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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: 1098018-CCC (Child Care Center) Investigator(s): Anna Parkin 651-431-6225 Suspected Maltreatment Reported: It was reported that an alleged victim (AV) left the facility without staff persons knowledge or supervision and was found along a road near the facility. Date of Incident(s): July 28, 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 August 9, 2023; from documentation and video footage provided by the facility; a law enforcement report; and through five interviews conducted with two supervisory staff persons (P1 and P2), two facility staff persons (SP1 and SP2), and a community person (CP1). According to the AV’s enrollment information, the AV was three years old and enrolled in the preschool one room at the time of the incident. According to the AV’s Amended Individualized Education Program (IEP), the AV was diagnosed with an autism spectrum disorder. The AV did not verbally communicate while at the facility. The facility was located on the corner of Jade trail (two lane street with no posted speed limit) and Hudson Road (two lane road with a 45-55 mile per hours speed limit). On the other side of Hudson Road was a grass area and then Interstate 94. Along Hudson Road to the west of the facility was other businesses and a swamp. The facility’s preschool one room was located along a hallway. At the end of the hallway, was the “big room” which was a large, open room. The big room had a playhouse structure, two attached bathrooms, and two emergency exit doors without alerts, one leading towards the parking lot and the other leading to a grass area and then Hudson Road. CP1 stated that on July 28, 2023, at approximately 3:30 p.m., while driving east on Hudson Road, s/he saw the AV walking alone along the west shoulder of Hudson Road. There were cars driving both directions on Hudson Road and CP1 and two other community persons (CP2 and CP3) pulled over to assist the AV. CP2 and CP1 both followed the AV to ensure s/he was safe. The AV did not talk to CP1 or CP2 during that time. CP2 continued to follow the AV while CP1 called 9-1-1. CP3 told CP1 s/he was familiar with the facility so s/he called the facility. The AV continued to walk through some grass, past a swamp, and into a parking lot of a business. CP1 saw a staff person (later identified as SP1) and two other staff persons (later identified as P1 and P2) run out of a side door and to the AV. CP1 stated from the time s/he saw the AV walking alone until the time SP1, P1, and P2 came outside it had been approximately seven minutes. The AV did not have any injuries. According to the law enforcement report, on July 28, 2023, at 3:32 p.m., CP1 called 9-1-1 stating that the AV was alone along the road and had possibly left from the facility. While two law enforcement officers (LEO1 and LEO2) were in route, they found out the AV had been brought back to the facility. LEO1 and LEO2 went to the facility and interviewed staff persons who provided information consistent with the information below. LEO1 and LEO2 verified the AV’s “wellbeing” and notified FM1 and FM2 about the incident. P1 and P2 provided the following information: · On the day of the incident, P1 was in his/her office when s/he received a phone call from CP3, who had a child who also attended the facility. CP3 told P1 that there was a child outside alone. P1 took off running down the hallway with the phone still in his/her hand. P2 saw P1 and followed him/her into the big room where SP1 and P3 were standing near the emergency exit door. P3 had a panicked look on his/her face and said something like the AV was outside. P1 and P2 went out the emergency exit door and saw SP2 running parallel to Hudson Road so P1 and P2 ran after SP2. · Shortly after leaving the facility, P1 and P2 saw the AV standing in a parking lot. CP2 was near the AV and there were approximately three cars pulled over alongside the road. P1 and P2 took the AV and brought him/her back to the facility into P1’s office. P1 then notified FM1 and FM2 about the incident. Later that day, FM1 came to pick up the AV and told P2 that the AV previously ran from other persons. Video footage provided by the facility showed the following: · On July 28, 2023, at 2:30:09 p.m., SP1 and the AV were at the end of a line of children entering the big room. SP2 and multiple other children were already in the room. SP1 walked towards the windowsill with his/her back to the room while typing on the iPad (use to keep attendance and counts of children) and the AV walked around the room. SP2 was on another iPad. At 2:30:39 p.m., the AV opened the emergency exit door and walked outside. SP1 moved out of the view of the camera and SP2 bent down and assisted a child. · At 2:31:42 p.m. (one minute later), SP1 walked back into the view of the camera and looked around a corner and then looked inside the bathrooms. SP1 walked around the room and appeared to talk to someone. At 3:32:20 p.m., SP1 and SP2 walked across the room and checked the bathrooms and other areas, including the playhouse. SP1 opened the door and walked into the hallway and at 2:32:48 p.m., SP2 walked to the emergency exit door. At 3:33:19 p.m., P3 came into the big room and started looking inside the bathrooms. At 2:33:29 p.m. (approximately three minutes after the AV left the facility), SP2 went out the emergency exit door. P3 watched out the door and approximately one minute later, SP1 returned into the big room from the hallway. · At 2:34:22 p.m., P1 and P2 entered the big room and ran out the emergency exit door. SP1 and P3 stood near the emergency exit door during that time while the other children played in the room. At 2:36:41 p.m. (seven minutes after the AV initially left the facility), SP2 walked inside the emergency exit door carrying the AV. SP1 provided the following information: · On the day of the incident, SP1 had been the only staff person working in the preschool one. At approximately 3:30 p.m., SP1 began to transition the nine children, including the AV, into the big room which was typical to combine with other rooms at that time. SP1 had all the children, including the AV, sit on a rug in the preschool one room and s/he completed a name to face check and wrote it down. SP1 carried the AV and walked with the other children along the hallway. Before going into the big room, the AV “squirm[ed]” so SP1 set the AV down with the other children. SP2 and other preschool children were already inside the big room when SP1 and the children came in. P3 was just leaving the big room and SP1 saw the AV walk into the big room last and P3 closed the door behind the AV. · After SP1 finished another name to face check, s/he walked across the room and placed the clipboard (used to document the name to face) and the iPad on the windowsill. SP1 turned around and looked at the climber because the AV had a history of climbing on the climber and SP1 wanted to make sure the AV was safe. SP1 did not see the AV on the climber so s/he asked SP2 if s/he saw the AV and SP2 stated s/he had not. SP1 stated it had been approximately one to two minutes from when s/he saw the AV until s/he realized the AV was not inside the big room. SP2 went and check in the bathrooms while SP1 looked inside the playhouse. When SP1 and SP2 did not see the AV, SP1 opened the door to the hallway and looked out but did not see the AV. SP1 was able to see P3 inside his/her room so SP1 asked P3 if s/he remembered the AV going into the big room behind SP1 and P3 responded that s/he had. · P3 came into the big room and SP2 ran out the emergency exit door. When SP2 brought the AV back inside, the AV was “happy” and did not have any injuries. SP2 provided the following information: · When s/he arrived in the big room with his/her children, s/he completed a name to face count of the children and all children were accounted for. SP1 and the preschool one children, including the AV, then came into the big room and the door was closed. SP2 continued playing with some children from his/her room and less than one minute later, SP1 walked over and asked if SP2 had seen the AV. SP2 did not so s/he started looking around the big room including the bathrooms and inside the playhouse but did not see the AV. SP1 went to look in the hallway when SP2 looked at the emergency door and saw three cars parked along Hudson Road through the emergency door. That was when SP2 realized the AV may have gone out the emergency exit door and immediately ran towards the door and outside. · SP2 ran to a person standing outside one of the cars and s/he told SP2 that the AV went towards a business. SP2 then ran along the road and saw the AV. SP2 called the AV’s name, went to the AV, and picked up the AV from a business parking lot. At some point P1 and P2 also arrived and SP2 carried the AV as they all returned to the facility. The AV did not have any injuries. According to the Child Supervision policy, all children were under direct, active supervision by sight and sound “at all times.” Staff persons conducted a name to face transition and logged the transition on the attendance clipboard. Facility documentation showed that SP1 and SP2 and other staff persons interviewed received training on the facility’s Child Supervision policy and the Reporting of 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: Information from all sources was consistent that on July 28, 2023, the AV left the big room through an emergency exit door without the knowledge or supervision of a staff person which was inconsistent with the facility’s Child Supervision policy and was a violation of Minnesota Statutes, section 245A.02, subdivision 18, and Minnesota Rules, part 9503.0045, subpart 1, item A. Minnesota Statutes, section 260E. 30, subdivision 3, stated that rather than making a determination of substantiated maltreatment by an individual, the commissioner of human services shall determine that a nonmaltreatment mistake was made by the individual. A nonmaltreatment mistake occurs when:
(1) at the time of the incident, the individual was performing duties identified in the center's child care program plan required under Minnesota Rules, part 9503.0045; (2) the individual has not been determined responsible for a similar incident that resulted in a finding of maltreatment for at least seven years; (3) the individual has not been determined to have committed a similar nonmaltreatment mistake under this paragraph for at least four years; (4) any injury to a child resulting from the incident, if treated, is treated only with remedies that are available over the counter, whether ordered by a medical professional or not; and (5) except for the period when the incident occurred, the facility and the individual providing services were both in compliance with all licensing requirements relevant to the incident.
Consistent information was provided that at the time of the incident, SP1 and SP2 were supervising children from both preschool rooms while in the big room. Although SP1 and SP2 was not aware that the AV left the big room, SP1’s and SP2’s actions or conduct were determined to be a nonmaltreatment mistake for the following reasons: (1) Supervision was defined in the facility’s Child Supervision policy. SP1 and SP2 were performing duties identified in the child care program plan. SP2 was interacting with children. SP1 had just taken attendance that included the AV, set down the clip board and iPad, and turned around to look for the AV and immediately realized the AV was not there. SP1 and SP2 immediately took action by checking around the area. (2) SP1 and SP2 have not previously been found responsible for a similar incident that resulted in a finding of maltreatment or a nonmaltreatment mistake in the past. (3) SP1 and SP2 have not previously been found responsible for a similar incident that resulted in a finding of a nonmaltreatment mistake in the past. (4) The AV was uninjured and did not require medical care after the incident. (5) Outside of this incident, the facility, SP1, and SP2 were in compliance with all relevant licensing requirements. The nonmaltreatment mistake to the AV by SP1 and SP2 was not maltreatment. Pursuant to Minnesota Statutes, section 260E.35, subdivision 6, paragraph (b), the investigative data in this report will be maintained by the Department of Human Services for a period of five years. Action Taken by Facility: The facility completed an internal review and determined that policies and procedures were adequate and followed. The facility provided additional training to all staff persons on active supervision. After the incident, the AV received one to one staffing and supervision. The facility also installed alerts on the emergency exit doors if they open. Action Taken by Department of Human Services, Office of Inspector General: SP1 and SP2 were not determined as a perpetrator of maltreatment of the AV because the Department of Human Services found that the incident for which each was responsible met the criteria to be determined a nonmaltreatment mistake. SP1 and SP2 were notified by the Office of Inspector General that any future incident of possible neglect of an alleged victim for which either is responsible might not be considered a nonmaltreatment mistake. On September 13, 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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