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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.”
Investigator(s): Anna Parkin Suspected Maltreatment Reported: Allegation One: It was reported that on September 19, 2022, an alleged victim (AV1) was left alone on a playground. Allegations Two: It was also reported that on September 20, 2022, an alleged victim (AV2) was left alone in the toddler room. Allegation Three: It was also reported that on October 4, 2022, an alleged victim (AV3) was left alone on the playground. Date of Incident(s): September 19, 20, and October 4, 2022 Nature of Alleged Maltreatment Pursuant to Minnesota Statutes, section 260E.03, subdivision 15, paragraph (a), clauses (1) and (2): Failure by a person responsible for a child's care to supply a child with necessary food, clothing, shelter, health, medical, or other care required for the child's physical or mental health when reasonably able to do so. Failure to protect a child from conditions or actions that seriously endanger the child's physical or mental health when reasonably able to do so. Summary of Findings: Pertinent information was obtained during a site visit conducted on October 24, 2022; from documentation at the facility; and through ten interviews conducted with a supervisory staff person (P1), five facility staff persons (P2, SP1, SP3-SP5), and four of AV1-AV3’s respective family members (FM1-FM4). Attempted were made via phone and certified mail to contact and interview another staff person (SP2), but SP2 did not respond to the requests. The facility had a shared toddler and preschool playground that was accessible from two doors, one in the toddler room and one in the preschool room. The playground was enclosed with a chain link fence and was located next to the facility’s parking lot. The playground was visible to the roads and businesses nearby including a four-lane highway. According to the facility’s risk reduction plan, staff persons kept “constant watch of all children” as they transitioned, for those children staying behind, those moving, and those already in a new location. Staff persons counted how many children they have before they left an area, while they were moving, and once they arrived at the new location. Facility documentation showed that staff persons interviewed in this investigation, including SP1-SP5, received training on the facility’s risk reduction plan and the Maltreatment of Minor’s Act prior to the incident. Relevant Rules and Statutes: Minnesota Statutes, section 245A.02, subdivision 18, and Minnesota Rules, part 9503.0045, subpart 1, item A, stated that a child must have supervision at all times and that supervision was defined as occurring when a program staff person is within sight and hearing of a child at all times so that the program staff person can intervene to protect the health and safety of the child. Allegation One: It was reported that on September 19, 2022, AV1 was left alone on a playground.
According to AV1’s enrollment information, AV1 was 3 years old and enrolled in the preschool room at the time of the incident. P1 stated on September 19, 2022, at approximately 6 p.m., SP1 called P1 who was no longer at the facility. SP1 told P1 that sometime between 3 and 6 p.m., SP1 and SP2 lined up and counted the preschool children before going inside. SP1 and SP2 did not count the preschoolers when walking through the doorway. Approximately two minutes after coming inside from the playground, FM1 came into the preschool room and asked where AV1 was. SP1 realized that AV1 had been left outside on the playground “for a little bit” and SP1 went and got AV1 who had been hiding on the playground. On September 20, 2022, P1 spoke to SP2 who said that when they were outside on the playground, they lined up, SP2 counted the children, they went to walk inside, and that must have been when AV1 ran and hid. SP2 did not provide any additional information to P1 about the incident. During the interview with SP1, when discussing a different incident, SP1 ended the interview so this investigator was not able to discuss this incident with SP1. FM1 stated on the day of the incident, at pick up time, s/he walked into the preschool room and did not see AV1. FM1 stated there were two staff persons in the room, SP1 and another staff person but FM1 was not able to recall who it was. FM1 looked at SP1 and asked where AV1 was and SP1 did not know. SP1 went outside to the playground and found AV1 hiding inside a play house. FM1 had not noticed AV1 on the playground when s/he arrived at the parking lot. SP1 told FM1 that they had “just come inside” prior to FM1 arriving. FM1 and FM2 did not have concerns with the facility. Conclusion Allegation One: A. Maltreatment:
Consistent information was provided that on September 19, 2022, AV1 was left alone on the preschool playground without the knowledge or supervision of staff persons which was inconsistent with the facility’s risk reduction plan and was a violation of Minnesota Statutes, section 245A.02, subdivision 18, and Minnesota Rules, part 9503.0045, subpart 1, item A. AV1 left on the playground unsupervised and without staff persons knowledge allowed them access to dangers outside the facility including community persons and traffic. Therefore, there was a preponderance of the evidence that there was a failure to supply AV1 with necessary care and a failure protect AV1 from conditions or actions that seriously endangered AV1’s physical or mental health when reasonably able to do so. It was determined that neglect occurred (Failure by a person responsible for a child's care to supply a child with necessary food, clothing, shelter, health, medical, or other care required for the child's physical or mental health when reasonably able to do so. Failure to protect a child from conditions or actions that seriously endanger the child's physical or mental health when reasonably able to do so). 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. SP1 and SP2 were each responsible for the care and supervision of AV1 when AV1 was left on the playground unsupervised. SP1 and SP2 were each trained on the facility’s risk reduction plan and the Reporting of Maltreatment of Minors Act. SP1 and SP2 were each responsible for maltreatment of AV1. 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 neglect for which SP1 and SP2 were responsible did not meet statutory criteria to be determined as recurring or serious because it was a single incident for which AV1 did not sustain a serious injury that reasonably required the care of a physician. Allegations Two: It was also reported that on September 20, 2022, AV2 was left alone in the toddler room. According to AV2’s enrollment information, AV2 was 2 years and 9 months old and enrolled in the toddler room at the time of the incident. On the day of the incident, it was AV2’s first or second day attending the facility and his/her information had not yet been uploaded into the app. P2 stated on September 20, 2022, at approximately 9 a.m., SP3-SP5 and P2 were working in the toddler room. SP3-SP5 assisted the children, including AV2, with getting ready to go outside and P2 went to wash dishes in the kitchen. P2 was unaware of when SP3-SP5 took the children outside. After approximately 15 to 20 minutes, P2 finished washing the dishes so was going to join SP3-SP5 and the children outside. When P2 walked through the toddler room, s/he heard a child crying. P2 saw AV2 crying and sitting alone on the floor near the door that leads outside. AV2 did not have any injuries. P2 brought AV2 to the kitchen and gave him/her a sippy cup to drink and sat with AV2 until s/he was “calm.” After a couple of minutes, P2 heard the other children and staff persons come inside the toddler room so P2 brought AV2 back into the toddler room. P2 told SP3-SP5 that AV2 was left inside and SP4 responded they had not been outside for “very long.” SP3-SP5 were not aware that AV2 was left inside. P2 then called P1 to notify him/her. P1 stated on September 20, 2022, P2 called P1 because s/he was “very rattled.” P2 said that s/he was washing dishes and heard someone in the toddler room crying for “a little while.” P2 went into the toddler room and found AV2 alone. Later on, P1 spoke to SP3-SP5 about the incident and provided verbal training. SP3 provided the following information: · On the day of the incident, between 9 and 9:30 a.m., SP3 and SP5 brought approximately 11 toddlers outside on the playground while P2 stayed inside to do dishes and SP4 used the bathroom. · SP3 counted the number of toddlers as they walked out the door by touching their heads and counting out loud. SP3 did not recall if s/he looked around the room before closing the door and going outside. SP3 did not remember if SP5 counted the children as they walked out to the playground. After SP4 was done in the bathroom, s/he came outside as well. SP3 counted the children “a couple of times” while on the playground. · At approximately 9:45 to 9:50 a.m., it was time for SP3 to go on break so s/he went back inside the facility into the toddler room and saw P2 and AV2 inside the room. AV2 was crying but there was no injuries to him/her. SP3 was not able to remember how long s/he had been outside. SP3 did not talk to P2 but later that day, P1 told SP3 that P2 found AV2 alone in the room. SP3 stated that when s/he was counting, s/he “still somehow missed” counting AV2 but did not use the app or have an attendance list. SP4 provided the following information: · At approximately 9:30 or 10 a.m., SP3, SP4, and another brand new staff person who was possibly SP5, and approximately 12 toddlers gathered near the door to go outside and during that time, AV2 stood next to SP4. SP4 and SP3 counted the heads of the children and during that time, a child went to the other side of the room so SP4 walked across the room to get him/her. SP4 and the child walked back to the group and SP4 continued to count heads. SP4 and SP3 counted the same number of children and then they went outside. · Approximately two minutes later, SP4 came back inside to use the bathroom and saw P2 and AV2 right outside the toddler room in the hallway. P2 asked SP4 if s/he forgot AV2 inside. AV2 did not have any injuries. SP4 stated s/he had counted the toddlers heads but must have miscounted. P2 and AV2 stayed inside the toddler room while SP4 went back outside for approximately ten minutes before returning inside with the class. SP5 provided the following information: · At approximately 9 a.m., SP5 went outside onto the toddler playground with some of the toddlers (SP5 did not remember how many) while SP3 and SP4 assisted the other toddlers with getting ready. SP5 stated approximately five minutes after s/he went outside, SP3 and SP4 came outside with the rest of the toddlers and told SP5 the number of toddlers they had. At one point, SP4 went inside to use the bathroom and then came back outside but did not say anything to SP5. · Approximately five minutes after going outside, SP3-SP5 and the toddlers returned inside the toddler room. SP5 had not seen AV2 after coming back inside but P2 came into the toddler room and told them that AV2 was left alone inside. The last time SP5 recalled seeing AV2 was prior to going out on the playground. SP5 did not know the children in that room “well” because s/he had only been in the infant room prior to this. SP5 stated s/he learned to use the app to count children but SP3 and SP4 did not have the app outside with him/her while on the playground because they were counting heads which SP5 did not know how to do at that time. SP5 stated every time after the incident, s/he made sure to double check how many children were supposed to have been in the room. FM3 was not aware of the incident prior to talking to this investigator. AV2’s first day attending the facility was on September 20, 2022, and s/he only was there approximately two hours. Conclusion Allegation Two: A. Maltreatment:
Information from all sources was consistent that AV2 was left alone in the toddler room, without the knowledge or supervision of staff persons which was inconsistent with the facility’s risk reduction plan and was a violation of Minnesota Statutes, section 245A.02, subdivision 18, and Minnesota Rules, part 9503.0045, subpart 1, item A. SP3-SP5 provided conflicting information regarding how long AV2 was left alone in the classroom, when they became aware that AV2 was left alone, and their conversations with P2 about AV2 being left alone. P2 stated that s/he was gone from the classroom between 15-20 minutes prior to finding AV2 in the classroom and P2 did not know at what point the classroom went outside. SP3 stated that they went outside between 9 and 9:30 a.m. and when s/he went inside between 9:45 and 9:50 a.m., P2 was with AV2. SP4 stated that AV2 was unsupervised for approximately two minutes. SP5 stated that the classroom was only outside for five minutes prior to returning inside. Although it was not able to be determined how long AV2 was in the classroom, AV2 was a toddler, did not have self-preservation skills, and would not have been able to provide for him/herself in the event of an emergency. Therefore, there was a preponderance of the evidence that there was a failure to supply AV2 with necessary care and a failure protect AV2 from conditions or actions that seriously endangered AV2’s physical or mental health when reasonably able to do so. It was determined that neglect occurred (Failure by a person responsible for a child's care to supply a child with necessary food, clothing, shelter, health, medical, or other care required for the child's physical or mental health when reasonably able to do so. Failure to protect a child from conditions or actions that seriously endanger the child's physical or mental health when reasonably able to do so). 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. SP3-SP5 were each responsible for the care and supervision of AV2 when AV2 was left inside the toddler room unsupervised. SP3-SP5 were each trained on the facility’s risk reduction plan and the Reporting of Maltreatment of Minors Act. SP3-SP5 were each responsible for maltreatment of AV2. 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 neglect for which SP3-SP5 were responsible did not meet statutory criteria to be determined as recurring or serious because it was a single incident for which AV2 did not sustain a serious injury that reasonably required the care of a physician. However, information obtained by the Department of Human Services, in combination with this report, resulted in SP4 being disqualified for recurring maltreatment. SP4 was disqualified from providing direct contact services. Allegation Three: It was also reported that on October 4, 2022, AV3 was left alone on the playground. AV3 did not have enrollment information at the facility but did have documentation in his/her file from another licensed facility. According to that documentation, AV3 was three years old at the time of the incident. The facility’s failure to have enrollment documentation was a violation of Minnesota Rules, part 9503.0115 and 9503.0125, which stated that a record must have been maintained for each child. P2 stated that on October 4, 2022, at approximately 5:10 p.m. as s/he was about to leave the facility, s/he went to the preschool room because SP1 was alone with approximately five children including toddler and preschool children. SP1 had just closed the door from the playground and P2 asked if s/he needed anything. SP1 said s/he needed help looking for his/her personal cell phone and asked P2 if s/he could stay with the children, so P2 did while SP1 walked into the hallway. P2 then looked on the facility app for the attendance and noticed that AV3 was still checked in but was not in the room. AV3’s sibling was in the room, so P2 opened the door to the playground and saw AV3 standing by bushes holding SP1’s personal cell phone. P2 went and brought AV3 inside and AV3 did not have any injuries. SP1 then returned to the preschool room and P2 told SP1 that AV3 was alone outside and SP1 said s/he did not know AV3 was out there. P2 stated it had been approximately two to five minutes between the time SP1 brought the children inside to when P2 looked outside, found AV3, and brought him/her inside. The next day, P2 told P1 about the incident. P1 stated on October 5, 2022, s/he was in the office verbally coaching SP1 about supervision. At that time, SP1 did not say anything to P1 regarding the incident with AV3 the day prior. A little while later, P2 told P1 that on the previous day (October 4, 2022), SP1 left AV3 alone on the playground. After returning inside, P2 asked SP1 where AV3 was and SP1 responded that s/he did not know and that s/he did not have his/her personal cell phone. AV3 was found on the playground with SP1’s cell phone. SP1 had not told P1 about the incident so P1 went and discussed the incident with the board. SP1 stated on October 4, 2022, at approximately 5:10 p.m., SP1 was on the playground with P2 and possibly another staff person (P3). P2 and possibly P3 brought the toddlers inside. SP1 had all the preschool children line up on the sidewalk while SP1 held the door for the children to walk inside. SP1 knew that AV3 ran behind some bushes because SP1 heard AV3 but could not see him/her. P2 was inside so after letting the other children inside, SP1 walked over and got AV3 from the bushes as FM4 pulled up in his/her vehicle. When this investigator asked SP1 about P2 coming into the preschool room while SP1 was looking for his/her personal cell phone, SP1 did not recall that happening. When this investigator asked SP1 about information that AV3 was alone on the playground with SP1’s cell phone, SP1 declined to provide any additional information and then hung up the phone. A subsequent email was sent by this investigator about a follow up interview, but SP1 did not respond. FM4 stated that SP1 told him/her that AV3 was left alone on the playground for approximately four to five minutes. AV3 did not have any injuries and FM4 did not have concerns with the facility. Conclusion Allegation Three: A. Maltreatment:
Consistent information was provided that on October 4, 2022, AV3 was left alone on the playground without the knowledge or supervision of staff persons which was inconsistent with the facility’s risk reduction plan and was a violation of Minnesota Statutes, section 245A.02, subdivision 18, and Minnesota Rules, part 9503.0045, subpart 1, item A. AV3 left on the playground unsupervised and without staff persons knowledge allowed AV3 access to dangers outside the facility including community persons and traffic. Therefore, there was a preponderance of the evidence that there was a failure to supply AV3 with necessary care and a failure protect AV3 from conditions or actions that seriously endangered AV3’s physical or mental health when reasonably able to do so. It was determined that neglect occurred (Failure by a person responsible for a child's care to supply a child with necessary food, clothing, shelter, health, medical, or other care required for the child's physical or mental health when reasonably able to do so. Failure to protect a child from conditions or actions that seriously endanger the child's physical or mental health when reasonably able to do so). 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. SP1 was responsible for the care and supervision of AV3 when AV3 was left on the playground unsupervised. SP1 was trained on the facility’s risk reduction plan and the Reporting of Maltreatment of Minors Act. SP1 was responsible for maltreatment of AV3. 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. Although it was determined that the substantiated neglect for which SP1 did not result in an injury to AV3, given that SP1 was found responsible for two separate incidents of maltreatment (see allegation one), it was considered recurring. SP1 was disqualified from providing direct contact services. 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 three internal reviews and determined that policies and procedures were adequate but not followed. SP2-SP5 received additional supervision training and written disciplinary action. SP1 no longer worked at the facility. Action Taken by Department of Human Services, Office of Inspector General: SP2, SP3 and SP5 were not disqualified from providing direct care services as a result of the maltreatment determination in this report. However, each were 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 staff person. The determination that SP2, SP3, and SP5 were responsible for maltreatment is subject to appeal. SP1 and SP4 were 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 SP1 and SP4 was responsible for maltreatment and the disqualification of each is subject to appeal. On December 7, 2022, the facility was issued a Correction Order for the violations outlined in this report, failing to complete incident reports, and failing to report possible maltreatment as required. 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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