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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: 1047343-CRF (Children’s Residential Facility) Investigator(s): Gessner Rivas (651) 431-3970 Suspected Maltreatment Reported: It was reported that a staff person (SP) was observed on security footage entering a bathroom followed by an alleged victim (AV) and the SP and the AV kissed in the bathroom. Date of Incident(s): January 06, 2026 Nature of Alleged Maltreatment Pursuant to Minnesota Statutes, section 260E.03, subdivision 20; and subdivision 15, paragraph (a), clauses (1) and (2): "Sexual abuse" means the subjection of a child by a person responsible for the child's care, by a person who has a significant relationship to the child, or by a person in a current or recent position of authority to any act that constitutes a violation of section 609.342 (criminal sexual conduct in the first degree), 609.343 (criminal sexual conduct in the second degree), 609.344 (criminal sexual conduct in the third degree), 609.345 (criminal sexual conduct in the fourth degree), or 609.3451 (criminal sexual conduct in the fifth degree). Sexual abuse includes threatened sexual abuse. 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 February 12, 2026; from documentation at the facility and law enforcement records; and through four interviews conducted with facility staff persons (P1 and P2), the SP, and the AV. The facility was a juvenile residential facility that focused on encouraging the development of healthy living and social skills to prepare youth to re-enter the community. The facility had a video recording system that recorded common areas of the facility. The AV was admitted to the facility for substance use issues, was diagnosed with post-traumatic stress disorder (PTSD), and was on probation for unspecified legal reasons. The AV strengths were that s/he was calm, positive, helpful, and encouraging. The AV struggled to understand, regulate, and manage his/her emotions. The AV struggled with symptoms of PTSD having nightmares and ruminating on past traumatic experiences. The AV needed assistance to successfully complete high school and to access appropriate care from community mental health care professionals.
The facility’s Ethics, Boundaries, & Professionalism policy prohibited staff persons from engaging in relationships with clients beyond the “staff/client relationship,” refrain from excessive or inappropriate self-disclosure including personal contact information. The SP provided the following information: · The SP stated that s/he was trained by the facility on professional boundaries between staff persons and clients. · The SP noted that the AV was very flirtatious with the SP, but not in a sexual manner but the AV would comment in the presence of others that the SP was “pretty.” At first the SP ignored the AV but then they began to engage in conversations about the facility and shared details of their personal lives which the SP noted the facility discouraged. · The AV had made a Christmas card and passed it on to the SP. They shared notes with one another; the SP wrote about her/his personal life. When asked if the notes contained writing about their personal feeling for one another, the SP stated that they would flirt with each other and that the AV’s writings were explicit. · The SP recalled that P1 and another staff person coached the SP on observing professional boundaries with the AV and not giving the AV preferential treatment such as allowing the AV to stay up late. · On January 6, 2026, the SP stated that s/he was taking care of laundry and garbage after other residents had gone to their bedrooms; the AV approached the SP wanting the SP to go to the AV’s bedroom. The SP went into the bathroom and the AV followed the SP where they shared a kiss. When asked who initiated the kiss, the SP stated it was mutual. · The SP stated that there was another kiss, on a separate occasion the AV told the SP, s/he wanted to whisper something to the SP; the AV then kissed the SP on the check. On another occasion, the SP gave the AV a hug to comfort the AV and the AV grabbed the SP’s buttocks and the SP backed away because it caught her/him by surprise. The AV provided the following information: · The AV stated that s/he initiated all contact between the AV and the SP; the AV began by saying “some stuff,” to the SP, telling the SP that s/he liked the SP. The AV and the SP had many conversation in which they talked about everything. · The AV recalled going into a bathroom with the SP on one occasion. The AV recalled having kissed the SP twice on two separate occasions but stated that the bathroom was not one of those occasions. The kisses were closed mouth. When the AV and the SP kissed, the AV stated that the SP said that s/he could not be doing that. The AV confirmed that s/he had grabbed the SP’s buttocks. Security camera footage provided by the facility showed the AV and the SP standing in the hallway of the facility talking on January 6, 2026, at 9:39 p.m. Less than a minute into the video the SP walked into a room and the AV approached the door which was kept open by the SP; the SP stood in the doorway for a moment before entering the room completely. The AV remained in the room for 20 seconds before walking out and turning the corner in the hallway. Moments later the SP stepped out of the room with a laundry basket full of garments and walked down the same hallway where the AV followed the SP. No other security footage was made available by the facility. P1 provided the following information: · P1 stated that for certain areas like bathrooms and laundry rooms, staff persons were prohibited from being alone with clients and other areas not covered by cameras. All staff persons received training which included boundaries between staff persons and clients. · P1 learned that the AV had tried to pass contact information along to the SP; questioned the SP about it and the SP said s/he threw the note away. Other staff persons had noted that the SP was flirtatious with the AV and had on at least on one occasion allowed the AV to stay up past bedtime. · The security footage of January 6, 2026, was the only instance that was captured on video showing inappropriate activity between the SP and the AV. P1 found no other security footage in which the AV and SP entered into areas not covered by cameras. P1 questioned the SP about January 6, 2026, and the SP admitted to having shared a kiss with the AV in the bathroom. The SP also disclosed that there had been two other instances in which there was physical contact between the SP and the AV. · No specific dates were provided, but the SP noted that on one occasion the AV had touched the SP’s buttocks and on that same date, the AV had kissed the SP. The SP told P1 that when the AV touched her/his buttocks, the SP did not do anything. The SP noted that those instances occurred in the AV’s bedroom. P2 provided the following information: · P2 noted that sometime prior to Christmas of 2025, the AV had written a card for the SP in which the AV referred to the SP as “beautiful.” Staff persons counseled the AV that s/he could not talk about staff persons that way. · Sometime after Christmas 2025, the AV gave a Christmas card and gave it to the SP, in which the AV wrote something along the lines of, “Have you been naughty or nice?” The SP was told that s/he needed to return the card to the AV. P2 told another staff person that the SP was to be retrained on boundaries. Later that same day, P2 saw the SP and AV sitting at a table together. · P2 recalled that a week prior to the incident of January 6, 2026, that P1 had met with the SP and reinforced the expectations about boundaries between staff persons and clients and that failure to follow those expectations would lead to termination. · On January 7, 2026, P2 learned from another staff person that the SP had allowed the AV to stay up late the night before. P2 and other staff persons viewed camera footage and observed that the AV had given the SP another card and saw the AV follow the SP into the bathroom. P1, P2, and the SP were trained on the Reporting of Maltreatment of Minors Act. Conclusion: A. Maltreatment: The SP and the AV shared notes in which they discussed their feelings about each other. The SP and the AV both acknowledged that they kissed. The SP stated that it was mutual, but the AV stated that s/he initiated the kissing. The SP and the AV acknowledged that they share at least two kisses; one was a closed mouth kiss and the other was a kiss on the SP’s cheek by the AV. Video security footage captured the AV following the SP into a room where one of the kisses was alleged to have happened. The SP and the AV acknowledged that on one occasion the AV grabbed the SP’s buttocks. The SP admitted to giving the AV preferential treatment by allowing the AV to stay up late. Although there were concerns that the SP had a sexual relationship with the AV, given that no information showed that the SP had sexual contact with the AV and the SP and that kissing did not meet the definition for sexual abuse, there was not a preponderance of the evidence that the SP had sexual contact with the AV. It was not determined that sexual abuse occurred ("sexual abuse" means the subjection of a child by a person responsible for the child's care, by a person who has a significant relationship to the child, or by a person in a current or recent position of authority to any act that constitutes a violation of section 609.342 (criminal sexual conduct in the first degree), 609.343 (criminal sexual conduct in the second degree), 609.344 (criminal sexual conduct in the third degree), 609.345 (criminal sexual conduct in the fourth degree), or 609.3451 (criminal sexual conduct in the fifth degree). Sexual abuse includes threatened sexual abuse). However, the facility encouraged the development of healthy living and social skills to prepare youth to re-enter the community. Given the AV’s history, it was reasonable that the AV would continue to need supports to develop and maintain necessary life and social skills including assistance to successfully complete high school, to access appropriate care from community mental health care professionals, and to regulate his/her emotions and mental health. The SP’s interactions with the AV including kissing hindered the AV’s ability to have a consistent understanding of the parameters of a therapeutic relationship which could interfere with other individuals’ attempts to provide therapeutic services to the AV both now and in the future. Therefore, there was a preponderance of the evidence that the SP’s interactions with the AV were detrimental to the AV’s mental health which was a failure to supply the AV with necessary care and a failure to protect the AV from conditions or actions that seriously endanger the AV’s physical or mental health when reasonably able to do so. It was 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). B. Responsibility pursuant to Minnesota Statutes, section 260E.30, subdivision 4, paragraph (a), clauses (1) and (2): When determining whether the facility or individual is the responsible party, or whether both the facility and the individual are responsible for determined maltreatment in a facility, the investigating agency shall consider at least the following mitigating factors: (1) whether the actions of the facility or the individual caregivers were according to, and followed the terms of, an erroneous physician order, prescription, individual care plan, or directive; however, this is not a mitigating factor when the facility or caregiver was responsible for the issuance of the erroneous order, prescription, individual care plan, or directive or knew or should have known of the errors and took no reasonable measures to correct the defect before administering care; (2) comparative responsibility between the facility, other caregivers, and requirements placed upon an employee, including the facility’s compliance with related regulatory standards and the adequacy of facility policies and procedures, facility training, an individual’s participation in the training, the caregiver’s supervision, and facility staffing levels and the scope of the individual employee’s authority and discretion; and (3) whether the facility or individual followed professional standards in exercising professional judgment. The SP was trained on the Reporting of Maltreatment of Minors Act. The SP was responsible for maltreatment of the AV. C. Recurring and/or Serious Maltreatment: The Office of Inspector General is required to evaluate whether substantiated maltreatment by an individual meets the statutory criteria to be determined as “recurring or serious.” Individuals determined to be responsible for recurring or serious maltreatment are disqualified from providing direct contact services. Minnesota Statutes, section 245C.02, subdivision 16, states: “Recurring maltreatment” means more than one incident of maltreatment for which there is a preponderance of evidence that maltreatment occurred and that the subject was responsible for the maltreatment. Minnesota Statutes, section 245C.02, subdivision 18, states: "Serious maltreatment" means sexual abuse, maltreatment resulting in death, neglect resulting in serious injury which reasonably requires the care of a physician whether or not the care of a physician was sought, or abuse resulting in serious injury. For purposes of this definition, "care of a physician" is treatment received or ordered by a physician, physician assistant, or nurse practitioner, but does not include diagnostic testing, assessment, or observation; the application of, recommendation to use, or prescription solely for a remedy that is available over the counter without a prescription; or a prescription solely for a topical antibiotic to treat burns when there is no follow-up appointment. For purposes of this definition, "abuse resulting in serious injury" means: bruises, bites, skin laceration, or tissue damage; fractures; dislocations; evidence of internal injuries; head injuries with loss of consciousness; extensive second-degree or third-degree burns and other burns for which complications are present; extensive second-degree or third-degree frostbite and other frostbite for which complications are present; irreversible mobility or avulsion of teeth; injuries to the eyes; ingestion of foreign substances and objects that are harmful; near drowning; and heat exhaustion or sunstroke. Serious maltreatment includes neglect when it results in criminal sexual conduct against a child or vulnerable adult. It was determined that the substantiated neglect for which the SP was responsible did not meet statutory criteria to be determined as recurring or serious because the SP’s pattern of behavior was considered a single incident and because the AV did not sustain a serious injury. Pursuant to Minnesota Statutes, section 260E.35, subdivision 6, paragraph © all investigative data maintained in this report will be kept by the Department of Human Services for at least ten years after the date of the final entry in the report. Action Taken by Facility: The facility completed an Internal Review and determined that its policies and procedures were not followed. The SP was no longer employed by the facility. Action Taken by Department of Human Services, Office of Inspector General: The SP was not disqualified from providing direct care services as a result of the maltreatment determination in this report. However, the SP was notified by the Office of Inspector General that any further substantiated act of maltreatment, whether or not the act meets the criteria for “serious,” will automatically meet the criteria for “recurring” and will result in the disqualification of the SP. The determination that the SP was responsible for maltreatment is subject to appeal. 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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