|
MALTREATMENT INVESTIGATION MEMORANDUM Minnesota Statutes, section 626.557, subdivision 1 states, “The legislature declares that the public policy of this state is to protect adults who, because of physical or mental disability or dependency on institutional services, are particularly vulnerable to maltreatment.”
License Number and Program Type: 1118835 -H_CRS (Home and Community-Based Services-Community Residential Setting) Investigator(s): Gessner Rivas 651-431-3970 Suspected Maltreatment Reported: It was reported that on an unknown date prior to June 22, 2023, a staff person (SP) gave a vulnerable adult (VA) a cannabis vape cartridge. Date of Incident(s): Prior to June 22, 2023 Nature of Alleged Maltreatment Pursuant to Minnesota Statutes, section 626.557, subdivision 9c, paragraph (b), and Minnesota Statutes, section 626.5572, subdivision 15, and subdivision 17, paragraph (a): The failure or omission by a caregiver to supply a vulnerable adult with care or services, including but not limited to food, clothing, shelter, health care, or supervision which is reasonable and necessary to obtain or maintain the vulnerable adult's physical or mental health or safety, considering the physical and mental capacity or dysfunction of the vulnerable adult and which is not the result of an accident or therapeutic conduct. Summary of Findings: Pertinent information was obtained during a site visit conducted on August 3, 2023; from documentation at the facility; and through five interviews conducted with two facility staff persons (P1 and P2), a supervisory staff person (P3), the VA, and the SP. The VA was diagnosed with attention-deficit hyperactivity disorder (ADHD) with severe executive function impairment and disruptive mood dysregulation disorder. The VA’s Self-Management Assessment stated that the VA had a history of smoking cigarettes and vapes. At the time of the incident, the VA was over 18 years old and enjoyed playing video games. The VA was subject to guardianship. The VA provided the following information: · The VA stated that s/he had found some “vapes” on the road, but they were “burned down” and asked the SP to get some “vapes” for her/him. The SP gave the VA two vapes and a cartridge, one of which was a pink lemonade flavor. · The VA stated that the cartridge contained marijuana. The VA had the vapes and cartridge for a few days until they were lost and later found and turned in to staff person(s). The VA stated that those were the only vapes and cartridge provided by the SP. The SP provided the following information: · The SP stated that the VA smoked every chance s/he got. On June 19, 2023, the SP and two other staff persons, P1 and P2, drove to Grand Rapids, MN to pick up the VA from a family member’s home to bring the VA back to the facility. The SP drove back from Grand Rapids and recalled rolling down the window because someone in the car was smoking; there was a “fruity candy smell”. The SP stated that s/he was not smoking in the car on the drive back, but either P1 or P2 was, and the VA wanted her/his vape. Staff persons were not allowed to smoke in the company car. · The SP smoked tobacco products but did not use vapes. The SP stated that s/he did not provide the VA with any vape containing marijuana or tobacco products and did not recall seeing any other staff person doing so. The VA was known to pick up tobacco products and vapes s/he found on the ground when out in the community. P1 provided the following information: · On the drive from Grand Rapids back to the facility, P1 sat up front with the SP. The VA sat in the backseat with P2. The VA stated that s/he stole and smoked a “blunt” from her/his family member and began to vape in the car which the VA had when s/he got in the car; P1 did not know where the VA got the vape or the scent of the vape. · The SP was driving and asked the VA to stop vaping, but the VA blew smoke at the SP. P1 stated that the VA vaped the whole way back to the facility, for approximately one hour. · P1 stated that the following day, the VA was in the garage with a different staff person, P1 noticed that the VA had a vape in her/his hand and the VA said that her/his dab pen had broken (a dab pen was a vaporizing device which contains cannabis concentrates). P1 asked what that was and the VA said that the dab pen was her/his “weed pen” and showed it to P1. · P2 stated s/he did not see anyone give the VA a vape pen. P2 provided the following information: · P2 stated that the VA got the vape from her/his backpack and that the VA vaped during the car ride from the family member’s house all the way back to the facility and that the SP asked the VA not to blow smoke at the SP. P2 did not recall if the vape had a scent. P2 stated that staff persons were advised to ask the VA not to smoke or vape but not to push the subject because the VA could become aggressive. · P2 confirmed that the VA stated that s/he had smoked a “joint” at his/her family member’s house. P2 did not see anyone give the VA any vape or cartridge. P2 was present when P3 asked the VA where the VA obtained the vapes and the VA said it was from the SP. P3, a supervisory staff person, provided the following information: · P3 stated that staff persons were unaware that the VA had any vapes. Upon learning that the VA had vape products, P3 talked to the VA about vaping. The VA stated that the SP provided the VA with vapes and a cartridge containing cannabis on June 19, 2023. · P3 stated that the VA was known for initially not being truthful but the guilt of that would eventually wear on the VA and s/he would “come clean.” Facility records showed that the SP was trained on the Reporting of Maltreatment of Vulnerable Adults Act and the care plans for the VA. Conclusion: Information was consistent that on June 19, 2023, when staff persons drove the VA back to the facility from Grand Rapids, the VA vaped in the car throughout the car ride back to the facility. Staff persons did not know where the VA obtained the vape products; P1 and P2 did not see the SP give the VA any vape products. P1 and P2 stated that the VA stated in the car that the VA had smoked a “joint” while visiting her/his family member. P1 stated that the following day the VA commented that her/his “weed” vape had broken. When asked by P3, the VA stated that the SP had given her/him vapes and a cartridge containing cannabis on June 19, 2023. Although the VA stated that s/he obtained the vape products from the SP, the SP denied providing the VA with any vape products. Given that P3 stated the VA had a history of not providing accurate information,, that the VA had commented in the car that the VA had obtained a “blunt” while visiting her/his family member, that P1 and P2 each stated they did not see the SP give the VA vapes, and that P1 and P2 both stated that the VA had the vape when s/he got in the car for the drive back to the facility and the VA vaped throughout the drive back on June 19, 2023, there was not a preponderance of the evidence whether the SP supplied the VA with vape products and failed to provide the VA with reasonable and necessary care and supervision. It was not determined whether neglect occurred (the failure or omission by a caregiver to supply a vulnerable adult with care or services, including but not limited to food, clothing, shelter, health care, or supervision which is reasonable and necessary to obtain or maintain the vulnerable adult's physical or mental health or safety, considering the physical and mental capacity or dysfunction of the vulnerable adult and which is not the result of an accident or therapeutic conduct.) Action Taken by Facility: The facility completed an internal review and determined that policies and procedures were adequate but not followed by the SP. The SP no longer worked at the facility. Action Taken by Department of Human Services, Office of Inspector General: No further action taken.
|
