Severe reports
The most serious findings in the state inspection reports we hold: deaths,
sexual and physical abuse, restraints that injured a child, suicide attempts,
medical neglect and hospitalisations. Every quote below is the licensing
agency's own wording, and each one was read against its report by a person
before it was listed here.
Nexus Gerard Family Healing MN
Given that [the staff person] did not intervene to protect [the alleged victim] as multiple youth chased him/her, sprayed him/her with water, and physically assaulted [the alleged victim] including punching [the alleged victim] in the stomach causing [the alleged victim] to bend over and grab his/her stomach and another occasion when [the alleged victim] was hit with a skateboard in the groin appearing to make [the alleged victim] scream and cover his/her groin with his/her hands, there was a preponderance of the evidence that there was a failure to supply [the alleged victim] with necessary care required for [the alleged victim]’s physical or mental health and a failure to protect [the alleged victim] from conditions or actions that seriously endangered [the alleged victim]'s physical or mental health when reasonably able to do so.
From the state's report. Maltreatment determined as to neglect of an alleged victim by a staff person.. The state numbers or abbreviates the people in a report instead of naming them; we spell its codes out in square brackets, such as [Staff 1] for S1 or [Former client 3] for FC #3.
On March 24, 2026, three clients (C1-C3) ran away from the facility, climbed into dumpsters, and ingested unknown items. Staff called 9-1-1 and took [Child 1] to an emergency room after s/he repeatedly vomited.
From the state's report. Violation cited by DHS. The state numbers or abbreviates the people in a report instead of naming them; we spell its codes out in square brackets, such as [Staff 1] for S1 or [Former client 3] for FC #3.
Bar None Residential Services MN
In plain words: { summary: Medical and police records showed potential bodily fluid on a child in the program during an exam. The child reported that a staff member gave them a THC vape pen during a sexual assault. The state found that the facility failed to respond to the sexual assault and provide necessary care because four staff members did not report it until the child called for help. } Our summary of the state's report. The state's own wording follows.
A. Maltreatment: Regarding Sexual Abuse Information provided in [the alleged victim]’s medical record and in law enforcement information showed that during [the alleged victim]’s SANE exam, speckled fluorescence appeared under ultraviolet light that indicated potential bodily fluid. [...] Sexual abuse includes threatened sexual abuse.) Regarding Neglect The [the alleged victim] provided consistent information that [the staff person] provided [the alleged victim] with a THC vape pen during the time of the sexual assault. [...] Additionally, given that [the alleged victim] called and reported the sexual assault him/herself, after four staff persons with various levels of authority failed to report the incident, and that without [the alleged victim] reporting the incident him/herself the alleged sexual assault would have not been investigated there was a preponderance of the evidence that the facility failed to respond to a sexual assault and supply [the alleged victim] with necessary care and services.
From the state's report. Maltreatment Determined as to sexual abuse and neglect of an alleged victim by a staff person.. "[...]" marks text left out between sentences. The state numbers or abbreviates the people in a report instead of naming them; we spell its codes out in square brackets, such as [Staff 1] for S1 or [Former client 3] for FC #3.
In plain words: { summary: A video showed a staff member punching a child in the face twice on purpose. The state found that physical abuse occurred. } Our summary of the state's report. The state's own wording follows.
Regarding physical abuse Although [the staff person] did not recall having any physically aggressive behaviors towards [the alleged victim], given that the video of the incident showed [the staff person] hit [the alleged victim] in the face with a closed fist twice which was not accidental, there was a preponderance of the evidence that [the staff person] engaged in conduct that was not accidental causing physical and/or threatened injury to [the alleged victim]. It was determined that physical abuse occurred (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.
From the state's report. Maltreatment determined as to neglect and physical abuse of an alleged victim by a staff person.. The state numbers or abbreviates the people in a report instead of naming them; we spell its codes out in square brackets, such as [Staff 1] for S1 or [Former client 3] for FC #3.
Northwestern Minnesota Juvenile Center MN
The [the alleged victim] was taken to the emergency department of the hospital where s/he was evaluated and diagnosed with an open displaced fracture and laceration of his/her right index finger and a laceration of the right little finger. [...] Staff persons were not permitted to push or shove youth and [the staff person] should not have closed the bedroom door without ensuring that the doorway was clear.
From the state's report. Maltreatment determined as to physical abuse of the alleged victim by the staff person.. "[...]" marks text left out between sentences. The state numbers or abbreviates the people in a report instead of naming them; we spell its codes out in square brackets, such as [Staff 1] for S1 or [Former client 3] for FC #3.
Additionally, assessments completed by SP2 showed that [the alleged victim] experienced and/or was “high risk” to sexual trafficking and/or commercial sexual exploitation to which the facility maintained certification in compliance with FFPSA that specialized its programming in serving youth with this history and/or vulnerability of being victim to. [...] Additionally, there were no attempts made by staff persons to contact the G prior to or after [the alleged victim] left the facility, with the G being unaware that there were any concerns with [the alleged victim]’s behavior, health, and/or safety until [the alleged victim] arrived at the G’s home in “the middle of the night.” It was later determined that after [the alleged victim] left the facility, [the alleged victim] was sexually assaulted by the C who was then criminally charged, convicted, and sentenced for sexually assaulting a minor ([the alleged victim]) during the evening of May 25, 2024.
From the state's report. Maltreatment determined as to neglect of an alleged victim by a staff person. "[...]" marks text left out between sentences. The state numbers or abbreviates the people in a report instead of naming them; we spell its codes out in square brackets, such as [Staff 1] for S1 or [Former client 3] for FC #3.
Ramsey County Juvenile Detention Center MN
Sexual abuse includes threatened sexual abuse.)
From the state's report. Maltreatment determined as to neglect of the AV by the SP..
PrairieCare Residential Services MN
It was determined that physical abuse occurred (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.
From the state's report. Maltreatment determined as to physical abuse of an alleged victim by a staff person..
Any injuries resulting from the use of restraint and seclusion procedures; c.
From the state's report. Violation cited by DHS.
Grafton Integrated Health Network Minnesota Psychiatric Residential Tr MN
Any injuries resulting from the use of restraint and seclusion procedures; c.
From the state's report. Violation cited by DHS.
Ramsey County Juvenile Detention Center MN
It was determined that physical abuse occurred (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.
From the state's report. Maltreatment determined as to physical abuse of an alleged victim by a staff person..
In plain words: A staff member forced a child to the ground with too much force, causing face and knee injuries. The state decided physical abuse occurred. Our summary of the state's report. The state's own wording follows.
The [the staff person] reached in and removed [the alleged victim], forcing [the alleged victim] to the ground with excessive force causing [the alleged victim] to sustain injuries to her/his face and knee. [...] Given the testimony provided through interviews with staff persons and the facility’s requirement per policy to de-escalate a potential use-of-force situation, to use the least amount of force reasonable, the physical injuries sustained by [the alleged victim], and staff persons belief that [the staff person] used excessive force or overreacted there was a preponderance of the evidence that [the staff person]’s conduct was not accidental and caused [the alleged victim] physical injury. It was determined that physical abuse occurred (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.
From the state's report. Maltreatment determined as to physical abuse of the AV by the SP.. "[...]" marks text left out between sentences. The state numbers or abbreviates the people in a report instead of naming them; we spell its codes out in square brackets, such as [Staff 1] for S1 or [Former client 3] for FC #3.
Sexual abuse includes threatened sexual abuse).
From the state's report. Maltreatment determined as to neglect of an alleged victim by a staff person..
Therefore, there was a preponderance of the evidence that physical abuse of [the alleged victim] occurred.
From the state's report. Maltreatment determined as to physical abuse of an alleged victim by a staff person.. The state numbers or abbreviates the people in a report instead of naming them; we spell its codes out in square brackets, such as [Staff 1] for S1 or [Former client 3] for FC #3.
Northwestern Minnesota Juvenile Center MN
In plain words: A child in the program got a cut requiring stitches after a staff member took them to the floor. Witnesses and a discipline document stated that the staff member used excessive force and an unapproved technique. Our summary of the state's report. The state's own wording follows.
A. Maltreatment: On January 5, 2022, [the alleged victim] sustained a cut on his/her chin and received stitches after being taken down to the floor by [the staff person]. [...] However, P1 was in the timeout room at the time of the incident and stated that the way [the staff person] took [the alleged victim] to the floor was “excessive” and that s/he noticed blood on [the alleged victim]’s face after the incident; P2 watched the video and said that [the staff person]’s actions were not consistent with his/her training; and [the staff person]’s Staff Discipline Document stated that [the staff person] used “excessive force” when taking [the alleged victim] to the floor, using a technique that was not approved by the facility.
From the state's report. Maltreatment determined as to neglect and physical abuse of an alleged victim by a staff person.. "[...]" marks text left out between sentences. The state numbers or abbreviates the people in a report instead of naming them; we spell its codes out in square brackets, such as [Staff 1] for S1 or [Former client 3] for FC #3.
Law enforcement did a search warrant on [the staff person]’s phone and did not see any indication that [the staff person] was friends with clients on Snapchat but said that may have been because none of the clients “accepted” [the staff person]’s friend request. [...] Regarding Sexual Abuse Given the information provided by [Child 1] and [Child 8] that [the staff person] “patted” them and other clients on the buttocks over their clothing and also made comments about “smacking” [Child 1]’s “butt,” that [the staff person] was a staff person in authority who intentionally touched their buttocks, which was an intimate part, and making comments that were in appropriate and sexual in nature, there was a preponderance of the evidence that [the staff person]’s conduct included statements and overt acts that represented a substantial risk of sexual abuse to [Child 1] and [Child 8].
From the state's report. Maltreatment determined/substantiated as to sexual abuse of two alleged victims and neglect of twelve alleged .... "[...]" marks text left out between sentences. The state numbers or abbreviates the people in a report instead of naming them; we spell its codes out in square brackets, such as [Staff 1] for S1 or [Former client 3] for FC #3.