|
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: 1002184-CCC (Child Care Center) Investigator(s): Lindsay Arth/Beth Virden 651-431-6537 lindsay.arth@state.mn.us Suspected Maltreatment Reported: It was reported that a staff person (SP) pulled on an alleged victim’s (AV’s) arm, more than once, causing injury and that the SP kicked the AV. Date of Incident(s): April 19, 2024 Nature of Alleged Maltreatment Pursuant to Minnesota Statutes, section 260E.03, subdivision 18, paragraph (a), and subdivision 23, paragraph (a): "Physical abuse" means any physical injury, mental injury, or threatened injury, inflicted by a person responsible for the child's care on a child other than by accidental means. "Threatened injury" means a statement, overt act, condition, or status that represents a substantial risk of physical or sexual abuse or mental injury.
Summary of Findings: Pertinent information was obtained during a site visit conducted on May 3, 2024; from documentation at the facility; and through interviews conducted with the AV’s family member (FM), facility staff persons (the SP, P1, P2, and P3), and a supervisory staff person (P4). Attempts were made via telephone and email to contact another of the AV’s family members, but the family member did not respond. The facility provided childcare services. At the time of the incident, the AV was two years old and enrolled in the toddler classroom. The FM provided the following information: · On April 19, 2024, at 10:20 a.m., the facility called and told the FM that the AV fell and “landed on [his/her] arm weird and that [s/he was] hurt.” The SP and P1 were working in the classroom at the time. · At 10:25 a.m., the facility sent a picture of the AV’s left forearm. The FM believed the AV’s left wrist looked “red and swollen.” [Note: This picture was provided for this investigation. The area directly above the AV’s left wrist appeared larger in circumference than the rest of his/her forearm. The AV’s face and left elbow were not included in the picture.] · Around 2 or 3 p.m., P2, who was a family friend, picked the AV up and brought him/her home for the day. · Around 4 or 5 p.m., the FM arrived home and saw the AV. The FM believed the way the AV was favoring his/her left arm looked like a nursemaid’s elbow and the AV’s left elbow looked “red.” The AV did not have a history of sustaining nursemaid’s elbows. However, the FM had experience caring for them. The FM was able to “pop it back in” (realign the AV’s elbow) at home. The AV showed “relief” on his/her face and began playing “normal” within ten minutes. The redness on his/her elbow and wrist subsided. The FM did not bring the AV to a doctor or seek additional medical attention at that time. · About a week after the incident, the facility contacted the FM again. They had initially believed the AV’s injury was sustained from a fall; however, after reviewing camera footage, it was determined the injury likely occurred from the SP pulling the AV’s arm. The AV had been picking up a toy and the SP grabbed the AV and pulled his/her arm. The facility did not state anything about the SP kicking the AV. · The FM was familiar with the SP and, “was blown away” because s/he did not view the SP “as someone who could do that.” The FM had no prior concerns with the SP’s conduct. “I was very surprised.” · When the facility initially told the FM about the new information regarding the AV’s elbow injury, that it was sustained from being pulled, the FM immediately thought P1 was responsible, not the SP. “[P1] was the one I thought it was because I heard multiple parents complain about [P1] lifting kids up by their wrists and have seen it a few times myself. Nothing crazy. Just pulling them ….” · The AV told a family member that a teacher grabbed him/her “really hard” and was “mean” to him/her. According to www.webmd.com, “Nursemaid’s elbow means the elbow has slipped out of its normal place at the joint … Nursemaid’s elbow is a common injury among toddlers and preschoolers … Nursemaid’s elbow can happen if you tug or pull on a child’s lower arm or hand, especially if the arm is twisted. It doesn’t take much force for the injury to happen. The most common cause of nursemaid’s elbow is a pulling-type injury.” The facility provided camera footage of the toddler classroom from 9:30:00 to 10:10:00 a.m. on April 19, 2024; and upon review, the following was noted regarding the incident between the SP and the AV: · At 9:46:00 a.m., two to three children, including the AV, were playing with toys on one side of a low shelving unit. On the other side of the same shelving, seven children were playing on a rug with P2 and P3. P2 had his/her back to the AV; P3 was facing the AV. The SP was standing and moving between the shelving unit and the rug. P1 was standing in the back of the room tending to a child’s diaper on the changing counter, and there were five to six other children moving around the room. [Note: It was difficult to see all of the children at once or count them on the camera footage. The facility’s documentation stated that there were 19 children in the classroom at the time of this incident.] · The AV appeared to be moving his/her body in a typical manner; the AV was using both of his/her arms without apparent issue. · At 9:46:08 a.m., the SP walked up to the AV and grabbed his/her left hand. The SP took one to two steps to his/her left and pulled the AV toward him/her causing the AV to stumble to the floor. The SP let go of the AV’s hand and began to pick up toys as the AV crawled away using both of his/her arms. · The SP held out a small bin while another child put toys inside it. The AV was lying on the floor appearing to play with a toy. The AV then crawled a couple of steps and the SP walked over to the AV, bent down, and had an interaction with the AV that was blocked by the SP’s body. The SP continued picking up toys as the AV sat on the floor. At 9:46:49 a.m., the SP stood and used his/her foot to turn the AV’s body approximately 90 degrees. The SP grabbed the AV’s left hand and lifted upward so that the AV’s left arm was straight up in the air. The SP lifted the AV into a standing position by pulling upward on his/her left hand. Once the AV was standing, the SP took three to four steps while still holding the AV’s left hand. The AV walked with the SP but then appeared to fall to the floor, so the SP lowered the AV’s hand/arm. The SP momentarily let go of the AV’s hand but then picked it up again and lifted the AV to his/her feet, and, with the AV’s hand and arm straight up in the air, brought the AV to a chair near P1 in the back of the room. The AV sat down, and the SP picked up toys around the chair. The AV initially lied on his/her side in the chair but then s/he sat up, appeared to be crying, and held his/her left arm across his/her torso with his/her right hand. · At 9:47:18 a.m., the SP offered his/her hand to the AV, but the AV did not reach out for it. The SP touched the AV’s head or shoulder, which prompted the AV to stand from the chair and walk beside the SP. The AV was holding his/her left elbow with his/her right hand across the front of his/her torso. The SP led him/her to the shelving unit and pointed to toys on the floor. The AV squatted down and used his/her right arm/hand to pick up the toys. The AV was not moving his/her left arm, which remained hanging and still at his/her left side. After picking up some toys, the AV stood and was holding his/her left elbow with his/her right hand across the front of his/her torso. · At 9:28:06 a.m., the SP lifted the AV into his/her arms by lifting from the AV’s underarms. The AV was now in the SP’s arms facing the SP. The SP carried the AV to the counter by P1. The SP checked a cabinet for something while the AV sat on the counter in front of the SP. · At 9:48:27 a.m., the SP lifted the AV from his/her underarms and carried him/her through a door to an adjoining classroom. The SP appeared to set the AV down on a counter in the other classroom. The door closed behind them, and they were no longer visible. At 9:49:00 a.m., the SP reentered the toddler classroom carrying the AV. The SP stood on the rug and walked around the classroom while continuing to hold the AV. · Later, the SP was sitting on a windowsill and speaking to P3, who was sitting on the floor. The SP was using his/her arms and appeared to be showing P3 a lifting motion and pointing to the AV, who was sitting next to the SP. The SP did this more than once and kept looking at the AV. The SP remained sitting with the AV and appeared to be staring off. · The camera footage ended at 10:10:00 a.m. [Note: More information regarding this footage is forthcoming.] The SP provided the following information: · The AV had not expressed any pain in his/her arm prior to the incident or earlier in the day. At the time of the incident, the SP and the AV were picking up toys. “[The AV] was kind of throwing [him/herself] on the ground and I was kind of helping [him/her]. I had [his/her] arm but didn’t realize I was pulling on it and I didn’t even think that I was being aggressive at all, but then after, [s/he] was holding [his/her] arm and I don’t know what happened.” · “I had been helping [him/her] because [s/he] was dragging [him/herself] on the floor and I didn’t realize that I was pulling on [his/her] arm … I didn’t realize that I was hurting [him/her].” · “[The AV] just grabbed [his/her arm] and was rubbing it.” · The SP said that in hindsight, s/he should have left the AV alone. “[The AV] was not wanting to stand up.” Staff should not “force” a child to clean up toys. The SP should have tried to motivate the AV by making it a fun activity or singing a song. · The SP denied kicking the AV and denied being upset with the AV. · The SP saw the AV fall to the ground at one point but could not recall how the AV fell. The SP did not know when the AV’s arm started hurting. · The SP did not have concerns with other staff persons but said that P1 sometimes grabbed children by their arm. However, P1 did not pull the children or do so in an “ill way.” The SP did not see P1 pull the AV’s arm and did not know if the AV expressed pain after interacting with P1 on April 19, 2024. P1-P4 provided the following information: · P1 said that on April 19, 2024, the AV was “not listening and tipping baskets over.” P1 believed the SP was “getting frustrated.” The SP went over to the AV and told him/her to help pick up the toys. The SP grabbed the AV’s left wrist. P1 did not believe the SP’s grab was “hard” but rather, “just trying to help” the AV. The AV then started crying, holding his/her left wrist, and saying that his/her wrist “hurt” and “ow.” P1 added that earlier that day, s/he had tried to bring the AV somewhere else in the room and pulled on the AV’s arm. P4 observed this interaction between P1 and the AV when reviewing camera footage. P4 talked to P1. P1 said that s/he should have lifted the AV from under his/her arms. The AV started crying after P1’s interaction. P1 did not believe the AV was injured at that point but rather, s/he was crying because s/he was “upset.” P4 reminded P1 of the appropriate way to pick up a child. · P2 did not see what happened to cause the AV’s injury, but saw the AV afterwards crying, not using his/her left arm, and saying “owie.” The AV did not make any statements to P2 about what happened. · P3 was not watching the SP or the AV and did not see what happened. However, at one point, the SP approached holding the AV and said that the AV fell while the SP was holding his/her hand. P3 checked the AV’s left arm and the AV “cried” each time P3 tried to move it so P4 was notified. · P4 arrived at the classroom and saw the AV with an ice pack and not using his/her left arm. The AV was grabbing his/her left wrist area. P4 could not tell if the AV’s wrist was swollen. P4 called the FM, and then reviewed camera footage. P4 provided information regarding the video that was consistent with the video as outlined above. P4 did not check the AV’s leg for injury and the AV did not make any statements about his/her leg hurting. [Note: P1-P3 each said they did not see anyone kick the AV.] · P4 then met with the SP. The SP said that s/he picked the AV up by his/her left wrist and that the AV was “slipping down to the ground.” “[The SP] thinks that’s when [the AV] got hurt.” · P1 and P3 each said that the AV was using his/her left arm in a typical manner prior to the incident. · P2 did not have concerns with the SP’s conduct. P2 never saw the SP grabbing or pulling a child. · P3 said that the SP was “one of the most loveable teachers … so gentle.” P3 did not have concerns with the SP’s conduct. · P4 did not have prior concerns with the SP’s conduct. However, the SP’s conduct according to the camera footage was not consistent with the SP’s account of what happened. The SP said that the AV “slipped down to the ground” while the SP was holding his/her hand. “We did not see that” in the camera footage. If a child declined to help clean up or fell to the floor, staff should not force them to help. Staff should be letting the child have “their moment” and approach them later with alternate activities and choices. The facility’s policies and procedures included the following: · Staff were responsible for developing a supporting, trusting relationship with each child. If challenging behaviors occurred, staff were supposed to modify the environment, clearly communicate expectations, encourage alternate activities, and validate feelings. · Staff were prohibited from using corporal punishment, including, but not limited to, rough handling, shoving, shaking, excessive tickling, slapping, kicking, biting, pinching, hitting, spanking, and pulling arms, hair, or ears. The facility provided camera footage of the toddler classroom from 9:30:00 to 10:10:00 a.m. on April 19, 2024; and upon review, the following additional information was noted: · The SP, P1, P2, and P3 were present in the classroom, moving around or sitting on the rug. · At different points, two children sat on top of a kitchen playset, which appeared three to four feet high based on other objects in the room. A child climbed onto the same playset countertop and kneeled for over one minute. No staff intervened. A child stood and jumped off of a table three separate times. No staff intervened. At least three different children stood in windowsills for over a minute each, one child for two minutes, before a staff intervened. At different points, three children stood on child-sized chairs and attempted to climb over a Dutch door (three to four foot high). The SP was actively interacting with one child who was standing on the chair. The SP opened the Dutch door and this same child, who was still hanging onto the door, was pulled off of his/her chair and onto the floor. Two children were repeatedly climbing over a shelving unit of some kind, which was about three to four feet high based on other objects in the room. No staff intervened. The AV and another child threw blocks at each other, more than once, with the AV ultimately striking the child in the face with a block. No staff intervened. The staff conduct during these incidents was in violation of Minnesota Statutes, section 245A.02, subdivision 18, and Minnesota Rules, part 9503.0045, subpart 1, item A, which states that a child must have supervision at all times and that supervision was defined as occurring when a program staff person was 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. · A child climbed onto a playset countertop and P1 approached from behind, pulling the child backwards in a quick motion before dropping the child to the floor on his/her feet a few inches off of the floor. P1 picked up another child and walked with him/her under one arm so that the child’s torso was held in P1’s underarm with his/her arms and legs dangling on either side. P1’s actions were a violation of Minnesota Rules part 9503.0055, subpart 3, item A which states that the license holder must have and enforce a policy that prohibits the subjection of a child to corporal punishment. Corporal punishment includes, but is not limited to, rough handling, shoving, hair pulling, ear pulling, shaking, slapping, kicking, biting, pinching, hitting, and spanking. · P1 did not wash his/her or the child’s hands after each diaper change. This occurred more than once. The SP did not wash his/her hands or the child’s hands after using the student toilet. P1’s and the SP’s actions were a violation of Minnesota Rules 9503.0140, subparts 13 and 14, which states in part that a child’s hands must be washed with soap and water after a diaper change or toilet use and a staff person must wash their hands with soap and water after changing a child’s diaper. · P1 did not wear gloves during at least one diaper change and did not change gloves between each diaper change. P1 left more than one child unattended on the changing counter while gathering supplies from overhead cabinets. One child was left unattended for 20 seconds. P1 did not disinfect and wipe down the changing surface between each diaper change. [Note: The facility’s Diapering Policies and Procedures state that staff persons were required to wear gloves and remove them after cleaning the child, keep one hand on a child the entire time, and disinfect and wipe down the changing table.] P1’s actions were a violation of Minnesota Rules 9503.0140, subpart 12, which states in part that the center must have and follow diaper changing procedures and post them in the diaper changing area. Facility documentation stated that the staff persons interviewed for this investigation received training on the facility’s policies and procedures and the Reporting of Maltreatment of Minors Act.
Conclusion: A. Maltreatment: The facility’s camera footage for April 19, 2024, showed the SP pulling the AV’s left arm more than once. The SP’s conduct was inconsistent with facility’s policies and procedures, which prohibited staff from pulling a child’s arm, and it was a violation of Minnesota Rules part 9503.0055, subpart 3, item A. The SP said, “[The AV] was kind of throwing [him/herself] on the ground and I was kind of helping [him/her]. I had [his/her] arm but didn’t realize I was pulling on it and I didn’t even think that I was being aggressive at all, but then after, [s/he] was holding [his/her] arm and I don’t know what happened … [The AV] just grabbed [his/her arm] and was rubbing it.” The AV did not appear injured prior to the SP’s interaction but was injured after according to the camera footage. 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. It was determined the SP’s actions were a nonmaltreatment mistake for the following reasons: 1) At the time of the incident, the SP was performing duties identified in the center's childcare program plan. Although the AV sustained a nursemaid’s elbow, this type of injury was a common injury among toddlers and did not take much force to occur, according to www.webmd.com. There was an occasion when the AV fell to the floor while the SP was holding the AV’s hand. So, it could not be determined if the AV’s injury was a result of the SP’s actions during the incident or the AV falling to the floor while the SP held the AV’s hand/arm in the air. In addition, no one had prior concerns with the SP’s conduct, including the FM. The SP was described as “one of the most loveable teachers … so gentle,” and the SP did not appear upset with the AV during the incident; 2) The SP was not determined responsible for a similar incident of maltreatment within the previous seven years; 3) The SP was not determined responsible for a similar nonmaltreatment mistake under this paragraph within the previous four years; 4) The AV’s nursemaid’s elbow did not require medical care after the incident; and 5) Except for the period when the incident occurred, the facility and the SP were both in compliance with all licensing requirements relevant to the incident. 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 determined that policies and procedures were adequate but not followed. “[The AV] was not properly moved from an area. Which caused a dislocated elbow.” The SP was no longer employed. 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 August 8, 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.
|
