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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: 1047403-CCC (Child Care Center) Investigator(s): Tessa Ripka 651-431-6612 Suspected Maltreatment Reported: It was reported that an alleged victim (AV) walked out of a barn door at a fair and was missing for three minutes. Date of Incident(s): July 14, 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 18, 2023; from documentation at the facility; and through three interviews conducted with two facility staff persons (SP1, SP2), and the AV’s family member (FM). The AV was four years old at the time of the incident and enrolled in the Preschool 2 classroom. SP1 and SP2 provided the following information: · On the date of the incident, SP1 and SP2 took 14 children (11 school age children, and 3 preschool age children including the AV) to a county fair for “daycare day.” When they arrived at the fair the children participated in a special activity, ate lunch, and then went to the bathrooms. · At approximately 12:15 p.m., SP1 said that they counted the children after they left the bathroom and walked to the barns to look at animals. SP1 walked in the barn first and went to the door on the opposite side. SP2 was at the back and followed the children as they went through the aisles petting and looking at the animals. SP2 thought there were three aisles of animals. The barn was small enough that you could see the opposite end and the all the aisles. · Approximately two to three minutes after they entered the barn, SP1 received a call from the facility on his/her cell phone around 12:15-12:20 p.m. They said someone called from the fair and the AV was at the sheriff’s booth, near the “little barn.” The barn that they were in was parallel to the little barn. · SP1 peeked around the corner of the barn and saw the AV standing near the sheriff’s booth. SP1 called to the AV and the AV ran over. The AV did not seem to be bothered by the incident. The children finished looking in the barn and gathered by the door. They then went on a ride, got ice cream, and returned to the facility. SP2 thought they were in the barn for “maybe” 15 minutes total. · SP1 said they had not yet counted the children in the barn when the AV was missing because they were not ready to leave the barn yet. Typically, they gathered all the children by the door and then counted as they left each barn. SP1 thought the AV left through a side door in the barn. SP1 did not realize there was a side door. · The side door exited to small space between that barn and the little barn. There was a door to the little barn directly across from the barn door where the children were. Through the little barn was the sheriff’s booth. Facility policy information showed that staff persons were trained to take a name clipboard every time the children left the classroom. Staff persons did a name to face count when they arrived in the next place. One staff person did a head count while the other staff person did a name to face count with the clipboard. The clipboard was kept up to date. Staff persons circulated to provide constant supervision. Staff persons worked together in supervision of all children. According to www.wunderground.com, the outdoor condition at the facility, on July 14, 2023, at the time of the incident, was “fair” with a temperature of 82 degrees Fahrenheit (°F) and wind speed of 9 miles per hour (mph). Facility documentation showed that all staff persons were trained on the facility’s policies and the Reporting of Maltreatment of Minors 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, state that “supervision” means 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; and that children are required to be supervised at all times. Conclusion: A. Maltreatment: Information was consistent that on July 14, 2023, SP1 and SP2 took 14 children to a county fair. At approximately 12:15 p.m., they entered an animal barn and looked around. SP1 walked to the opposite door and waited while SP2 walked along with the children as they looked at the animals. SP1 received a call from the facility. The facility had received a call that the AV was at the sheriff’s booth which was near the animal barn that the class was in. SP1 and SP2 thought the AV went out the side door of the barn at some point but both SP1 and SP2 were unaware that the AV had left the building which is a violation of Minnesota Statutes, section 245A.02, subdivision 18 and Minnesota Rules, part 9503.0045, subpart 1, item A. Given that the AV, who was four years old at the time of the incident, walked out of the barn without staff person’s knowledge or supervision and was in a location that could expose the AV to community dangers, and that staff persons were not with the AV to intervene in the event of an injury or emergency, there was a preponderance of the evidence that there was a failure to supply care or supervision required for the AV’s physical health when reasonably able to do so and a failure to protect the AV from conditions that seriously endangered his/her physical or mental health when reasonably 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; and/or 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. SP1 and SP2 were trained on the facility’s policies and the Reporting of Maltreatment of Minors Act prior to the incident. Both SP1 and SP2 were responsible for the care and supervision of the AV at the time of the incident. SP1 and SP2 were 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 as it was a single incident, and the AV was not injured. 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 and followed. 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. On October 6, 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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