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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: 801680-CCC (Child Care Center) Investigator(s): Danielle Morrison 651-431-5647 Suspected Maltreatment Reported: It was reported that a staff person (SP) set an alleged victim (AV) down “forcefully” in a chair, which caused the AV to hit his/her head on a table and resulted in a laceration that required medical attention. Date of Incident(s): June 6, 2023 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 June 16, 2023; from documentation at the facility; and through four interviews conducted with one supervisory staff person (P1), two facility staff persons (P2 and P3), and the AV’s family member (FM). This investigator reached out to the SP by telephone and mail to request an interview, but the SP did not respond. The AV was 23 months old and enrolled in the toddler classroom at the time of the incident. Due to the AV’s age, s/he was not interviewed for this investigation. The facility’s toddler classroom had three tables lined up parallel to each other for meals. There was a bathroom with a half door about eight feet away from the closest table. On the other side of the classroom there were learning areas, such as a library, dramatic play, and blocks. On June 6, 2023, the FM received a telephone call from a staff person (P4) at the facility and was told the AV had an accident and the AV cut his/her forehead and s/he needed stitches. The FM picked up the AV and by that time the bleeding had stopped. The SP told the FM that the AV was running, slipped, and fell hitting his/her head on the table. The FM took the AV to urgent care and was “shocked” at how deep the cut was. The AV received three stitches in his/her forehead. Around 4 p.m. that day the FM returned to the center to pick up his/her other child. The FM talked with the SP to tell the SP how the AV was doing and to ask again what had happened. At that time the SP said s/he was carrying the AV which was different than what was told to the FM before. The SP was not “really clear” with what happened, so the FM asked the facility supervisors to review the video footage. The next morning when the FM dropped off, s/he was told that they had not had a chance to review the video, but they were going to review it at 10 a.m. At 11:30 a.m. the FM still had not heard anything, so s/he sent an email and around noon, P1 called the FM to say that s/he was “sorry” and that it was an “intentional act” that the SP did. On June 9, 2023, the FM reviewed the video footage and saw the SP “rip” breakfast away from the AV and throw it away. The SP then “yanked” the AV up from a chair and “forcefully slam[med]” the AV into another chair and the AV hit his/her head on the table. The FM had prior concerns that the SP acted like s/he did not want to be there and was “annoyed.” The FM had not witnessed anything that made him/her think the SP was not taking care of the children. This investigator reviewed the video footage and saw the toddler classroom having breakfast. The SP and P2 were walking between the tables and appeared to be talking with the children, although there was no audio on the footage. Around 9 a.m., P2 went into the bathroom with a group of children and was no longer visible on the video. The SP remained by the tables and helped children clean up. Around 9:01 a.m., the SP took the AV’s plate and dumped the remains in the garbage. At 9:02 a.m., the SP pulled back the AV’s chair and picked the AV up under his/her arms, the SP then swung the AV under the SP’s right arm and picked up the AV’s cup of milk with his/her left hand. The SP carried the AV to another table, set the AV’s milk down, pulled out a chair, and then moved the AV in front of the SP’s body and had both hands on the AV’s rib cage. The SP then raised the AV slightly and set the AV down in a swift motion. The SP appeared to let go of the AV before the AV was seated in the chair. The AV’s head fell forward into the edge of the table. The AV started crying. The SP looked at the injury, held his/her hands up to stop the blood, and looked towards the bathroom door. At that point, P2 stepped out of the bathroom, made a telephone call, and then walked out of camera view again. Around 9:03 a.m., P1 walked into the classroom to assist with first aid. P1 was working in a preschool classroom when P2 came in and said that the AV hit his/her head on the table and was bleeding. P1 and P2 switched classrooms at that time. P1 went into the classroom, and s/he cleaned up the AV. P1 was told by the SP that the AV fell forward and hit his/her head on the table. While P1 was assisting in cleaning up the AV, P4 walked in and P1 told P4 to call the FM. The FM arrived about 15 minutes later and took the AV to the doctor. The AV required three stitches. When the FM came to the center later on that day the FM was told by the SP that the SP was holding the AV and the AV was “upset” and fell forward hitting his/her head on the table. Because the SP told the FM two different explanations of what happened, P1 reviewed the video footage. P1 saw on the video that the SP “seemed somewhat upset.” The SP took the AV’s plate away in a “mannerism that [indicated] s/he was upset” and then picked the AV up and moved the AV and set the AV down in a “forceful” way which resulted in the AV hitting his/her head on the table. The SP told P1 s/he moved the AV to the other table to start cleaning, although this did not make sense to P1 because there were children still at both tables. P1 had no prior concerns with the SP and how s/he interacted with children. P2 said it was a “normal day” when the incident occurred. P2 went into the bathroom to assist children in washing their hands and the SP cleaned up the plates. The SP called, “[P2] call [P1],” P2 came out of the bathroom and saw the AV’s “bloody face,” called P1, and P2 went to preschool and s/he and P1 swapped roles. When P2 returned to the toddler classroom the AV had left with the FM. The SP told P2 that s/he moved the AV to a different table and once moved, the children at the other table were making the AV “fussy” or the AV was “upset” that s/he got moved and the AV swung his/her head and it hit the corner of the table. P2 did not remember anything “off” with the AV that morning and did not hear any crying until after the incident happened. P2 had no prior concerns about the SP. P3 was not working the day of the incident but normally worked in the toddler classroom with the SP. P3 had not witnessed the SP exhibit any behaviors that were inappropriate towards children. Photos of the AV showed an inch long laceration on the middle of his/her forehead. The facility’s Behavior Guidance Policy stated “Develop a supportive, trusting relationship with each child in our care as a foundation for discipline. Examples: establish eye contact, use nurturing touch; engage children in warm, playful interactions; and be actively engaged and present in the moment.” The SP, P1, P2, P3, and P4 were all trained on the facility’s Behavior Guidance Policy and the Reporting of Maltreatment of Minors Act. Law enforcement conducted an investigation and were also unable to reach the SP for an interview. Law enforcement reviewed the video footage and what they saw was consistent to FM1, P1, and this investigator. Formal charges of Neglect and Endangerment of a Child 609.378 were sent to the county attorney’s office for review. Relevant Rule and/or Statute Minnesota Rules, part 9503.0055, subpart 1, item A, states that facilities must ensure that each child is provided with a positive model of acceptable behavior. Minnesota Rules, part 9503.0055, subpart 3, item A, prohibits the use of corporal punishment including but not limited to in part, rough handling, kicking, hitting, and spanking. Conclusion: A. Maltreatment: Consistent information was provided that on June 6, 2023, the SP picked up the AV from a chair at one table and moved the AV to a chair at a different table. This investigator saw on video footage that the SP set the AV down in a swift motion and the AV hit his/he head on the corner of the table causing an inch long laceration that required three stitches. P1, FM, and law enforcement each reviewed the video footage. The FM stated that the SP “forcefully slam[med]” the AV down and P1 stated that the SP sat the AV down in a “forceful” way causing the AV to hit his/her head on the table. The SP’s actions were inconsistent of a professional caregiver in a facility licensed by the Department of Human Services, and were a violation of the facility’s Behavior Guidance Policy and a violation of Minnesota Rules, part 9503.0055, subpart 1 item A; and subpart 3, item A. The SP initially told the FM that the AV was running and slipped and hit his/her head on the table, but later stated s/he was carrying the AV when it happened. The SP told P2 that the AV was “upset” that the SP moved the AV from one table to another and the AV swung his/her head and hit the table. P2 said prior to the incident, s/he did not remember anything “off” with the AV. Given that video footage showed the SP set the AV down in a manner that was not consistent with the facility’s Behavior Guidance Policy, and that the AV sustained an inch long laceration that required three stitches as a result of the SP’s actions, there was a preponderance of the evidence that the SP’s actions were not accidental and represented a substantial risk of physical 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. The SP was trained on behavior guidance and the Reporting of Maltreatment of Minors Act. The SP was responsible for the care of the AV at the time of the incident. Therefore, the SP was responsible for the 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 was not recurring maltreatment because it was a single incident but did meet the statutory criteria to be determined “serious” maltreatment because the AV sustained an inch long laceration that required the care of a physician. The SP 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 an internal review and found their policies and procedures adequate but not followed by the SP. The SP no longer worked at the facility. Action Taken by Department of Human Services, Office of Inspector General: The SP was 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 the SP was responsible for maltreatment and the disqualification of the SP are each subject to appeal. On August 4, 2023, the facility was issued a Correction Order for the violations outlined in this report and a Correction Order for not maintaining the required staff person to child ratio. 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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