member (FM). Due to the AV’s age, s/he was unable to provide information about the incident. Attempts were made through phone and mail to reach the SP for an interview, but attempts were unsuccessful. The AV was 22 months at the time of the incident and enrolled in the Toddler 1 classroom. The Toddler 1 classroom was a large open room with wood like flooring. On the left side of the room, there were two kid-sized round tables with chairs. In the middle area of the room was a large round rug with some pillows around it. There was an approximately two foot tall shelf next to the rug. On the right side of the room along the wall were cupboards with a built in sink and a diaper-changing table. P1-P3 provided the following information: · P1 said s/he was at the diaper-changing table when the SP pulled the AV off the shelf and “tossed” the AV who then fell to the floor hitting his/her whole body, back, head, and neck. The AV lay on the floor for a few seconds and then started to cry. The SP picked up and held the AV and the AV continued to cry for “no more than two minutes.” · P2 said the SP came in and saw the AV and said something like “Are you serious? We are not doing this today.” The SP “stormed” to the shelf and tried to pull the AV off the shelf. The AV held on to the shelf and it rocked back and forth. P2 was nervous the shelf would fall on another child. The SP then “threw” the AV on the floor onto his/her back and the AV bumped his/her head on the floor. The SP picked up the AV and rocked the AV back and forth while saying, “I’m so sorry. I didn’t mean to do that.” · Another staff person came to check on the AV and his/her pupil dilation was normal. The AV was playing like normal and then ate lunch and took a nap. P1 said the AV seemed “tired” but was normally tired at that time. P2 said the AV “barely ate anything” and went down for a nap earlier than s/he typically does. · P1-P3 each did not have any previous concerns with the SP’s interactions with children. Video footage from the date of the incident, showed the AV lying on top of the shelf near the rug. The SP entered the room and walked toward the cupboard area, but then stopped and went to the shelf and pulled the AV’s left leg causing the AV to start to come off the shelf. As the SP pulled the AV, the AV held onto the side of the shelf with his/her left hand, which caused the shelf to tip slightly and move. The SP pulled the AV’s hand off of the shelf and then held the AV upright with one of the SP’s hands under each of the AV’s armpits. The AV was facing away from the SP. The SP swung the AV out horizontally toward the rug and let go of the AV without lowering the AV to the floor. The AV fell from approximately four feet high and landed flat on his/her back, hitting his/her head on the rug. The AV appeared to start crying or screaming. The SP squatted down and covered his/her face. The SP grabbed the AV and pulled the AV into the SP’s lap and held the AV as the SP appeared to cry. The FM said the AV did not eat any of his/her food on the evening of the incident. The following day, the FM took the AV to the hospital and a CT scan was completed. The medical professional felt the AV had sustained a mild concussion. Medical records showed the AV was seen by his/her medical provider on September 9, 2022 for assessment of a head injury and assault. A computerized tomography (CT) scan was completed and showed “no acute intracranial abnormality seen.” The AV had a “possible slight concussion” and was advised to return if s/he developed altered mental status and/or vomiting. The Child Guidance policy indicated that corporal punishment including but not limited to rough handling, shoving, shaking, excessive tickling, slapping, kicking, biting, pinching, hitting, spanking, and pulling arms, hair, or ears was prohibited. All staff persons interviewed for this investigation received training on the facility’s policies and on the Reporting of Maltreatment of Minors Act prior to the incident. Law enforcement also investigated this report and charged the SP with felony malicious punishment of a child. Relevant Rules and/or Statutes: Minnesota Rules, part 9503.0055, subpart 3, item A, states that the license holder must have and enforce a policy that prohibits the following actions by or at the direction of a staff person: Subjection of a child to corporal punishment, which includes, but is not limited to, rough handling, shoving, hair pulling, ear pulling, shaking, slapping, kicking, biting, pinching, hitting, and spanking. Conclusion: A. Maltreatment: Information was consistent that on September 8, 2022, the SP lifted the AV up by the armpits and tossed the AV from about four feet high towards the rug on the floor. The AV landed on his/her back, hitting his/her head. The SP’s actions of roughly grabbing the AV and tossing the AV towards the rug were inconsistent with the standards of a professional caregiver in a facility licensed by the Department of Human Services; a violation of the facility’s policies; and a violation of Minnesota Rules 9503.0055, subpart 3, item A. The SP’s actions were not accidental. Given that the AV was lifted into the air approximately four feet and tossed toward the rug with enough force that s/he landed flat on his/her back, hitting his/her head resulting in a possible concussion, there was a preponderance of the evidence that a physical injury was inflicted 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 260E.30, subdivision 4, paragraph (a), clauses (1) and (2): 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. Facility documentation showed that the SP received training on the Reporting of Maltreatment of Minors Act and on the facility’s policies, including the behavior guidance policy, prior to the incident. 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 or serious. It was a single incident and although the AV sustained a head injury, there was no loss of consciousness and s/he saw a medical provider for diagnostic testing and assessment only so the injury did not meet the definition of serious. 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 were adequate but not followed. The SP no longer worked at the facility. Action Taken by Department of Human Services, Office of Inspector General: The SP was not disqualified from providing direct care services as a result of the maltreatment determination in this report. However, the SP was notified by the Office of Inspector General that any further substantiated act of maltreatment, whether or not the act meets the criteria for “serious,” will automatically meet the criteria for “recurring” and will result in the disqualification of the SP. The determination that the SP was responsible for maltreatment is subject to appeal. On November 2, 2022, the facility was issued a Correction Order for the violation outlined in this report. 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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