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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: 802166-CCC (Child Care Center) Investigator(s): Danielle Morrison 651-431-5647 Suspected Maltreatment Reported: It was reported that two staff persons (SP1 and SP2) took a classroom to a nearby community park and when they returned, an alleged victim (AV) was still at the park without SP1 and SP2’s knowledge or supervision for approximately five to ten minutes. SP1 and SP2 noticed the AV was not in the classroom when they returned from the park, so SP2 went and found the AV who was still at the park. Date of Incident(s): April 18, 2023 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 April 27, 2023; from documentation at the facility; and through five interviews conducted with SP1, SP2, a supervisory staff person (P), the AV, and the AV’s family member (FM). The facility was located inside a church. There was an upper and lower parking lot to the church and the facility used a door off of the upper parking lot to go to the nearby community park which was 570 feet from the door the preschool classroom used to exit the facility. From the upper parking lot there was a small hill that led to the community park which had a tennis court and a playground. The playground had four swings, a climbing structure with two slides, a bridge, and a webbed rope climbing area. There was a fake rock in front of the climbing structure that children climbed on. The park was adjacent to one side of the lower parking lot. There was a residential street that was perpendicular to the park 285 feet away, that had a speed limit of 30 miles per hour. Another residential street ran parallel to the park on the other side of the lower parking lot 596 feet away, that had a speed limit of 30 miles per hour. The community park was not enclosed. The AV stated that a friend told the AV to stay on the playground, so when it was time to go inside the AV hid behind something. The AV stated that s/he counted cars when SP1 and SP2 were not outside with the AV, so s/he stayed “calm.” The AV also stated that there was still some snow outside, and the AV had his/her mittens on and was eating snow so s/he could have water to drink. The AV said SP2 found him/her on the playground and when they were walking back to the facility SP1 came down the hill. On April 18, 2023, SP2 stated that s/he and SP1 had 15 children and they went to the community park around 11:15 a.m. After about 20 minutes a child indicated that s/he needed to use the bathroom because s/he had had a bathroom accident. SP2 took a group of five children back to the classroom, where the child who had an accident changed and the other children went to the bathroom and read books. SP2 did not communicate to SP1 the number of children s/he brought back into the facility to use the bathroom. Between 11:45-11:50 a.m., SP1 returned to the classroom with the other children and parents were there to pick up some of the children. The children were on the carpet and SP2 realized the AV was not there. SP1 and SP2 scanned the room and then SP2 brought a child out to a parent in the upper parking lot, looked around the upper parking lot, and did not see the AV, so then SP2 ran down the hill to the playground. SP2 thought it was around 11:50 a.m. that s/he brought the child out to his/her parent in the parking lot and from there SP2 was not able to say how long it took to get to the playground because his/her adrenaline was going, and s/he did not have a good sense of time. SP2 saw the AV behind the playground equipment. SP2 said the AV did not look sad. SP2 and the AV walked back up the hill and the AV tried to explain what happened; the AV said a friend “suggested” s/he do “it.” While they were walking back, SP1 met them on the hill. SP2 said that SP1 let the FM know. SP1 stated that s/he and SP2 had 15 children at the playground when a child had to use the bathroom. SP2 asked if anyone else needed to go and SP2 took a group of children inside. SP1 did not remember if SP2 communicated with him/her the number of children SP2 took inside. SP1 counted nine children and thought the AV was with the group SP2 brought inside. SP1 said the remaining group stayed outside for another five to seven minutes and then started to put jackets and mittens back on. SP1 stated the group got back inside at 11:47 a.m. because they were a few minutes late for the parent pick up at 11:45 a.m. At that time SP2 asked SP1 “Where is [the AV]?” SP1 stated s/he thought the AV was with SP2. SP2 rushed out the door to look for the AV. The P happened to come into the classroom at that time and stayed with the other children while SP1 went outside. When SP1 went outside, SP2 and the AV were coming up the hill. SP2 told SP1 that the AV was poking his/her head around the rock when SP2 came down the hill. SP1 told the AV how scary that was and to always have a grown up with him/her. SP1 thought the AV was alone for about five minutes. SP1 let the FM know about the situation when s/he came to pick the AV up from the facility. The FM told SP1 that the AV had “hid” from the FM the night before at an event. The P stated that s/he was walking by the classroom around 11:45 a.m. and SP1 said s/he thought the AV was still at the park and that SP2 went to look. The P stayed in the classroom and had SP1 go look as well. The P said it was just a couple of minutes that s/he was in the classroom before SP1, SP2, and the AV returned. The P spoke with SP1 and SP2 about what had happened, and they both stated that they were at the park and some of the children needed to use the bathroom so SP2 took a group inside. SP1 stayed with the other children and counted nine children and thought the AV was with SP1. SP2 stated s/he brought five children inside and when SP1 came in with the other group they realized the AV was not with either of them. SP2 rushed out to the park, saw the AV, and brought him/her back to the classroom. SP2 stated the AV was “chatty” and not hurt or scared. The FM was aware of the situation and the AV told the FM that his/her friend told the AV to hide. The AV said a teacher found him/her. Prior to this the FM had no concerns with SP1 and SP2. According to www.wunderground.com, on April 18, 2023, at 11:53 a.m. the temperature was 49 degrees Fahrenheit (°F), and conditions were fair. The facility’s Risk Reduction Plan stated that staff persons “supervise the group and do head count” during outdoor play and “children are never to be out of sight of staff/supervisor” for areas that are difficult to supervise. The facility’s Family Handbook stated that “children attending [the facility] will be supervised at all times by a staff member or parent participant.” Facility documentation showed that the P, SP1, and SP2 were all trained on the Reporting of Maltreatment of Minors Act and the facility’s Risk Reduction Plan. Relevant Rule and/or Statute Minnesota Statutes, section 245A.02, subdivision 18, and Minnesota Rules, part 9503.0045, subpart 1, item A, states that a child must have supervision at all times and that supervision is 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. Conclusion: A. Maltreatment: Consistent information was provided that on April 18, 2023, SP1 and SP2 were at the nearby community park with 15 children when SP2 took a group back inside the facility to use the bathroom. SP1 stayed at the park and returned about 10-15 minutes later. At that time, it was realized that the AV was not with either group, so SP2 went out to look for him/her. The AV was still on the playground behind some of the play equipment. When SP2 and the AV were returning to the classroom they ran into SP1 on the hill. The AV was not hurt. It was estimated that the AV was without supervision for approximately 5 minutes which was a violation of Minnesota Statutes, section 245A.02, subdivision 18, and Minnesota Rules, part 9503.0045, subpart 1, item A. Although it was noticed that the AV was not with the group when SP1 returned to the classroom, given that SP1 and SP2 did not confirm the number each was responsible for when SP2 brought in a group of children to use the bathroom, that the AV was at a community park 570 feet from the building where SP1 and SP2 were not present to intervene if the AV was injured or in an emergency, there was a preponderance of the evidence that there was a failure to supply the AV with necessary care and a failure to protect the AV from conditions or actions that seriously endangered his/her physical or mental health. 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. Given that both SP1 and SP2 were supervising the AV on the playground and did not communicate with each other which group the AV was in when the group was split, and both SP1 and SP2 were trained on the Reporting of Maltreatment of Minors Act and the facility’s Risk Reduction Plan, SP1 and SP2 were both 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 neglect for which SP1 and SP2 were responsible did not meet statutory criteria to be determined as recurring or serious maltreatment as it was a one-time occurrence, and the AV did not sustain an injury. 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 found their policies and procedures adequate, but not followed by SP1 and SP2. Action Taken by Department of Human Services, Office of Inspector General: SP1 and SP2 were not disqualified from providing direct care services as a result of the maltreatment determination in this report. However, SP1 and SP2 were each 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 disqualification. The determination that SP1 and SP2 were each responsible for maltreatment is subject to appeal. In addition, on June 16, 2023, the facility was issued a Correction Order for the violations 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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