|
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: 800552-CCC (Child Care Center) Investigator(s): Tessa Ripka 651-431-6612 Suspected Maltreatment Reported: It was reported that an alleged victim (AV) was left outside without a staff person’s (SP) supervision and found after approximately five minutes by a community person. Date of Incident(s): September 5, 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 September 18, 2023; from documentation at the facility; and through five interviews conducted with three facility staff persons (SP, P1, P2), the AV’s family member (FM), and the AV. The facility was located inside a church. The Pre-K classroom was off a hallway that had five other classrooms and an office. The hallway had storage lockers along one side and at the end of the hallway was a door that led to a fenced playground. The AV was four years old at the time of the incident and enrolled in the PreK classroom. The AV said s/he did not remember a time that s/he was left on the playground alone. P1 provided the following information: · On the day of the incident in the afternoon P1 went to the SP’s classroom and said that the SP could bring the children outside. After 10-15 minutes, P1 realized that the temperature was above 85 degrees outside. P1 went outside and told the SP that they only had five more minutes outside before they needed to return indoors because of the heat. · P1 went back inside and started to clean up in the kitchen and other classrooms that were not in use. P1 passed the SP in the hallway and asked how many children s/he had because it was toward the end of the day so they may need to combine classes. The SP told P1 how many children s/he had. The number did not “sound right” to P1 and P1 asked the SP to go back and count again. P1 checked on the infant classroom and then saw that the school age children were dropped off and coming inside. · At 3:55- 4 p.m. a staff person went to get the school age children. The classroom was still outside at this point. Between 4-4:10 p.m., the school age children got off a bus and came inside. They washed their hands and got a snack. P2 then called P1 on a walkie talkie and said that the AV was left outside, and a community person had brought the AV to P2. When P1 received the walkie communication, s/he had just walked past the SP on the way to talk to the school age children that had just come inside. The SP was not in the classroom when the AV was brought in by the community person but returned shortly after. · Each classroom had a clipboard with a laminated sheet with each child in the class listed. Staff persons marked which children were in the classroom that day or crossed them out with a dry erase marker. During transitions staff persons used the list to count the children in the classroom. P2 provided the following information: · On the day of the incident, the SP came inside and brought his/her children into P2’s classroom. A while later a community person came into the classroom with the AV and said s/he was outside unsupervised. P2 talked with the parent for a minute or two then called P1. · P2 said the SP had been in the back area of the classroom and when s/he came to the front area said something to the AV like, “Why didn’t you come in when I called?” or “Why didn’t you hear me when I called?” P2 did not remember if the SP counted the children when s/he arrived in the classroom or if s/he told P2 how many children the SP had with him/her. · P2 thought the AV was outside by him/herself for at least five minutes. The SP provided the following information: · On the day of the incident, the SP put sunscreen on seven children and took them outside. After they played for a while, P1 came out and asked how long they had been outside. The SP said about 20 minutes. P1 said that they should come inside shortly because it was hot outside. · After approximately five minutes, the SP told the children to line up by the door. Two children were picked up while they were outside playing so the SP had five children left. The SP counted five children and then opened the door. · All the children ran in at once. The SP thought s/he counted “one head too many.” The children all ran into P2’s classroom as they were going to combine classrooms. The SP thought the AV must have run off outside after the SP counted the AV. The SP did not count the children once s/he was inside the classroom. · The SP did not ask P2 how many children s/he had in the classroom and did not compare the children to the names on the clipboard because s/he “didn’t think of it at the time.” · The SP then went to use the bathroom for approximately five minutes. When s/he returned to the classroom, s/he found out that the AV was left outside and brought back to the classroom by a community person. The SP thought the AV was outside for 4-5 minutes and “seemed fine” when the SP saw him/her. The FM had no previous concerns with the facility. The AV was “definitely afraid” but when asked later was “pretty nonchalant.” According to www.wunderground.com, the outdoor condition at the facility, on September 5, 2023, at the time of the incident, was “mostly cloudy” with a temperature of 91 degrees Fahrenheit (°F) and wind speed of 13 miles per hour (mph). The Employee Handbook stated that staff persons conducted a “face to name” when transitioning from one area to another. The Risk Reduction Plan stated that a “face-to-name” count was done when retuning inside from the playground. Facility documentation showed that the SP was trained on the facilities policies and the Reporting of Maltreatment of Minors Act. Relevant Rule and/or Statute Minnesota Statutes, section 245A.02, subdivision 18, and Minnesota Rules, part 9503.0045, subpart 1, item A, states that a child must have supervision at all times and that supervision is 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: A. Maltreatment: Information was consistent that on September 5, 2023, the AV was left on the facility’s playground without the knowledge or supervision of a staff person for five or more minutes, which was a violation of Minnesota Statutes, section 245A.02, subdivision 18, and Minnesota Rules, part 9503.0045, subpart 1, item A. The SP was not aware that the AV was still on the playground when the SP took the other children back to the classroom, which was inconsistent with the standards of a professional caregiver in a facility licensed by the Department of Human Services and a violation of the facility’s policies and procedures. When the SP brought the children inside, s/he brought them to P2’s classroom and s/he did not count them. Then the SP left the classroom. When the SP returned, s/he found out that a community person noticed the AV on the playground and brought him/her inside the facility. Although the playground was fenced, the AV, who was four years old, was unsupervised for at least five minutes with no staff person available to intervene if the AV attempted to do something dangerous, injured him/herself, or in the event of an emergency. Therefore, there was a preponderance of the evidence that there was a failure to supply the AV with necessary care and a failure to protect the AV from conditions or actions that seriously endangered the AV’s 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. The SP worked in the AV’s classroom and was responsible for supervision of the classroom at the time of the incident. The SP was trained on the facility’s policies, including the Risk Reduction Plan and the Employee Handbook 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 neglect for which the SP was 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 that policies and procedures were adequate but not followed by the SP when s/he did not do a face to name count and was unaware of how many children were in the classroom. The SP no longer worked at the facility. Action Taken by Department of Human Services, Office of Inspector General: The SP was not disqualified from providing direct care services as a result of the maltreatment determination in this report. However, the SP was 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 the disqualification of the SP. The determination that the SP was responsible for maltreatment is subject to appeal. On October 27, 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.
|
