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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: 1057458-CCC (Child Care Center) Investigator(s): Judith Schwanke 651-431-4033 Suspected Maltreatment Reported: It was reported that an alleged victim (AV) left the facility playground and was found between three and eight minutes later with a community person. Date of Incident(s): July 21, 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 July 28, 2023; from documentation at the facility; and through seven interviews conducted with a facility supervisory staff person (P1), facility staff persons (P2, SP1, SP2, SP3), the AV’s family member (FM), and a community person (CP). The facility was in a church located at a “T” intersection of two roads and approximately two blocks from a river. The church had a large “L” shaped parking lot on the south and west sides of the building. Beyond the south side of the parking lot was a large open field with an unfenced playground for older children and a “Gaga” ball pit. The field was surrounded by large trees on two sides and a two-lane street with a speed limit of 30 miles per hour that ran along the east side. At the back of the west parking lot were five large, stacked tires, two large vehicles, a garage, and two unlocked dumpsters. Beyond the west parking lot were large trees and a residential neighborhood. On the east side of the building was a playground for the toddler aged children. The playground was surrounded by a chain link fence that was approximately four feet high. There was a gate on the fence near the facility gymnasium entrance. The gate had a “U” shaped latch and a rope that was wrapped from the gate and a fence post. To the north of the facility was a two-lane street with a speed limit of 30 miles per hour. Across that road were two baseball fields, an elementary school, and a school bus facility. The elementary school had a large playground, which according to Google Earth, was 937 feet away from the facility toddler playground. At the time of the incident the AV was 26 months old and enrolled in the facility’s toddler classroom. The FM stated that on July 21, 2023, at approximately 10:15 a.m., s/he received a telephone call from the facility. SP1 told the FM that the AV had gotten out of the playground and was found in the baseball field across the street. On the same day, the FM went to the elementary school across from the facility to drop off items for his/her other school aged children and spoke with the CP. The CP told the FM that s/he found the AV and was with the AV for approximately ten minutes before a facility staff person arrived. The FM stated there were prior incidents when the AV left the gymnasium and the playground without staff supervision but the FM could not recall the dates. The CP stated that on July 21, 2023, at approximately 10 a.m., s/he went out the back door of the elementary school and saw a child (later determined to be the AV) walking toward the elementary school playground. The CP did not see any other adult around the AV, so the CP walked toward the AV, and they met on the sidewalk along a black fence. The CP asked the AV if s/he knew his/her name and if s/he saw his/her house, but the AV did not say anything to the CP. Then the CP took out his/her cellular phone and was about to call 9-1-1 when s/he looked up and saw a facility staff person walking toward him/her from the facility. The staff person (later identified as SP2) walked toward the CP and the AV. When they met, SP2 told the CP that the AV’s siblings attended that elementary school. The CP asked who the siblings were and then realized who the AV was. The CP gave the AV to SP2 and then returned to the elementary school. The CP estimated the AV was with him/her for approximately eight minutes. P1, SP1, SP2, and SP3 provided the following consistent information: · On July 21, 2023, at approximately 10 a.m., SP1, SP2, SP3, and the toddlers were on the playground. SP1, SP2, and SP3 were spread out and engaged with children. SP1 was approximately two or three feet away from the playground gate assisting another child when s/he heard the playground gate click and immediately asked SP2 and SP3 where the AV was. SP2 who also heard the gate click, immediately began looking for the AV on the playground as SP1 left the playground to look for the AV and SP3 supervised the children on the playground. Because of the rope on the gate, the AV could not open the gate and must have gotten out between the gate and the fence post. · When SP1 left the playground s/he “pounded” on the gymnasium door nearest the playground gate while s/he leaned back to look around for the AV. SP1 was let into the gymnasium by another staff person and SP1 asked him/her if they had seen the AV and was told no. Then, SP1 and the other staff person looked through equipment in the gymnasium but did not find the AV. SP1 then went back out the door and walked to the center of the south parking lot. There, SP1 saw SP2 along the building looking and calling for the AV. · While SP2 looked for the AV around the south and east side of the facility and continued to check on SP3 and the rest of the toddler group on the playground, as SP1 looked for the AV near the “Gaga” ball pit. · SP1 did not believe the AV could have gone far that fast so s/he left the “Gaga” ball pit and then went back to the playground gate to make sure the AV was not on the playground. SP1 did not find the AV and SP3 told SP1 that another child kept repeating that the AV was “at the park.” SP1 ran to the playground used by older children and searched there but did not find the AV. Then SP1 ran back to the facility and entered another set of doors nearest the older children’s playground. SP1 ran into the facility kitchen and looked for and shouted the AV’s name. SP1 ran down the facility hallway and looked for the AV in classrooms. P1 heard SP1 calling the AV’s name so P1 went outside and looked for the AV on soccer fields on the south side of the facility. · SP2 went to the west parking lot and looked around the cars that were there but did not find the AV. As SP2 went to the top of the parking lot s/he saw the AV in the outfield of the baseball field across the street. SP2 went across the street and met the AV and the CP along a fence near the elementary school playground. The AV was not crying and was “hanging out” with the CP. SP2 and the AV walked back toward the facility when SP1 came out of the facility front doors and saw them. SP1 stated the AV was “whining” because s/he wanted to be at the elementary school and because s/he wanted to be carried, and SP2 had made the AV walk back to the facility. · SP1, SP2, and the AV went back to the playground. SP3 stated the AV cried for “a little bit” and then resumed play. The AV did not try to leave the playground again while they were out that morning. · SP1, SP2, and SP3 estimated the AV was missing for approximately three minutes. · Prior to July 21, 2023, the AV had gotten out of the playground and ran a few steps before a staff person caught up with the AV and brought him/her back to the playground. The AV also left the gymnasium and went down a hallway before a staff person caught up to him/her and brought him/her back to the gymnasium. The facility’s Emergency and Accident Policies and Records showed that while children were on the playground they were supervised by sight at all times and staff positioned themselves so that they saw all children on all areas of the playground. Children stayed within the playground and left only with permission and when children were in the parking lot, a staff person always supervised children to avoid pedestrian accidents. It also showed that the facility, materials, and equipment were kept in good repair and inspected daily, and an annual maintenance check of all equipment was completed in the spring. When a child was missing, the incident was reported to licensing. Facility documentation showed that prior to the incident P1, SP1, SP2, and SP3 were trained on the facility’s Emergency and Accident Policies and Records and the Reporting of Maltreatment of Minors Act. 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: Information was consistent that on July 21, 2023, the AV’s classroom went outside to the playground with SP1, SP2, and SP3. While on the playground, SP1 and SP2 heard the gate click at the same time and immediately noticed the AV was missing. SP1 and SP2 immediately searched for the AV in and around the facility when shortly after searching, SP2 saw the AV across the street with the CP. SP2 brought the AV back to the playground. The AV was unsupervised between three to eight minutes which 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 states 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; (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. Although the AV was able to leave the playground and was unsupervised in the community between three and eight minutes, SP1’s, SP2’s, and SP3’s actions or conduct was determined to be a nonmaltreatment mistake for the following reasons: (1) At the time of the incident, SP1, SP2, and SP3 were each performing job related duties, as required by the facility’s policies, by engaging with toddlers on the playground. In addition, information provided showed that the rope was on the gate and that when SP1 and SP2 heard the gate make a noise they immediately noticed the AV was missing and began searching for the AV. (2) Neither SP1, SP2, nor SP3 had been determined responsible for any previous incident that resulted in a finding of maltreatment; (3) Neither SP1, SP2, nor SP3 had been determined to have committed a nonmaltreatment mistake under this paragraph; (4) The AV was uninjured and did not require medical care after the incident; and (5) Although the facility was not in compliance with all Minnesota Rules and Statutes at the time of the incident, SP1, SP2, and SP3 are not responsible for maltreatment solely because of the facility’s failure to maintain compliance with all licensing requirements. The nonmaltreatment mistake to the AV by SP1, SP2, and SP3 was not maltreatment. It was not 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.) 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 retrained staff on policies and procedures and installed door buzzers on doors and added a clamp lock to the toddler playground gate. Action Taken by Department of Human Services, Office of Inspector General: SP1, SP2, and SP3 were not determined as a perpetrator of maltreatment of the AV because the Department of Human Services found that the incident for which SP1, SP2, and SP3 were responsible met the criteria to be determined a nonmaltreatment mistake. SP1, SP2, and SP3 were notified by the Office of Inspector General that any future incident of possible neglect of an alleged victim for which SP1, SP2, and SP3 were responsible might not be considered a nonmaltreatment mistake. On October 18, 2023, the facility was issued a Correction Order for the violation outlined in this report, for combining groups with a larger than 36 month age range, for failing to comply with fire codes, and for failing to report possible maltreatment. 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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