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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: 1000964-CCC (Child Care Center) Investigator(s): Van Mulheron thu-van.mulheron@state.mn.us Suspected Maltreatment Reported: It was reported that an alleged victim (AV) was left in a preschool classroom room for approximately eight to nine minutes without a staff person’s (SP) knowledge or supervision. Date of Incident(s): April 2, 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 April 16, 2024; from documentation at the facility and through six interviews conducted with two supervisory staff persons (P1 and P2), three staff persons (P3, P4, and the SP), and the AV’s family member (FM). The AV’s enrollment form stated that at the time of the incident the AV was four years old and enrolled in the preschool 2 classroom. The facility had a preschool 1 and a preschool 2 classroom that were located next to each other. The preschool 2 classroom was a triangle, and upon entering from the hallway to the left of the classroom door along the wall were the children’s lockers and cots and then a children’s handwashing sink. To the right along the wall was an art shelf, a counter for teacher supplies, and then teacher cabinets. Past the teacher’s cabinet, the room extended to the right and a block area. The block area had a wall with a connecting door to the preschool 1 classroom. In between the children’s lockers and the teacher counter were two rectangle tables. Past the tables were toy shelves and additional play areas for the children. There was a video camera above the preschool 2 door. (Note: the door connecting to preschool 1 was not visible to the camera.) From the hallway, the preschool 1 classroom door opened to three activity tables. In the upper left corner of the preschool 1 room was the connecting door to preschool 2. Preschool 1 had a video camera located across the classroom from the connecting door. The FM said that on the day of the incident, P1 called him/her and told him/her that the AV was left alone in the classroom. The FM was “concerned” that the incident occurred, but the AV was “coloring” and did “not realize” s/he was alone. The FM had no prior concerns with the facility. P1-P4 and the SP provided consistent information that on April 2, 2024, at approximately 4:40 p.m., the SP worked in the preschool 2 classroom with nine children, including the AV. P3 and P4 worked in the preschool 1 classroom with nine children. The SP was preparing to transition the preschool 2 classroom into the preschool 1 classroom. P2-P4 and the SP provided consistent information that when a classroom moved to another classroom or the playground, staff persons were to use the Child Location Change form. Prior to leaving the classroom staff persons were to mark that a child was in attendance and holding onto a walking rope. Staff persons were to double check the classroom to ensure no children were left behind before leaving the room. When the class reached their destination the staff person was to mark on the form again to make sure that everybody reached or had transitioned. In addition, staff persons had the use of the ProCare App [a mobile application (app) platform used to communicate with families and streamline administrative functions] and a Daily Preschool Attendance Preschool to help with transitions. The SP provided the following information: · On the day of the incident, the SP had nine children, including the AV, in his/her care and s/he was preparing them preschool 2 class to combine with the preschool 1 class. The SP asked the children to cleanup, and to line up in the block area, and then the SP walked to the door that connected to the preschool 1 classroom. · The SP waited at the door and said for “all the kids immediately came to the door.” The SP thought, “Okay, everyone is here,” and “only counted” the children before they entered the preschool 1 classroom. The SP said s/he counted “eight” children and thought “everyone is here.” · The SP opened the connecting door and told P3 that s/he had “eight” children. The children’s names were written down by P3 on the attendance sheet. The SP could not remember if s/he called out the names or of P3 called out the names of the children as they entered the preschool 1 classroom. · The SP said that s/he “was going back” to the preschool 2 classroom when P4 asked for a bathroom break. The SP stayed in the preschool 1 classroom for “three to four minutes” until P4 returned to the class. The SP then took a bathroom break for a “few minutes” before returning to the preschool 2 classroom. · When the SP entered the preschool 2 classroom s/he saw a preschool 2 child with his/her parent at the lockers and then saw the AV “near a table.” The AV was not “crying” or “upset.” The SP said that s/he “was confused” and thought that the AV had come from the preschool 1 classroom into the preschool two classroom with the parent and child. The SP then took the AV to the preschool 1 classroom. · The SP asked P3 and P4 if the AV had left and gone with the preschool 2 child who left because the AV “was in my classroom.” P3 and P4 each replied, “No,” and then the SP realized his/her “mistake” and that s/he had left the AV unsupervised in the preschool 2 classroom. The SP then went and told P2 about the incident. · The SP said that s/he was trained to use name to face counts for every transition to make sure s/he had the right number of children. The SP said that the time of the incident s/he “did not use” any of the facility tools (ProCare app, Child Location Change form, or the daily combined Preschool Attendance form) to help with the transition and that s/he did not go back into the classroom to “check” that it was empty. · The SP said that s/he was not “in a rush” that day to transition the children to the preschool 1 class but “all the kids immediately came to the door” and s/he thought “okay, everyone is here.” P3 and P4 provided the following information: · At approximately 5 p.m., P3 and P4 were in the preschool 1 classroom. P3 was at an activity table closet to the connecting preschool 2 door and P4 as working with children at two activity tables furthest away from the door when the SP opened the connecting door from the preschool 2 classroom. P3 said that the SP was holding a clipboard and told P3, “I have seven children” and named the children as they entered the preschool 1 classroom; the AV was not one of the children. P3 “marked” the children onto his/her roster and asked the SP, “Are you sure we have all the kids?” The SP replied, “Yep, that’s it.” P4 said that the SP did not have a clipboard or a walking rope in his/her hands. P4 did not pay attention to who came in, did not know how many children entered the classroom, and “did not remember seeing [the AV’s] face.” · P3 said that the SP “seemed rushed” and wanted to “get out of here” which was not “normal” for the SP and the SP would “casually” leave at the end of his/her shift after his/her duties were completed. · P4 said that “normally” the SP went back to his/her classroom to “double check” for children, but that day the SP asked, “Are you guys good?” and P4 asked the SP to stay so that s/he could go to the bathroom. The SP stayed and P4 walked to the bathroom and returned after “three to four minutes.” · P3 said that after P4 left the classroom, the SP asked P3, “Are you sure we have all the kids?” P3 replied, “I marked down all the children you brought,” and the SP replied, “Okay.” When P4 returned to the classroom, the SP left the classroom through the hallway door to “go closed [his/her] room down.” · P3 said that the SP had been gone for “two to three minutes” when s/he returned to the preschool 1 classroom with the AV and said that the AV was in the classroom by him/herself. P3 asked the SP if the AV’s family member was there, and the SP replied, “No, [s/he] was in there by [him/herself]. I forgot [him/her] in there.” · P4 said that the SP had been gone for “three to four minutes” when s/he returned to the preschool 1 class. The SP asked P3 and P4, “Why was [the AV] in my room? I dropped [the AV] here.” P3 replied, “No, [the AV] did not come into the room.” The SP “seemed confused” and said, “Where [how did] I miss this, [s/he] was in that room still. The whole time.” · P3 said that the AV appeared “shocked” when s/he entered the classroom, and that the AV’s “eyebrows were raised up” as in “what is going on.” The AV was not crying but had “a hard time” with transitions to the “louder” preschool 1 room. The AV went an activity tabled and started coloring. P4 said that the AV was “not crying” and was “quiet” which was “normal.” · The SP asked P3 “what [s/he] should do next,” and P3 told the SP to talk to P1 or P2. At the end of P3’s shift P3 told P2 about the incident. P1 and P2 provided the following information: · P2 said that the SP came and told him/her about the incident. The SP told P2 that “[s/he] was sad that I made that mistake,” “apologized,” and “took ownership” of the incident. The SP told P2 that s/he thought the AV came with the group when they went into the preschool 1 classroom and that s/he had his/her “numbers wrong.” P2 then contacted and told P1. · The next day, P1 spoke with the SP who said that “when [s/he] was moving kids over … [s/he] was not thinking.” The SP also said that s/he “made a mistake” by going through the connecting door and not the main classroom door. P1 said that “typically” classrooms were to use the main door to exit the classroom when transitioning to another room and not the connecting door. The SP told P1 that s/he did not use the Preschool Attendance or the Change in Location Form to help with the transition. · P1 and P2 viewed the video footage of the incident and provided information that was consistent with the video footage as outlined below. · P1 and P2 had no prior concerns about the SP. The facility provided two videos of the incident. Video footage from preschool 2 was from 4:52 to 5:04:29 p.m. and video footage from preschool 1 was from 4:51:56 to 5:04:29 p.m. The video showed the following: · At 4:52 p.m., the SP was near the preschool 2 hallway door and there were nine children, including the AV, at the two rectangle tables coloring and playing with table toys. The AV was coloring at the rectangle table closest to the hallway door. · At 4:52:23 p.m., the SP walked to the tables and the children began to pick up their toys. The SP picked up markers and pushed in chairs at the table the AV was sitting. Five children walked to the block area and the AV remained seated coloring. · At 4:53:34 p.m., the SP walked to the block area in front of the connecting door and three more children walk over. The AV continued to color at the table. (At this point it did not appear that the SP had anything in his/her hands.) · From 4:53:35 to 4:54:07 p.m., the SP and eight children were in the block area, entered the preschool 1 classroom via the connecting door, and then were out of view of the preschool 2 camera. During this time, the AV continued to color at the table.
· At 4:53:40 p.m., the connecting door in preschool 1 opened and the SP stood by the open door and eight children walk into the preschool 1 classroom and then the SP stepped into the classroom and shut the door. P3 stood near the connecting door and P4 stood near the activity tables. · At 4:54:16 p.m., the SP remained in the preschool 1 classroom as P4 exited the classroom through the hallway door. · At 4:59:51 p.m., P4 returned to the classroom and the SP left the classroom through the hallway door. · At 5:01:50 p.m., a parent opened the preschool 1 hallway door and stood at the door while a child’s sibling entered the classroom. · At 5:01:17 p.m., the parent, the sibling, and the child exited the preschool 1 classroom through the hallway door. · At 5:01:52 p.m., the AV walked to the sink and began to wash his/her hands. · At 5:02:28 p.m., the parent and child entered the preschool 2 classroom through the hallway door and walked the child’s locker as the AV remained at the sink. · At 5:02:54 p.m., the SP entered the preschool 2 classroom room through the hallway door, stopped and looked at the AV, and then walked over to the sink. · At 5:03:26 p.m., the SP and the AV walked through the connecting door and into the preschool 1 classroom. The facility’s Safety and Supervision policy stated that, “all children must be within sight and sound at all times.” Additionally, staff persons were to “always know the exact number of children [they were] responsible for,” including the child’s name, and where they were at all times.” The facility’s Risk Reduction Plan stated that, “When transition [sic] from one area to another, children will form a line using a walking rope. Staff will call the children by name to hold on to the walking rope. Staff will use face to name every time the rope is used. One staff will be at the front of the line and one staff will be at the back of the line. Staff will count the number of children transitioning to ensure all children are present.” Facility records showed that P1-P4 and the SP were trained on the facility’s Safety and Supervision policy, Risk Reduction Plan, 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 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: Information was consistent that on April 2, 2024, the AV who was four years old was left in the preschool 2 classroom without the knowledge or supervision of the SP for approximately eight to nine minutes, , which was inconsistent with the standards of a professional caregiver in a facility licensed by the Department of Human Services, a violation of the facility’s policies and procedures, and a violation of Minnesota Statutes, section 245A.02, subdivision 18, and Minnesota Rules, part 9503.0045, subpart 1, item A. The SP had nine children, including the AV, when s/he was preparing the preschool classroom to transition to the preschool 1 classroom. The SP walked to the block area and the connecting door to the preschool 1 classroom. The SP waited at the connecting door and said that “all the kids immediately came to the door” and thought “okay, everyone is here.” The SP said that s/he “only counted” the children before they entered the preschool 1 classroom and that s/he had “eight” children. The SP entered the preschool 1 classroom and P3 added the eight children to the preschool 1 roster as the AV was left unsupervised in the preschool 2 classroom coloring at a table and washed his/her hands. The SP was going to go back to the preschool 2 classroom when P4 asked the SP to stay in the preschool 1 classroom to cover a bathroom break for P4. Then when P4 returned to the classroom, the SP went to the bathroom prior to returning to the classroom where s/he found the AV. 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 unsupervised in the preschool 2 classroom for approximately eight to nine minutes It was determined that a nonmaltreatment mistake for the following reasons: (1) At the time of the incident, the SP was preforming job-related duties and had transitioned the children to the preschool 1 classroom and although typically immediately returned to the classroom, on that day the SP stayed in preschool 1 to cover for P4 who needed to use the bathroom. When P4 returned, the SP went to the bathroom prior to returning to the classroom where s/he found the AV. (2) The SP had not previously been found responsible for a similar incident that resulted in a finding of maltreatment. (3) The SP had not previously been found responsible for a similar incident that resulted in a finding of a nonmaltreatment mistake in the past. (4) The AV, who was four years old, remained in the classroom coloring, and then washed his/her hands. The AV was uninjured and did not require medical care after the incident. (5) Except for this period when the incident occurred, the facility and the SP were in compliance with licensing requirements. The nonmaltreatment mistake to the AV by the SP was not maltreatment. 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 that their policies and procedures were adequate but not followed at the time of the incident. All staff persons were retrained on the facility’s Supervision Policy. Action Taken by Department of Human Services, Office of Inspector General: The SP was not determined as a perpetrator of maltreatment of the AV because the Department of Human Services found that the incident for which the SP was responsible met the criteria to be determined a nonmaltreatment mistake. The SP was notified by the Office of Inspector General that any future incident of possible neglect of an alleged victim for which the SP is responsible might not be considered a nonmaltreatment mistake. On July 3, 2024, 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.
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