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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: 809482-CCC (Child Care Center) Investigator(s): Anna Parkin 651-431-6225 Suspected Maltreatment Reported: It was reported that an alleged victim (AV) was left alone inside a classroom for approximately 12 minutes. Date of Incident(s): May 24, 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 June 9, 2023; from documentation at the facility; and through five interviews conducted with a supervisory staff person (P1), three facility staff persons (P2, P3, and the SP), and the AV’s family member (FM). According to the AV’s enrollment information, the AV was four years old and enrolled in the older preschool room at the time of the incident. The facility had a preschool playground that had a door that led inside to the older preschool room. There was a walkthrough bathroom that connected to the older preschool room on one side and the older toddler room on the other side. There was a baby gate separating the bathroom and older toddler room. P2, P3, and the SP provided the following information: · On May 24, 2023, at approximately 10:45 a.m., P2, P3, and the SP brought 21 preschool children, including the AV, outside to the playground. Awhile later, four children including the AV had to go inside to either use the bathroom or use their inhalers. P2 and the SP discussed the situation and decided that the SP would take the four children inside. · Shortly after going inside, another child decided s/he needed to use the bathroom so P2 opened the door and told the SP that another child was coming inside. The SP acknowledged that a fifth child was inside with them. Shortly after that, a sixth child got sand in his/her eye so P2 brought the sixth child over to the door that led inside, opened the door, and told the SP that a sixth child was coming inside and needed a washcloth to wipe his/her eyes. The SP acknowledged that the sixth child came inside. During that time, P2 watched the children playing on the climber and P3 was across the playground watching children playing in the sandbox. A few minutes later, the SP and the children came back outside onto the playground. · At approximately 11:05 a.m., P2 opened the door to the preschool room and set a tablet on the counter. P2 saw the AV inside the room alone and crying. P2 “immediately” brought the AV outside and consoled him/her. P2 went over near the SP and said the SP’s name. The SP looked over and told P2 that s/he counted the children before leaving the room. P2 responded that “obviously [the SP] had not” counted the children and walked away. P2, P3, and the SP each stated that the AV was not injured. The SP provided the following additional information: · While inside the older preschool room, the SP stood outside the bathroom while giving two of the children inhalers since the other two children, including the AV, were independent with using the bathroom. One of the children from outside could not decide if s/he needed to use the bathroom but then decided that s/he did and came inside which meant there were five children inside with the SP. During that time, a sixth child came into the room to get a washcloth for sand in his/her eye and one child left and went back out to the playground leaving five children with the SP. The SP stayed inside the preschool room assisting those children and when they were done, the SP had the children line up to go back outside. The SP counted four children and then walked back out to the playground. The SP stated that the number four “made sense in [his/her] head.” The SP did not check inside the bathroom prior to going back outside. · After a few minutes on the playground, the SP heard P2 say the SP’s name so the SP looked over and saw the AV who appeared “sad and scared.” The SP went over “right away” and comforted the AV. P1 stated that later on that day, s/he reviewed video footage from the old preschool room and saw that at 10:53 a.m., the SP and the other four children left the preschool room. During that time, the AV came out of the bathroom alone carrying a paper towel and threw it in the garbage in the older preschool room. The AV then looked around and stood in one spot for a while before walking and looking out the window to the preschool playground. At 11:05 a.m., P2 came back inside and found the AV. P1 was not able to save a copy of the video to provide it to this investigator. The FM stated that P1 told the FM two days after the incident occurred. The FM had one previous concern with the facility over bringing birthday treats on the AV’s birthday but no other concerns. According to the facility’s Supervision of Children policy, staff persons positioned themselves so that children were observed in all areas of a room. Staff persons “always” knew the number of children present “at all times.” Facility documentation showed that the SP and other staff persons interviewed in this investigation received training on the facility’s Supervision of Children policy and the Maltreatment of Minor’s Act prior to the incident. Relevant Rules and/or 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. Conclusion: A. Maltreatment: Information from all sources was consistent that on May 24, 2023, the AV was left in the older preschool bathroom for 12 minutes without the knowledge or supervision of a staff person which was inconsistent with the facility’s Supervision of Children policy and was a violation of Minnesota Statutes, section 245A.02, subdivision 18, and Minnesota Rules, part 9503.0045, subpart 1, item A. Given that no staff person was aware that the AV was in the classroom for 12 minutes, they would not have been able to intervene in the event of an emergency or to protect the AV. Therefore, there was a preponderance of the evidence that there was a failure to supply the AV with necessary care and a failure protect the AV from conditions or actions that seriously endangered the AV’s physical or mental health when reasonable 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. The SP was trained on the Supervision of Children policy and the Maltreatment of Minor’s Act. The SP was responsible for the care and supervision of the AV at the time of the incident. The SP had five children with him/her and counted four children which s/he stated “made sense in [his/her] head” but did not ensure that all of the children were out of the bathroom when s/he returned outside. Therefore, 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 neglect for which the SP was responsible did not meet statutory criteria to be determined as recurring or serious because it was a single incident for which 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 determined policies and procedures were adequate but not followed. All staff persons received additional training on supervision. 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 July 21, 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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