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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: 803815-CCC (Child Care Center) Investigator(s): Lindsay Arth 651-431-6537 Suspected Maltreatment Reported: It was reported that a staff person (SP) hit an alleged victim (AV) on the head causing a cut. Date of Incident(s): April 28, 2023 Nature of Alleged Maltreatment Pursuant to Minnesota Statutes, section 260E.03, subdivision 15, paragraph (a), clauses (1) and (2); subdivision 18, paragraph (a); and subdivision 23, paragraph (a): 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. "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 May 17, 2023; from documentation at the facility and law enforcement records; and through five interviews conducted with two facility staff persons (the SP and P2), two supervisory staff persons (P1 and P3), and the AV’s family member (FM). This investigator met and attempted to interview the AV but the AV did not want to talk to this investigator. The facility had multiple classrooms including a preschool room. The facility also had a room with a changing table and sink. Adjacent to this was a bathroom with toilet stalls. In the changing table/sink area was an approximately one-inch metal circular ring (a washer) with a hole in the middle where ribbon was tied to hang on a hook. This ring was used as a key to lock and unlock an area under the changing table for storage. The AV was approximately four years old at the time of the incident and enrolled in the preschool room. The AV enjoyed cars, trucks, and puzzles. P1, P2, P3, the Child Care Center Injury/Incident Report Form completed by P2, an untitled document written by P2, an untitled document written by P3, a photo of the AV’s injury taken from the facility, and the Fax Cover Sheet completed by P1 provided the following information: · On April 28, 2023, at 11:14 a.m., the SP and P2 were assisting children with toileting. P2 assisted two children in the bathroom stalls and the SP was in the adjacent room changing children on the changing table. P2 could hear the SP telling the AV to “sit down” and “stop messing around.” P2 then went into the area where the AV and the SP were to assist some children with washing their hands and noticed that the AV had a cut on his/her head that was bleeding. The AV did not have the cut earlier. The AV was not crying (P2 said that the AV often cried if s/he was hurt) but said that s/he had a “boo boo.” The SP said “something about [his/her] fingernail” causing the cut. · P2 then took the AV to P3’s office and told P3 about the injury. P3 saw the injury which P3 described as an approximately one-half-inch to one-inch long raised bump and cut that was red and looked a “little bloody.” P3 asked the AV if the injury “hurt” and the AV said that it did. The AV did not say how the injury happened. P3 said that s/he asked P2 what happened and P2 said that the SP told him/her that s/he “accidently hit [the AV] on the top of [his/her] head with [the SP’s] nails.” · P3 then told P2 to get ice for the AV because the injury was “swelling.” P3 also told P2 to wash the injury with warm soap and water which P2 did. · P3 questioned P2 whether the injury was from the SP’s fingernail so P2 went back to the SP and asked the SP again what happened. The SP told P2 that to be “completely honest,” s/he “hit” and “tapped” the AV on the head with the key to the changing table because the AV was not listening. The SP said that s/he was “frustrated” and “lost [his/her] temper.” During this time P1 arrived at the facility. · P1 said that around 11:20 a.m., s/he had just returned to the facility from an appointment and saw the AV, P2, and P3 in his/her office. P2 told P1 that the SP “hit” the AV on the head with the changing table key and that the AV had a “small cut and bump” on his/her head. P1 said that there was a “little edge” on the key which could be sharp. P1 then looked at the AV’s head and saw a “raised” bump and a “small little cut.” · P1 then spoke to the SP who said that s/he was “frustrated” and “hit” the AV on the head with the changing table key. The SP said that s/he was “very upset” that s/he made a “mistake.” P1, P2, and P3 said that if the SP was frustrated, s/he should have asked another staff person for help or asked for a “break.” P3 said that the SP could have asked him/her for help as s/he was in the office doing paperwork at the time of the incident. · The AV was “good” the remainder of the day and napped and participated in activities as normal. Around 3 p.m. when the FM picked the AV up, the AV told the FM that s/he had a “boo boo” on his/her head. P1 thought that the FM took the AV to the doctor after s/he picked the AV up. · P1 and P3 said that the SP was normally “quiet, “polite,” and “friendly.” P2 said that the children often ran up to the SP to give the SP a hug. P1, P2, and P3 did not have any concerns with the SP’s interactions with the children prior to the incident. P3 had never seen the SP frustrated with children. P1 and P2 were “shocked” by the incident. The law enforcement records said that the SP “admitted” to hitting the AV on the head with a “key ring” after s/he told the AV to stop running around. The SP “knew what [s/he] did was wrong” and “did not intend to harm [the AV].” The AV sustained an approximately two- and one-half centimeter cut on the top of his/her head. The report was sent to the county attorney and the SP was “charged” with “malicious punishment of a child.” The SP and an untitled document from the facility that was written by the SP provided the following information: · On April 28, 2023, around 10:45 a.m., the SP was in the bathroom with six or seven children and was trying to change a child’s diaper. During this time, the AV was running around and trying to hit and bite other children so the SP asked the AV “multiple times” to “stop goofing around.” The SP was “frustrated” because the AV was not listening so the SP picked up the key to the changing table and swung it to get the AV’s attention so that the AV would “stop” what s/he was doing. It was not the SP’s “intention” but the SP “unfortunately” hit the AV in the head with it. The SP did not “swing [the key] hard” and only wanted to “scare [the AV] a little bit.” The SP said that s/he did so because s/he “lost all [his/her] patience with [the AV].” The AV had “no reaction,” including that s/he did not say anything and did not cry and went “right back to what [s/he] was doing.” The SP “did not think that [s/he] left a mark” on the AV. However, around this time, P2 came into the bathroom and noticed a “tiny amount of blood” in the AV’s hair and saw the “mark.” The SP described the injury as a “little cut.” · The SP “did not know what sparked [him/her] to make that very poor choice” and the SP was “deeply sorry.” The SP said that the incident occurred in the “heat of the moment.” · The SP said that the AV had a history of not listening and that verbal redirection “did not work.” The SP had seen other staff persons, including P2, hit the AV on the head with a whiteboard or throw erasers, markers, pens, and pencils at the AV (Note: P2 denied doing this and P1 and P3 were not aware of this). P2 told the SP that staff persons could do these things as long as they did not get “caught doing it.” (Note: P2 denied saying this and P1 and P3 were not aware of this.) The SP had also seen P1 be “rough” with the children, including “throwing” children in a chair and “swatting” a child across the face. The SP said that other staff persons knew about this. (Note: P1 denied these things and P2 and P3 were not aware of P1 doing those things.) The SP had not seen any children with injuries because of P1’s and P2’s interactions. The SP said that s/he did not tell anyone about these things despite being a mandated reporter. · The SP said that s/he did not ask anyone for help at the time of the incident because s/he was the only staff person in the bathroom and did not want to leave the child on the changing table.
The FM provided the following information: · The AV did not say anything to the FM about the incident aside from that s/he had a “boo boo.” The AV also asked that the FM not to touch his/her head. · The FM said that because s/he was a nurse, the AV did not like doctors, and the AV was not showing signs of a concussion, the FM did not take the AV to the doctor because s/he did not want to cause the AV any more “stress.” However, at some point, the FM notified the AV’s pediatrician and told the pediatrician that the AV had a “bump” on his/her head but that the AV did not get hit “very hard” and was “fine.” The AV’s pediatrician “did not feel like” the AV needed to be seen by a doctor. · The FM also said that s/he used to work with the SP at a nursing home and that the SP was “fired” for “abuse and neglect there.” (Note: This investigator was not able to find information regarding this.) The SP had a “pattern” of neglect and abuse. · The FM did not have any other concerns with the facility and said that s/he “trusted” the facility. The Behavior Guidance Policies and Procedures said that positive reinforcement was used for acceptable behavior. Children were not to be subjected to corporal punishment including hitting. The Parent Handbook said that the facility was “fortunate” enough to have “competent and caring staff.” Redirection and “intervention” were used when able to avoid inappropriate behaviors. Facility documentation showed that the SP, P1, P2, and P3 each received training on the Reporting of Maltreatment of Minors Act and on the facility’s policies, including the behavior guidance policy, prior to the incident. Relevant Minnesota Statutes and Rules: Minnesota Rules part 9503.0055, subpart 3, item A, states that the license holder must have and enforce a policy that prohibits the subjection of a child to corporal punishment. Corporal punishment includes, but is not limited to, rough handling, shoving, hair pulling, ear pulling, shaking, slapping, kicking, biting, pinching, hitting, and spanking. Conclusion: A. Maltreatment: Information was consistent that on April 28, 2023, the SP “hit” the AV on the head with the changing table key, which caused an approximately two and a half centimeter cut that had bled on the top of the AV’s head. P2 applied ice and washed the injury with soap and water. The AV did not require medical attention for the injury. P1 and P2 said that the SP told them that s/he was “frustrated” with the AV and “lost [his/her] temper.” The SP told this investigator that s/he was “frustrated” and wanted to “scare” the AV because the AV was not listening. The SP’s action of hitting the AV on the head was inconsistent with the standards of a professional caregiver in a facility licensed by the Department of Human Services; was a violation of the facility’s behavior guidance policy and procedures; and a violation of Minnesota Rules, part 9503.0055, subpart 3, item A. Given that the AV was approximately four years old at the time of the incident; that although the AV was running, the AV was not a danger to him/herself or others; that the SP was frustrated by the AV’s actions; and that sustained a cut that bled and bump on his/her head, there was a preponderance of the evidence that the SP’s actions were not accidental and were a failure to supply the AV with necessary care, a failure to protect the AV from actions that seriously endangered the AV’s physical health, caused injury to the AV, and represented a substantial risk of injury to the AV. It was determined that neglect and physical abuse 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. "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). 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 responsible for the AV’s care and supervision at the time of the incident. The SP was trained on the facility’s policies, including the Behavior Guidance policy and the Reporting of Maltreatment of Minors Act. 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 physical abuse for which the SP was responsible was not recurring because the SP’s interaction was a single incident but was serious because the AV sustained a cut/tissue damage. 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 determined that policies and procedures were adequate but not followed by the SP. The facility indicated a need for additional training including to remind staff persons that they were to always ask for help if they were overwhelmed. The incident was not similar to prior incidents with the SP or the AV. 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 September 6, 2023, the facility was issued a Correction Order for the violation 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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