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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: 1099497-CCC (Child Care Center) Investigator(s): Danielle Morrison 651-431-5647 Suspected Maltreatment Reported: It was reported that two alleged victims (AV1 and AV2) left a toddler classroom and went down a staircase to another toddler classroom without staff person knowledge or supervision for approximately two minutes. Date of Incident(s): June 27, 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 August 1, 2024; from documentation at the facility; and through seven interviews conducted with two supervisory staff persons (P1 and P2), three facility staff persons (SP1, SP2, and SP3), and AV1’s and AV2’s family members (FM1 and FM2 respectively). This investigator spoke with a staff person (P3) but s/he declined an interview. This investigator also reached out to an additional staff person (P4) by mail, telephone, and email to request an interview, but P4 did not respond. AV1 was 27 months old and AV2 was 29 months old at the time of the incident, and both were enrolled in the Toddler C classroom. Due to their ages, AV1 and AV2 were not interviewed for this investigation. The facility was a stand-alone building with two levels. The Toddler A classroom was located on the main level and had an L shape design. Upon entering the classroom there was a walkway with bathrooms on one side and cubbies on the other. There was an area for eating that was visible and around the corner was a changing table, sink, and a carpeted area with toy shelves. The classroom was in a hallway along with other classrooms. At one end of the hallway was the main facility entrance, and at the other end there was a ramp that veered to the left ending at a doorway that led to a playground. There was an open space just past where the ramp ended that had a staircase that led to the lower level. There were seven stairs, a landing, and then additional stairs that led to the lower level that had classrooms including the Toddler C classroom. The facility’s Accident Report form stated that on June 27, 2024, at approximately 8:06 a.m., AV1 and AV2 opened the Toddler A classroom door and ran toward the stairs. SP1, SP2, and SP3 noticed AV1 and AV2 were not in the classroom and went after them. FM1 was not aware of the incident but stated s/he had no concerns about AV1’s well-being. FM2 stated P2 told him/her that AV2 and some other children “escaped” a toddler classroom and may have been unsupervised for “a short amount of time.” SP1, SP2, and SP3 provided consistent information that they were working in the upstairs Toddler A classroom on an unknown date. The toddler classrooms were combined while children were being dropped off in the morning. AV1 and AV2 got out of the classroom and went downstairs to the Toddler C classroom. SP1, SP2, and SP3 provided the following additional information: · SP2 stated that s/he, SP1, and SP3 were in the Toddler A classroom. SP1 was cleaning up because s/he was going to take his/her class to the Toddler C classroom, and SP3 was seated in the classroom. SP2 did not remember if SP1 told the class, “Let’s clean up.” A family member came in to drop off his/her child (not AV1 or AV2), and when that family member left, SP2 helped that child wash his/her hands. · SP2 then saw that the Toddler A classroom door was open. SP2 looked out the door into the hallway and then closed the door thinking that the family member must have left it open. One to two minutes later P4 entered the Toddler A classroom and asked if SP1 had gone to the Toddler C classroom because there were two children on the stairs. SP1 went and looked in the classroom’s bathroom, and then left the Toddler A classroom to find the children. SP2 initially thought AV1 and AV2 left when the family member did, but later watched video footage that showed that AV1 and AV2 opened the door themselves and left the Toddler A classroom. · SP3 stepped into the Toddler A classroom to maintain staffing ratios until the Toddler B classroom staff person arrived. SP3 stated that s/he was in the Toddler A classroom for about 15 minutes when SP1 told his/her class to clean up. SP2 was focused on his/her group of children from Toddler A and SP3 was focused on his/her group of children from Toddler B. When SP1 realized that AV1 and AV2 were not with the group s/he ran out to find them. SP3 heard SP1 found them in their Toddler C classroom downstairs. · SP1 said s/he was cleaning up, SP3 was seated, and SP1 thought SP2 was standing next to SP3. SP1 told his/her class to clean up and had started counting the Toddler C children in preparation to leave the classroom when SP2 noticed the classroom door was open. · SP1 was told by P4 that s/he saw AV1 and AV2 on the stairs and P1 told P4 that they must be with their family members. SP1 went downstairs and found AV1 and AV2 seated in the Toddler C classroom. SP1 said AV1 and AV2 seemed “fine.” · SP3 heard P4 say that s/he and P1 were in the hallway and walked by the children who were on the stairs, and thought SP1 was with the children in front of the group. · SP2 said that staff persons did not let children in the area by the door, staff persons were “always” watching, and children were told that only staff persons opened the doors. SP3 and SP1 each stated that SP1 “normally” got the children ready by telling them to clean up, lining them up, and then leading them down the stairs to his/her classroom. P1 and P2 provided the following information: · P1 stated that on an unknown date around 8 a.m., P4 came up the stairs and told P1 that s/he thought s/he heard children downstairs. P1 did not see any children on the stairs when s/he looked down so s/he told P1 the children must be with family members. · SP1, SP2, and SP3 told P1 they were in the Toddler A classroom together when SP1 told the Toddler C classroom to clean up so they could go to their classroom. SP1 counted the Toddler C children at that point and realized AV1 and AV2 (P1 thought there might have been a third child), were missing. SP1 ran downstairs and found them in the Toddler C classroom. · P1 said that SP1’s procedure for transitioning was to tell the children it was time to clean up, have the children line up against the wall, count them, and then lead them down the hallway and stairs to their classroom. · P2 was not at the facility on June 27, 2024. When s/he returned the following Monday (July 1, 2024), s/he pulled video footage of the incident and spoke with SP1, SP2, and SP3. SP2 and SP3 told P2 that a family member had just left the classroom from dropping off his/her child and SP2 and SP3 thought that family member had not shut the door completely. · P2 reviewed video footage and saw that SP1 was having the children clean up, when AV1 and AV2 went to the door and opened it themselves and ran out down the hallway and down the stairs to their classroom. P2 saw SP1 open the classroom’s bathroom door and then run out down the hallway. · P2 heard from SP1 that s/he had told the children to line up and when SP1 counted s/he realized AV1 and AV2 were not there and checked the classroom’s bathroom. At that time, P4 entered the classroom and told the staff persons that AV1 and AV2 were on the stairs, and P1 and P4 thought SP1 was in the front of the line with them. This investigator reviewed video footage and observed the following: · On June 27, 2024, at 8:07:41 a.m., AV1 and AV2 headed toward the Toddler A classroom door while SP2 sat on a chair near the sink with a child next to him/her, SP1 was seated in a chair across the room from SP2 with a different child in front of him/her, and SP1 was by the toy shelves talking to other children. At 8:07:46 a.m., AV1 opened the classroom door, then AV1 and AV2 entered the hallway and ran down the hallway toward the stairs. At 8:07:56 a.m., SP2 helped a child wash his/her hands, SP3 was seated in a chair facing the play area of the Toddler A classroom, and SP1 was standing on the carpet area in the classroom. At 8:08:01 a.m., AV2 grabbed the handrail on the staircase, walked down four steps, then sat on his/her bottom, and scooted down the last 3 steps to the landing. At 8:08:06 a.m., AV1 went to the other side of the steps and was slightly out of view of the camera angle. · At 8:08:20 a.m., AV2 left the landing to the second set of steps and was not in view of the camera any longer. AV1 moved to the other side of the stairs and was looking back up the stairs when P4 walked by, followed by P3 with a cart, and then P1. At 8:08:31 a.m., SP2 noticed the door was open and looked out into the hallway as P1 and P4 were walking by. At that time, AV2 entered the Toddler C classroom downstairs. At 8:08:46 a.m., P4 entered the Toddler A classroom, AV1 was still on the staircase, and AV2 was in the Toddler C classroom out of view of the camera angle. · At 8:09:06 a.m., AV1 entered the Toddler C classroom, and P4 walked further into the Toddler A classroom. At 08:09:18 a.m., SP1 checked the classroom’s bathroom, went back to the group on the carpet, and then ran out of the Toddler A classroom. · At 8:09:54 a.m., SP1 entered the Toddler C classroom, took AV2 by the hand and walked out of view of the camera angle to get AV1 who was around the corner in the classroom. The video footage ended there. The facility’s Leaving a Child Unattended Policy stated, “Under no circumstance should [staff persons] leave a child unattended or alone. This places the child in immediate danger.” The facility’s Risk Reduction Plan stated, “Staff persons perform a face to name list count when leaving their classrooms and arriving in the playroom, playground, or vice versa.” Facility documentation showed that SP1, SP2, SP3, P1, P2, and P4 were each trained on the facility Risk Reduction Plan and the Reporting of 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 June 27, 2024, SP1, SP2, and SP3 were engaged with children in the Toddler A classroom when SP1 told the Toddler C children to clean up in preparation to leave the room. At 8:07:46 a.m., AV1 and AV2 went to the Toddler A classroom door, opened it, ran down the hallway to the stairs, went down the stairs by themselves and entered the Toddler C classroom, which was unoccupied at that time. Video footage showed P1, P3, and P4 walk by the staircase while AV1 was still on the stairs. P1 stated that P4 said s/he thought s/he heard children downstairs and P1 thought they were with their family members. At 8:08:46 a.m., P4 entered the Toddler A classroom and told SP1 – SP3 that AV1 and AV2 were on the stairs and s/he thought SP1 was with them. Video footage showed that within 12 seconds, SP1 checked the classroom’s bathroom and then left the classroom to begin searching for AV1 and AV2. At 8:09:54 a.m., SP1 found AV1 and AV2 unharmed in the Toddler C classroom. Information was consistent that AV1 and AV2 were unsupervised without staff person knowledge for approximately two minutes which was a violation of Minnesota Statutes, section 245A.02, subdivision 18, and Minnesota Rules, part 9503.0045, subpart 1, item A. 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. SP1’s, SP2’s and SP3’s actions were determined to be a nonmaltreatment mistake for the following reasons: (1) at the time of the incident, SP1, SP2, and SP3 were performing duties as required in the facility’s policies; SP1 helped children clean up, SP2 helped a child was his/her hands, and SP3 was engaged with a child in front of him/her; (2) SP1, SP2, and SP3 had not been determined responsible for a similar incident that resulted in a finding of maltreatment; (3) SP1, SP2, and SP3 had not been determined to have committed a similar nonmaltreatment mistake under this paragraph; (4) there were no injuries to AV1 and AV2 as a result of this incident; and (5) except for the period when the incident occurred, the facility, SP1, SP2, and SP3 were in compliance with all licensing requirements relevant to the incident. The nonmaltreatment mistake to AV1 and AV2 by SP1, SP2, and SP3 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 their policies and procedures adequate and followed by SP1, SP2, and SP3. SP1, SP2, and SP3 were retrained on supervision. Action Taken by Department of Human Services, Office of Inspector General: SP1, SP2, and SP3 were not determined as a perpetrator of maltreatment of AV1 and AV2 because the Department of Human Services found that the incident for which SP1, SP2, and SP3 were responsible met the criteria to be determined a nonmaltreatment mistake. SP1, SP2, and SP3 were notified by the Office of Inspector General that any future incident of possible neglect of an alleged victim for which SP1, SP2, or SP3 is responsible might not be considered a nonmaltreatment mistake. On November 1, 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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