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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: 802768-CCC (Child Care Center) Investigator(s): Danielle Morrison 651-431-5647 Suspected Maltreatment Reported: Allegation One: It was reported that while transitioning from a playground to the Red Room (toddler classroom), an alleged victim (AV) left the line without staff person knowledge or supervision and wandered hallways and ended up outside on a playground. The AV was without supervision for approximately eight minutes. Allegation Two: It was reported that the AV left a gymnasium without staff person knowledge or supervision and then left the facility. The AV was without supervision for approximately three minutes. Date of Incident(s): Allegation One: November 20, 2023 Allegation Two: November 27, 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 December 19 and 20, 2023; from documentation at the facility; and through 10 interviews conducted with two supervisory staff persons (P1 and P2), seven facility staff persons (SP1, SP2, SP3, SP4, P3, P4, and P5) and the AV’s family member (FM). The AV was 35 months old at the time of the incidents and enrolled in the Red Room (toddler classroom). Due to the AV’s age, s/he was not interviewed for this investigation. The facility was located inside a community building. The facility had a secure entrance leading to a hallway with five classrooms on one side. On the other side of the hallway was a gymnasium that was used by both the facility and community persons who were YMCA members. At the end of the hallway there was a door that led outside to a fenced in playground utilized by the facility and a door that led to a space used for the community’s afterschool program (Endzone). The Endzone room had a door that led out to an outside area adjacent to the fenced in playground on one side and a parking lot on the other side. The gymnasium had three doors. One door (childcare) led to the facility’s hallway, the second (members) door led to a community hallway with a tornado shelter across from the gymnasium, and the third (main) door led to a community membership hallway that had locker rooms, and administration offices on one side, and the facility’s office on the other side. The membership hallway led to an outside door on one end and the other end led to the community building space including an exit to the parking lot. The facility’s Supervision Policy stated that staff persons were trained on active supervision which included the following six strategies: setting up the environment, positioning staff persons, scanning and counting, listening, anticipating children’s behavior, and engaging and redirecting. The Supervision Policy also stated that children were to be supervised at all times. The facility’s Risk Reduction Policy stated that staff persons were to make frequent sweeps of areas occupied by children, were to make frequent face to name counts, and were trained on active supervision. When children were transitioned from one location to another location, staff persons were to perform a name to face count before leaving the area, perform a head count when the children were walking through the door, perform a head count before walking though the next door, and perform a count when the group was in the new area. The FM was aware of the incidents. The FM stated the facility was “very” forthcoming about what had happened and their action plans. The FM stated they put child locks on the door and gates in the gymnasium. The FM thought it became a “game” to the AV. P5 stated that the AV and another child ran out of the classroom a “couple of times” in the past but staff persons had been able to follow them. Facility records showed that SP1, SP2, SP3, SP4, P1, P2, P3, P4, and P5 were each trained on the facility’s Risk Reduction Plan, Supervision Policy, and the Maltreatment of Minors Reporting 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. Allegation One: It was reported that while transitioning from a playground to the Red Room (toddler classroom), the AV left the line without staff person knowledge or supervision and wandered hallways and ended up outside on a playground. The AV was without supervision for approximately 8 minutes. SP1 provided the following information: · Around 11 a.m. on the day of the incident, SP1 and SP2 were on the playground and brought the children inside. SP1 stated they stopped at the door in the hallway where s/he performed a headcount, counted 12 children (including the AV), and then they walked down the hallway toward the Red Room. · SP1 led the group back to the Red Room, and SP2 was at the back of the line. When they reached the Red Room, there was a family member there to drop off his/her child and the family member wanted to show SP1 something in the child’s bag. · SP1 was trying to count the children when the family member was talking to SP1 so SP1 asked SP2 if s/he had the children, and SP2 stated s/he had them all. Once the children were all inside the Red Room, SP1 counted the children and “they were all there.” SP1 counted the child that had just come back from an appointment that the family member had dropped off instead of the AV. · P3 came into the Red Room carrying the AV and told SP1 and SP2 they had a missing child. The AV had the “biggest smile” on his/her face. P1 told SP1 the AV was without supervision for 11 minutes. · SP1 stated s/he was trained to count before and after each door. SP1 stated the AV and two other children were “notorious” for running out of the classrooms. SP1 stated the AV and another child in the classroom had the same jackets. SP2 provided the following information: · On the day of the incident, SP2 was in the classroom for SP3 who was on break. SP1 and SP2 brought the children in from the playground including the AV. SP1 was the leader and SP2 was walking behind the group. As they were coming inside, P3 was taking the Orange Room children outside so the hallway was busy. · SP1 was the first one in the classroom, and SP2 asked how many children they had and then s/he counted 12 heads. There was a child in the Red Room who had the same jacket, outdoor clothing, and similar hair coloring to the AV, so SP2 thought s/he “miscounted.” · P3 brought the AV into the classroom and SP1 and SP2 realized the AV had not been in the classroom. · SP2 learned afterwards that the AV slipped away from SP1 and SP2 while in the hallway and SP2 “was not paying attention.” The AV had run down the hallway to the Endzone and through a door that led outside. P4 saw the AV and grabbed his/her hand through the fence while P3 ran around to get the AV. P1 told SP2 that the AV was without gone 10 minutes. · SP2 was trained to count heads before and after leaving any doorway. SP2 stated that the AV had attempted to open doors and run from staff persons in the past. P4 said s/he was on the preschool playground with P3 when the AV walked out of the facility with a toy vacuum on the other side of the fence. The AV came out of the Endzone that was at the end of the childcare hallway. P4 called the AV over to the fence. P4 tried to grab the AV’s jacket, but the AV ran away. P4 called the AV over again and P4 was able to grab a hold of the AV’s jacket through the fence. While P4 held onto the AV’s jacket, P3 used the walkie talkie to call for help and then took four children inside and out the other door to where the AV was. P3 brought the AV back to the Red Room. P4 said s/he was trained to count out loud at every door and have one staff person at the front of the line and one at the back of the line. P3 said s/he and P4 were outside around 11 a.m. on the day of the incident and one of their children said, “[The AV]’s outside.” P3 and P4 looked at the fence. P4 “coaxed” the AV over the fence. P3 used the walkie talkie to get help, but no one answered, so s/he took three of his/her children to go out the door to bring the AV back to his/her classroom. When P3 approached the AV, s/he tried to run away, but P4 had his/her jacket. P3 picked up the AV to bring him/her inside because the AV did not want to go inside “willingly.” Once inside P3 tried to put the AV down, but s/he tried running off, so P3 picked the AV back up and carried the AV to the Red Room. P3 was not able to remember who the staff persons were in the classroom, but they were “surprised”, they thought the AV was in the classroom and did not see the AV leave. One was playing with children on the floor and the other one was still helping some children take off their winter gear. P3 was trained to count the children at each door and have one staff person in front and one staff person in the back when transitioning. On November 20, 2023, management at the facility reviewed video footage and noted the following: · 11:00 a.m.-Red Room went inside from the playground. · 11:01 a.m.-SP1 was at the Red Room door, and SP2 was at the back of the line. The AV left the line and went into the Orange Room. SP2 got another child in line and his/her back was turned when the AV left the line. · 11:02 a.m.-SP2 shut the Red Room door after the children were in the classroom. · 11:03 a.m.-The AV left the Orange Room (which was unoccupied) with a toy vacuum and steered it toward the Red Room and then back down the hallway toward the Endzone (which were not accessible to YMCA community members). · 11:04 a.m.-The AV entered the Endzone with the toy vacuum through an open door at the end of the childcare hallway. · 11:09 a.m.-P4 saw the AV outside of the facility on the big playground area used for Endzone afterschool care. P4 walked to the fence and held onto the AV so s/he was not able to get away. · 11:10 a.m.-P3 left the playground with four other children, went inside, and then ran out of the Endzone door to get the AV. P4 was still holding onto the AV. · 11:11 a.m.-P3, the AV, and P3’s four children walked down the hallway to the Red Room and P3 and the AV entered the Red Room at 11:12 a.m. · 11:13 a.m.-SP1 took off the AV’s jacket and boots, put on the AV’s shoes, and the AV joined the other children who were sitting with SP2 while s/he read a book. P1 reviewed video footage and spoke with SP1, SP2, P3, and P4 and provided consistent information as above. P1 added that SP1 started counting children when the family member was dropping off so SP1 went into the classroom to talk to that family member. When SP2 followed in the with rest of the children and they counted, they counted the same number they previously had, but it should have been one higher to include the child who was just dropped off. Conclusion for Allegation One: Consistent information was provided that on the day of the incident, SP1 and SP2 were bringing a group of children in from the playground, including the AV, and during the walk from the outside door to the classroom, the AV left the line without SP1 or SP2 noticing and went into the Orange Room. SP1 stated that s/he was stopped by a family member who was dropping off a child as SP1 brought the children into the classroom. SP1 counted 12 children which was the number s/he and SP2 had. P1 stated that when SP1 and SP2 counted, they counted the number they previously had but it should have been one higher to include the child who was just dropped off. SP1 and SP2 stated that there was another child in the classroom who had the same coat as the AV, so SP2 thought s/he “miscounted” once they were in the classroom. The AV left the Orange Room with a toy vacuum and made his/her way to the Endzone and then outside onto the after-school playground. P3 and P4 were outside on the preschool playground and noticed the AV. P4 called the AV over and held onto his/her jacket through the fence, while P3 took a few children into the building and out the Endzone door to bring the AV back inside. P3 stated that when s/he brought the AV back into the Red Room, SP1 and SP2 were “surprised” and said they did not see the AV leave the 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 individuals were 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. Although video footage showed the AV was unsupervised for approximately eight minutes without staff person knowledge which was a violation of Minnesota Statutes, section 245A.02, subdivision 18, and Minnesota Rules, part 9503.0045, subpart 1, item A, SP1’s and SP2’s actions and conduct 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. Allegation Two: It was reported that the AV left a gymnasium without staff person knowledge or supervision and then left the facility. The AV was without supervision for approximately 3 minutes. SP1 provided the following information to this investigator and during the facility’s internal review: · On November 27, 2023, SP1, SP3, and SP4 were in the gymnasium with 16 children. SP1 was standing between the main door and the members door. SP3 was putting away toys in a closet and SP4 was also by the closet with his/her back toward the children. · SP1 heard a child screaming coming from the childcare door, the child had his/her arm stuck in the door. At that moment SP3 popped his/her head out of the closet and asked where the AV was. SP1 did a headcount and did not see the AV. SP1 took off out of the main door to look for the AV. · SP1 ran into P2 and told P2 the AV ran off and they needed help. SP1 went back into the gymnasium and s/he and SP3 switched roles so that SP3 could go look for the AV and SP1 stayed with the children in the gymnasium. P2 entered the gymnasium holding the AV’s hand and stated the AV got outside again and was in the parking lot. · SP1 stated s/he was not sure how long the AV was gone for. SP3 provided the following information to this investigator and during the facility’s internal review: · On November 27, 2023, SP3 and SP4 were cleaning up toys in the gymnasium and SP1 was making sure the kids were sitting along the wall as they were getting ready to go back to the Red Room. SP3 came out of the closet and noticed the AV was gone and asked where the AV went. · SP3 yelled down the hallway for help and then SP3 stayed with the children and had SP1 and SP4 go and look for the AV. SP1 came back into the gymnasium so s/he and SP3 switched, so SP3 could look for the AV. SP3 went back in the gymnasium and told SP1 that they were going to bring the other children back to the Red Room, and that was when P3 came into the gymnasium with the AV. · P3 told SP3 that the AV was found by P4 on the walking trail next to the hockey rink outside. P3 told SP3 s/he would call the FM and told SP3 to make sure the AV was “always” in their eyesight. SP3 stated there have been other instances of the AV running off. · SP3 stated the AV was gone for a “long period of time” and then said 12 minutes. SP4 provided the following information to this investigator and during the facility’s internal review: · On November 27, 2023, the children were sitting against the wall. SP4 was stopping children from entering the storage closet as s/he and SP3 were putting away toys and bicycles. SP4 heard another child crying because their fingers were shut in the childcare door. SP3 was consoling that child when SP3 said the AV was gone. · SP4 left the gym and went to look outside by the Endzone. SP4 said s/he circled around three times and then s/he saw the AV with P2. SP4 said it was “probably five minutes” the AV was gone, but it felt like “forever.” · SP4 stated that the AV tried to leave “all the time.” If you gave the AV an inch, s/he ran away from the staff person. SP4 stated it was “scary” and that s/he expressed concerns to management and asked for help with the AV. P4 provided the following information to this investigator and during the facility’s internal review: · On November 27, 2023, P4 was getting his/her class ready to go to the gymnasium, when s/he heard SP3 yell P4’s name. P4 popped his/her head out of the Orange Room door and SP3 told P4 that, “We can’t find [the AV], did you see [the AV] run by?” · P4 had not seen the AV run by so s/he took two of his/her children (so the other staff person stayed in ratio) to go look for the AV. P4 looked in two classrooms (Green and Purple) and that was when P4 saw P2 and P2 asked if P4 could help look for the AV. A community person approached P4 and stated that there was a child outside. · P4 left the two children s/he had with P2 and went out to get the AV. At first P4 did not see the AV so s/he went back inside to ask the community member again where s/he saw the AV. P4 went back outside and saw the AV and called his/her name. The AV ran to P4 who picked the AV up. The AV kept repeating that s/he was cold. · P4 left the AV with P2 and then brought his/her children back to the Orange Room. P2 said on November 27, 2023, s/he was giving a tour when SP1 came around the corner and said, “We lost [the AV], [s/he] got out of the gym.” P2 immediately stopped the tour and started to help look for the AV. P2 and P4 both ended up by the membership desk when a community member stated there was a child outside, so P2 took the two children P4 had with him/her and P4 ran to grab the AV. P4 brought the AV back inside and P2 took the AV to the office for a “little bit” and then brought him/her back to the Red Room. On November 27, 2023, management at the facility reviewed video footage and noted the following: · 11:01:34 a.m.-The AV ran out of the main gym doors to the membership hallway. SP3 was at the closet putting away toys, SP4 was at the childcare door with a child, and SP1 was walking around watching the other children. · 11:01:46 a.m.-The AV went through the childcare office and out past the membership desk. · 11:02 a.m.-The AV ran out the front doors as a member walked inside. The AV ran across the parking lot to the track. · 11:03 a.m.-P4 ran outside after the AV. · 11:04 a.m.-P4 brought the AV back inside to P2. P1 reviewed video footage and spoke with SP1, SP3, SP4, P2, and P4 and provided consistent information as above. Conclusion for Allegation Two: Consistent information was provided that on November 27, 2023, while cleaning up in the gymnasium to transition back to the Red Room, SP3 and SP4 were by the closet putting away toys, and SP1 was watching children. During this time, the AV ran out of the main door that led to the membership hallway. SP1 and SP4 ran out of the gymnasium in search of the AV, SP1 alerted P2, SP4 yelled down the hallway to get P4 to help search for the AV. P2 and P4 were by the membership desk when a community person stated there was a child outside. P4 ran outside, found the AV, and brought him/her back inside. Although video footage showed that the AV was unsupervised 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, given that the AV had a history of running out of the classrooms, that SP3 noticed right away that the AV was gone, that the AV was not injured, and that immediate actions were taken to find the AV, there was not a preponderance of the evidence that SP1, SP3, and SP4 failed to provide the AV with necessary care or failed to protect the AV. 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 added mesh gates in the gymnasium, added safety locks to the Red Room, the door at the end of the hallway leading to the Endzone was now closed at all times, classroom doors were kept closed during the day, and there was an additional staff person added to the classroom to “shadow” the AV. 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 responsible met the criteria to be determined a nonmaltreatment mistake. SP1 and SP2 were each 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 29, 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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