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February 10, 2023 Nadifo Jama Shidane, Authorized Agent Nurturing Bright Minds Academy Corp. 6716 Gleason Road Edina, MN 55439-1130 License Number: 1106142 (Child Care Ctr) Program Location: 6716 Gleason Road, Edina MN 55439-1130 Dear Nadifo Jama Shidane: The Minnesota Department of Human Services (DHS), Division of Licensing, received your request for reconsideration of Citations 1, 4, 5, 6, 7, 8, 9, and 10 from the Correction Order issued to you by the Department of Human Services on January 25, 2022. SUMMARY OF CITATIONS AND RECONSIDERATION DETERMINATION: Citation 1. Staff distribution requirements were not maintained. A teacher or assistant teacher did not directly supervise an aide. Toddler (Toddler classroom)-The day of the visit, an aide qualified staff person was supervising two children from 11:00 a.m. to 1:30 p.m. A second staff person with the qualifications of at least teacher was required. Preschool (Preschool classroom)-It was determined through a conversation with a staff person that on the day of the visit, an aide qualified staff person would supervise one toddler and three preschool aged children from approximately 1:30 p.m. until the end of the day. A second staff person with the qualifications of at least teacher was required. Your Response. Your request to reconsideration indicated that the program had a variance to combine toddlers, preschool, and school-aged children, but that during the inspection visit, had separated the two toddlers from the three preschoolers to accommodate them in the learning activity before lunch, and then would combine them for group activity. Applicable Law. Minnesota Rules, part 9503.0040, subpart 2, item D; and Minnesota Rules, part 9503.0034, subpart 1.
Reconsideration Determination. The first staff member needed to meet the required staff-to-child ratio must be a teacher, with some exceptions for assistant teachers and experienced aides for limited times. Minnesota Rules, part 9503.0040, subpart 2, item D. Regarding the violation in the toddler classroom, the toddlers were separated from other groups of children for approximately two-and-a-half hours, and as such, were their own group. In this case, the staff member was supervising the toddlers was an aide, not an assistant teacher or experienced aid (as defined by Minnesota Statutes, 245A.14, subdivision 8), and was supervising a group of toddlers in a separate classroom for approximately two-and-a-half hours, without a teacher-qualified staff person present. Similarly, staff indicated that an aide-qualified staff person would supervise a toddler and three preschoolers from 1:30pm until the end of the day. The first staff member required to meet ratio must be a teacher, or in limited circumstances, and experienced aide or assistant teacher. The aide in this case, was not an experienced aid or an assistant teacher, and was supervising a group children for several hours. The citation is affirmed. Citation 4. The program did not have documentation on site to show that 1 of 3 (SP1) staff persons met the: education requirements of the teacher job classification for which the staff person was employed (SP1); and experience requirements of the teacher job classification for which the staff person was employed (SP1). Your Response. You did not provide specific information regarding this citation. In your request for reconsideration, you stated that prior to the licensing review you communicated with your licensor regarding paperwork and new rules, and your licensor assured you that everything was compliant. You stated that these violations are issues you communicated with DHS on to ensure compliance. You did not provide any documentation to supporting that assertion. Applicable Law. Minnesota Rules, parts 9503.0032, subpart 2; and 9503.0120, item B.
Reconsideration Determination. License holder’s must maintain a personnel record at the center for each staff person, the record must contain documentation indicating that the staff person meet the education and experience requirements for their position. Minnesota Rules, part 9503.0120, item B. SP1 was working as a teacher in the program, at times SP1 was the only staff person supervising groups of children for several hours. However, SP1 did not have the qualifications to be a teacher. Minnesota Rules, part 9503.0032, identifies the required credentials, education, and experience required to be qualified as a teacher. The program’s Personnel Information Form for SP1 identifies that SP1 was qualified as an aide, not a teacher. There was no documentation on site to demonstrate that SP1 was qualified as a teacher. The citation is affirmed. Citation 5. The required in-service training had not been completed for 4 of 4 (SP1, SP2, SP3 and SP4) individuals (director, staff persons, substitutes, or unsupervised volunteers) for the previous concluded calendar year. In-service training did not include: • the required number of in-service training hours for the previous concluded calendar year (SP1, SP2, SP3 and SP4); • training on abusive head trauma that was at least one half hour in length as required by Minnesota Statutes, section 245A.40, subdivision 5a (SP1, SP2, SP3 and SP4); • training on allergy prevention and response as required by Minnesota Statutes, section 245A.41, subdivision 1 (SP1, SP2, SP3 and SP4); • training on emergency preparedness as required by Minnesota Statutes, section 245A.41, subdivision 3 (SP1, SP2, SP3 and SP4); • training on handling and disposal of bodily fluids as required by Minnesota Statutes, section 245A.41, subdivision 2 (SP1, SP2, SP3 and SP4); • training on handling emergencies and accidents as required by Minnesota Rules, part 9503.0110, subpart 1 (SP1, SP2, SP3 and SP4); • training on health policies as required by Minnesota Rules, part 9503.0140, subpart 1 (SP1, SP2, SP3 and SP4); • training on reporting responsibilities as required by Minnesota Statutes, chapter 260E and Minnesota Rules, part 9503.0130 (SP1, SP2, SP3 and SP4); • training on the risk reduction plan as required by Minnesota Statutes, section 245A.66, subdivision 2 (SP1, SP2, SP3 and SP4); • training on sudden unexpected infant death that was at least one half hour in length as required by Minnesota Statutes, section 245A.40, subdivision 5 (SP1, SP2, SP3 and SP4); • training on cultural dynamics every two years as required by Minnesota Statutes, section 245A.40, subdivision 7 (4) (SP1, SP2, SP3 and SP4); and • training on disabilities every two years as required by Minnesota Statutes, section 245A.40, subdivision 7 (5) (SP1, SP2, SP3 and SP4). Your Response. You stated that prior to the inspection, you e-mailed and called the licensor to ask if the center needed to change anything to meet licensing standards, and you were assured by the licensor that you were doing “perfectly sufficient and meeting standards.” You did not provide any supporting documentation.1 Applicable Law. Minnesota Statutes, section 245A.40, subdivision 7.
Reconsideration Determination. A license holder must ensure that the center director, staff persons, substitutes, and unsupervised volunteers complete in-service training each calendar year: staff persons who work more than 20 hours per week must complete 24 hours of in-service training each calendar year; staff persons who work 20 hours or less per week must complete 12 hours of in-service training each calendar year. Minnesota Statutes, section 245A.40, subdivision 7. The required annual training includes training on: health and safety procedures, handling emergencies and accidents, maltreatment reporting responsibilities, reducing the risk of sudden unexpected infant death, the risk of abusive head trauma, the center’s risk reduction plan, and a child’s individual child care program plan as applicable. Every two years, the annual training must also include: child development and learning, pediatric first aid, pediatric, cardiopulmonary resuscitation, cultural dynamic, and disabilities. In addition, all training must be documented and maintained on site in each personnel record. Minnesota Statutes, section 245A.40, subdivision 7. During the licensing visit, the DHS licensor asked the director to provide the in-service training logs, as they were not maintained in the center’s personnel files as required. The director provided a prefilled in-service training form that was not signed or dated, nor did it include the names of staff persons who completed the training. When asked about the missing portions of the form, director told the DHS licensor that staff still needed to sign and date the in-service training form. An undated, unsigned form that does not identify the names of any staff persons who completed the training is not sufficient to document that training was completed. The evidence is sufficient to support finding that staff did not complete training as described in the citation. The citation is affirmed. Citation 6. 1 of 3 (C3) children's files reviewed did not contain a current immunization record, a signed notarized statement of parental objection to the immunization, or a medical exemption. Your Response. You stated that the child’s records were in another state, and that the pandemic had made obtaining the records difficult. Applicable Law. Minnesota Rules, parts 9503.0125, item G; and 9503.0140, subpart 5.
Reconsideration Determination. License holders must ensure that at the time of enrollment, a child’s record contains the required health and immunization record. Minnesota Rules part 9503.0125, item G. While in your request for reconsideration you stated that the child’s records were in another state, during the licensing visit, the center director told the DHS licensor that the child was a conscientious objector and was believed to be exempt from requiring an immunization record. The required immunization information in a child’s record can be a current immunization, a medical exemption, or a signed notarized statement of parental objection to immunization. Minnesota Rules, 9503.0140, subpart 5. The child had neither of those in the record. Further, difficulty in obtaining immunization records, does not exempt a license holder from the requirement. Citation 6 is affirmed. Citation 7. The risk reduction plan did not include specific policies and procedures to ensure adequate supervision of children at all times, with particular emphasis on supervision of school age children when using the restroom and visiting the child's personal storage space. Your Response. You stated that your risk reduction plan is the same risk reduction plan that the licensor approved less than a year ago, and that you believed through your communication with the licensor prior to the inspection that the Risk Reduction Plan was suitable. Applicable Law. Minnesota Statutes, section 245A.66, subdivision 2, paragraph (f).
Reconsideration Determination. Child care centers must develop a risk reduction plan that identifies general risk to children served, and must establish procedures to minimize identified risk, train staff on the procedures, and annually review the procedures. Minnesota Statutes, section 245A.66, subdivision 2, paragraph (a). The plan must include specific policies and procedures to ensure adequate supervision of children at all times, including supervision of school-age children when using the restroom and visiting the child's personal storage space. Minnesota Statutes, section 245A.66, subdivision 2, paragraph (f). During the licensing visit, the DHS licensor requested that the center provide the most recently completed version of the risk reduction plan. The plan provided to DHS during the licensing visit did not include supervision of school-age children when using the restroom and visiting the child's personal storage space. While you assert that the plan was reviewed less than a year prior, it appears that the plan was last reviewed as part of the pre-licensure review over a year prior to the licensing visit. At that time, the requirement to include that component in the plan was not part of the pre-licensure plan review. It is the license holder’s responsibility to maintain continued compliance with current regulations. The citation is affirmed. Citation 8. The program did not evaluate the risk reduction plan each calendar year. There was no documentation to verify that an annual evaluation of the center's risk reduction plan was done in 2021. Your Response. You stated that your Staff Wall posting and Health Nurse Consultant folder show that you updated the Risk Reduction Plan. Applicable Law. Minnesota Statutes, section 245A.66, subdivision 3.
Reconsideration Determination. The license holder must review the risk reduction plan each calendar year and document the review. Minnesota Statutes, section 245A.66, subdivision 3. During the licensing visit, the DHS licensor requested that the center provide the most recently completed version of the risk reduction plan. The plan provided to DHS during the licensing visit did not include documentation of the required annual review, nor did the director or other staff at the center notify the licensor during the visit or exit interview of any other more current risk reduction plan. As there was no documentation of an annual review made available to DHS at the time of the licensing review, the citation is affirmed. Citation 9. The license holder did not have a written emergency plan that included accommodations for infants and toddlers. Your Response. You stated that your Emergency Preparedness Plan is the same Emergency Preparedness Plan that the licensor approved less than a year ago. You added that you believed your communication with the licensor prior to the inspection led you to believe that the Emergency Preparedness Plan was suitable. Applicable Law. Minnesota Statutes, section 245A.41, subdivision 3.
Reconsideration Determination. A licensed child care center must have a written emergency plan for emergencies that require evacuation, sheltering, or other protection of a child, and the plan must be written on a form developed by the commissioner and include accommodations for infants and toddlers. Minnesota Statutes, section 245A.41, subdivision 3, paragraph (a), subparagraph (8). During the licensing visit, the DHS licensor requested that the center provide the most recently completed version of the Emergency Preparedness Plan. The plan provided to DHS during the licensing visit did not include accommodations for infants and toddlers, and therefore, did not comply with the law. It is the license holder’s responsibility to maintain compliance with applicable regulations. Citation 9 is affirmed. Citation 10. The license holder did not review and update the emergency plan annually. There was no documentation to verify that an annual review and update of the center's emergency plan was done in 2021. "Annual" or "annually" means prior to or within the same month of the subsequent calendar year. Your Response. You stated that the Staff Wall posting and the Health Nurse Consultant folder show that the center updated its Emergency Preparedness Plan. Applicable Law. Minnesota Statutes, section 245A.41, subdivision 3, paragraph (d).
Reconsideration Determination. License holders must review and update the emergency plan annually, and documentation of the review must be maintained in the program’s administrative records. Minnesota Statutes, section 245A.41, subdivision 3, paragraph (d). During the licensing visit, the DHS licensor requested that the center provide the most recently completed version of the Emergency Preparedness Plan. The plan provided to DHS during the licensing visit did not include documentation of the annual review and update, nor did the director or other staff at the center notify the licensor during the visit or exit interview of another emergency preparedness plan. As there was no documentation of an annual review and update made available to DHS at the time of the licensing review, the citation is affirmed. Disposition: The Commissioner has reviewed the relevant laws and all of the information you submitted in response to the Correction Order. Citations 1, 4, 5, 6, 7, 8, 9, and 10 are supported by the record and affirmed. This is a final agency decision. The Commissioner appreciates your response and encourages you to continue to work cooperatively with your licensor to ensure the safety and well-being of the children you serve. Sincerely,  Afsheen Foroozan, Attorney Legal Counsel’s Office Office of Inspector General 11 DHS provides technical assistance throughout the year, but utilizes licensing reviews and investigations to determine a license holder’s comprehensive compliance with licensing rules and statutes. Further, license holders are responsible for maintaining compliance with licensing regulations at all times. Being compliant with a requirement at one point in time does not absolve the license holder of their obligation to continue to follow applicable regulation in order to maintain compliance.
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