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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: License number-CCC (Child Care Center) Investigator(s): Danielle Morrison 651-431-5647 Suspected Maltreatment Reported: It was reported that an alleged victim (AV) was in the hallway without staff person knowledge or supervision for approximately three minutes. Date of Incident(s): February 7, 2024 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 February 22, 2024; from documentation at the facility; and through five interviews conducted with a supervisory staff person (P1), three facility staff persons (SP1, SP2, and P2), and the AV’s family member (FM). The AV was 12 months old and enrolled in the infant room at the time of the incident. Due to his/her age the AV was not interviewed for this report. The facility was located in the lower level of a community building. There were several classrooms. The facility had their own secure entrance on the lower level that led into a hallway. Along one side of the hallway was an office, an infant classroom, and a toddler classroom. On the other side of the hallway was a classroom and an indoor gymnasium. There were windows from the hallway looking into the toddler classroom and the gymnasium. The window looking into the gymnasium was approximately 12 inches off the ground). Upon entering the infant classroom, there was tiled floor where a table and highchairs were placed for the children to eat. Then there was carpeted space for the children to play. There were two toy shelves placed side by side on the edge of the carpet area as a way to block the children from crawling onto the tiled area. On the opposite side of the carpeted space there was a changing table that was flush to the wall, this meant that when a staff person changed a child’s diaper the staff person’s back was to the rest of the classroom and the door. SP1, SP2, and P1 provided consistent information that on the day of the incident, SP2 was sitting on the floor engaging with a few children behind the toy shelves, and SP1 was changing a child’s diaper. SP1 and SP2 could not remember if someone had recently left the classroom, but they were unaware that the door was not shut and latched all the way. The AV crawled out into the hallway and P2 brought the AV back into the classroom while SP1 was still in the process of changing the child’s diaper. SP1 thought the AV was out of the classroom for “a couple of minutes” and SP2 thought “under a minute.” SP2 stated that the shelves “blocked” his/her view of the bottom of the door. P2 said that on the day of the incident around 3:00 p.m., s/he was in the toddler classroom with his/her children and a community person tapped on the widow from the hallway and got P2’s attention that the AV was in the hallway. P2 told the other staff person in the toddler classroom that s/he had to go get the AV. P2 went into the hallway, picked up the AV, and brought the AV back to the infant classroom. P2 said the AV was not crying and was looking into the window of the gymnasium. The FM said that on February 7, 2024, s/he was told that the AV crawled out of the door from the infant classroom. The FM thought a community person had left the door open while one of the staff persons was changing a diaper. The FM said the staff persons were “excellent” and treated the AV well. The FM thought it could have happened to anyone. This investigator reviewed video footage and observed the following: · At 3:11:59 p.m., a community person walked in the hallway away from the facility entrance. At this time the infant door was slightly ajar. · At 3:12:24 p.m., the infant door opened slightly more and at 3:12:31 p.m. the AV was seen crawling into the hallway. The AV looked back toward the door. · At 3:12:44 p.m., the AV turned and started crawling toward the gymnasium and toddler windows. At 3:12:54 p.m. the AV was no longer visible on camera. · At 3:15:01 p.m., the community person who had walked in at the beginning of the video, walked toward the infant room with his/her child and poked his/her head into the infant classroom. · At 3:15:13 p.m., P2 walked into view holding the AV. P2 walked into the infant classroom and shut the door behind him/her. The facility’s Supervision Plan stated that staff persons were to position themselves in the classroom so that all areas of the classroom were well supervised. Facility records showed SP1, SP2, P1, and P2 were each trained on the facility’s Supervision Plan and the 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: Consistent information was provided that on the day of the incident, SP1 and SP2 were engaged with children in the infant classroom when the AV crawled out of the infant room door which was not fully latched and was slightly ajar. The AV was in the hallway when a community person walked by after picking up his/her child. That community person notified P2 who was in the toddler classroom. P2 left his/her classroom and brought the AV back to the infant classroom. 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 individuals had not been determined responsible for a similar incident that resulted in a finding of maltreatment for at least seven years; (3) the individuals had 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 individuals providing services were both in compliance with all licensing requirements relevant to the incident. Video footage showed the AV leaving the infant classroom which resulted in the AV being unsupervised without staff person knowledge for approximately three minutes which was a violation of Minnesota Statutes, section 245A.02, subdivision 18, and Minnesota Rules, part 9503.0045, subpart 1, item A. Although it was concerning that the AV who was 12 months old was unsupervised in the hallway, both SP1 and SP2 were engaged with other children at the time the AV left and the facility, although in a community building, the facility had a secure entrance so the AV could not have left the facility. Therefore, SP1’s and SP2’s actions were determined to be a nonmaltreatment mistake for the following reasons: (1) at the time of the incident, SP1 and SP2 were performing job related duties as required by the facility’s policies; (2) SP1 and SP2 had not been determined responsible for a similar incident that resulted in a finding of maltreatment; (3) SP1 and SP2 had not been determined to have committed a similar nonmaltreatment mistake under this paragraph; (4) There were no injuries to the AV as a result of this incident; and (5) except for the period when the incident occurred, the facility, SP1, and SP2 providing services were both in compliance with all licensing requirements relevant to the incident. The nonmaltreatment mistake to the AV by SP1 and SP2 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 found their policies and procedures adequate, but not followed by SP2. SP2 received a written warning. Other actions taken by the facility to ensure the safety of the children: the facility moved one of the toy shelves to another part of the classroom to prevent an obstructed view of the door, the facility moved the changing table to be perpendicular to the wall so that when a staff person was changing a child’s diaper, the staff person was able to see the door, the facility installed a safety lock, had the facility maintenance technician adjust the door so that it latched properly, and placed signs on the door for family members to ensure the door latched when a family member was entering or exiting the classroom. Action Taken by Department of Human Services, Office of Inspector General: SP1 and SP2 were not determined as perpetrators of maltreatment of the AV because the Department of Human Services found that the incident for which SP1 and SP2 were 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 SP1 or SP2 were responsible might not be considered a nonmaltreatment mistake. On March 27, 2024, 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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