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  • Tennessee Department of Children's ServicesTennessee Child Abuse Hotline Summary

    Death: NoNumber of Screen Outs: 15 (

    )

    History (not listed above):ASMT LOS/No Services Needed/04-05-2018INV SEE/AUPU/05-26-2017ASMT DEC, ENN, PHA/No Services Needed/05-05-2017ASMT DEC/Unable to Complete/04-05-2017ASMT PHA/No Services Needed/01-26-2017ASMT ENN/No Services Needed/01-04-2016ASMT PHA/No Services Needed/12-20-2016ASMT DEC/Services Recommended and Accepted/12-12-2016INV /SEE/AUPU/06-19-2013ASMT /LOS/No Services Needed/04-01-2013ASMT /ENN, PHA, PYA/No Services Needed (ENN), No Services Needed (PYA, PHA; AP:

    Services Recommended and Accepted (PHA, PYA; AP: 09-07-2012INV /SEE/AUPU/09-07-2012INV /AUPU/01-06-2010INV /DEC, PHA/Unable to Complete/04-16-2004

    Pending: /SO/ABD/04-27-2018Awaiting Screening: NoSubmitted: No

    County: Notification: NoneSchool/ Daycare: goes to school but it is unknown whereNative American Descent: UnknownActive Military: NoneDirections: None Given

    Reporter's name/relationship:

    Reporter states:

    (7), (2), (1) and (1) live with their mother, (26), and [hereafter referred to as 'Mr. in County. Mr.

    is the father of and father, lives in another county. hadanother child, (DOB 0 ), that passed away last year in County; was atriplet to and was living with a friend, Unknown, at the time. The circumstancessurrounding death are unknown; however, this was reported to DCS.

    There have been on-going drug concerns and domestic violence concerns in the home. Currently, there is an openassessment case on the family concerning Physical Abuse, Psychological Harm and Lack ofSupervision on all of the children.

    At 7:15 AM on 4/27/2018, DCS received a report that had woken up this morning and found unresponsive. had called Law Enforcement and EMS when she had found It is unknown whathappened after Law Enforcement had made the scene. DCS worker made the scene and observedthat had already been loaded into an ambulance where he was receiving CPR. was transferred toSt. Hospital; it is possible that is currently at the hospital. It was learned that hasbeen pronounced deceased. It is unknown if was already deceased by the time CPR had been started inthe ambulance. At this time, the official cause of death is unknown; an autopsy has not been performed.

    Page 2 of 11Form Id CS 0680 03/22/2019 2.43

    Case #2018.058

  • Tennessee Department of Children's ServicesTennessee Child Abuse Hotline Summary

    Participant(s)

    Name:

    Partipant ID:MaleGender: Date of Birth:

    Age:SSN: Race:

    Address:

    Deceased Date:

    NoAlleged Perpetrator:

    NoDCS Foster Child:

    School/ ChildCare Comments:

    External History Search Results:

    DCS History Search Results:

    DCS Intake Search Results:

    Contact:

    Contact Type:

    Contact Comments:

    Page 4 of 11Form Id CS 0680 03/22/2019 2.43

    Case #2018.058

  • Tennessee Department of Children's ServicesTennessee Child Abuse Hotline Summary

    Unknown Participant UnknownName:

    Partipant ID:Gender: Date of Birth:

    Age:SSN: Race:

    Address:

    Deceased Date:

    YesAlleged Perpetrator:

    NoDCS Foster Child:

    School/ ChildCare Comments:

    External History Search Results:

    DCS History Search Results:

    DCS Intake Search Results:

    Contact:

    Contact Type:

    Contact Comments:

    Page 5 of 11Form Id CS 0680 03/22/2019 2.43

    Case #2018.058

  • Tennessee Department of Children's ServicesTennessee Child Abuse Hotline Summary

    Name:

    Partipant ID:MaleGender: Date of Birth:

    Age:SSN: Race:

    Address:

    Deceased Date:

    NoAlleged Perpetrator:

    NoDCS Foster Child:

    School/ ChildCare Comments:

    External History Search Results:

    DCS History Search Results:

    DCS Intake Search Results:

    Contact:

    Contact Type:

    Contact Comments:

    Page 6 of 11Form Id CS 0680 03/22/2019 2.43

    Case #2018.058

  • Tennessee Department of Children's ServicesTennessee Child Abuse Hotline Summary

    Name:

    Partipant ID:MaleGender: Date of Birth:

    8 YrsAge:SSN: Race:

    Address:

    Deceased Date:

    NoAlleged Perpetrator:

    NoDCS Foster Child:

    School/ ChildCare Comments:

    External History Search Results:

    DCS History Search Results:

    DCS Intake Search Results:

    Contact:

    Contact Type:

    Contact Comments:

    Page 7 of 11Form Id CS 0680 03/22/2019 2.43

    Case #2018.058

  • Tennessee Department of Children's ServicesTennessee Child Abuse Hotline Summary

    Name:

    Partipant ID:MaleGender: Date of Birth:

    DeceasedAge:SSN: Unable toRace:

    Street, Address:

    04/27/2018Deceased Date:

    NoAlleged Perpetrator:

    NoDCS Foster Child:

    School/ ChildCare Comments:

    External History Search Results:

    DCS History Search Results:

    DCS Intake Search Results:

    Contact:

    Contact Type: UNKNOWN

    Contact Comments:

    Page 8 of 11Form Id CS 0680 03/22/2019 2.43

    Case #2018.058

  • Tennessee Department of Children's ServicesTennessee Child Abuse Hotline Summary

    Name:

    Partipant ID:FemaleGender: Date of Birth:

    3 YrsAge:SSN: Race:

    Address:

    Deceased Date:

    NoAlleged Perpetrator:

    NoDCS Foster Child:

    School/ ChildCare Comments:

    External History Search Results:

    DCS History Search Results:

    DCS Intake Search Results:

    Contact:

    Contact Type:

    Contact Comments:

    Page 9 of 11Form Id CS 0680 03/22/2019 2.43

    Case #2018.058

  • Tennessee Department of Children's ServicesTennessee Child Abuse Hotline Summary

    Name:

    Partipant ID:FemaleGender: Date of Birth:

    27 YrsAge:SSN: Race:

    Address:

    Deceased Date:

    NoAlleged Perpetrator:

    NoDCS Foster Child:

    School/ ChildCare Comments:

    External History Search Results:

    DCS History Search Results:

    DCS Intake Search Results:

    Contact:

    Contact Type:

    Contact Comments:

    Page 10 of 11Form Id CS 0680 03/22/2019 2.43

    Case #2018.058

  • Tennessee Department of Children's ServicesTennessee Child Abuse Hotline Summary

    Name:

    Partipant ID:FemaleGender: Date of Birth:

    2 Yrs 6 MosAge:SSN: Race:

    Address:

    Deceased Date:

    NoAlleged Perpetrator:

    NoDCS Foster Child:

    School/ ChildCare Comments:

    External History Search Results:

    DCS History Search Results:

    DCS Intake Search Results:

    Contact:

    Contact Type:

    Contact Comments:

    Page 11 of 11Form Id CS 0680 03/22/2019 2.43

    Case #2018.058

  • Child Protective Service Investigation Summaryand Classification Decision of Child

    Abuse/Neglect Referral

    Case Name : Investigation ID:

    Case Worker: W. Date: 06/21/2018

    Team Leader: A Date: 06/24/2018

    Instruction: Condense the finding rationale for each allegation relative to the child victim(s). Be sure to identifythe facts that provided for the classification decision.

    D. Case Workers

    E. Investigation Summary

    Summarize the key points and dates of the child or children’s statements and/or the observation of the child orchildren’s physical state or home environment:

    Summarize professional, medical or psychological findings or opinions: What is the collateral’s oral or writtenfinding/opinion of the incident(s)/allegation(s)?

    Summarize alleged perpetrator’s statement or admission: What is the perpetrator’s explanation of theincident(s)/allegation(s)?

    The case will be closed and classified as Allegation Unsubstantiated, Perpetrator Unsubstantiated for theallegation of Abuse Death; and Allegation Substantiated, Perpetrator Substantiated as to and

    for the allegation of severe Drug Exposed Child regarding and

    The alleged child victims were observed by Investigator initially to be in the care of relatives. The childrenwere seen by medical personnel due to concerns of drug exposure. As a result of the apparent drug use of the parent,Investigator filed A Petition to Declare Child Dependent and Neglected and a Protective Custody Order in theJuvenile Court of County, Tennessee in regards to and on April 27, 2018 which was grantedby the court in the best interest and safety of the children. The children are placed with their relative grandparents. Theirmedical, dental and well-being needs are being met while in DCS custody.

    At the time of death, an autopsy was ordered by Assistant District Attorney General and completed onApril 28, 2018. Investigator received the results on June 5, 2018. According to S. M.D. andForensic Pathologist, the cause of death was ruled as Natural Causes. According to Dr. the Pathologic Diagnosiswas Chronic Bronchiolitis and Tracheitis complicated by Group A Streptocooccus Bacteremia.

    According to preliminary interviews at the time of response, Ms. reported she put and to sleepon April 26, 2018 at approximately 10:00 p.m. in a crib together. Ms. said she checked on the children around 11:00p.m., noted they were asleep, and went to sleep herself. Ms. reported sometime during the night, got out ofthe crib and came to Ms. who was asleep on the couch, to sleep with her. On April 27, 2018 somewhere around6:45 a.m., Ms. woke up and attempted to wake up, but when she moved him, the child allegedly didn'trespond. Ms. picked up, who was positioned on his stomach with his face head down, to find that his bodywas warm and limp. Ms. also allegedly made a statement to Officer that the bedroom in which the deceasedchild was located smelled of sex. Investigator Detective and Detective with the Police Department began searching the residence and located several white pills in the bedroom where the crib waslocated, lying on the floor. There were several pills still intact and others were observed to be crushed. There was an emptyover the counter mucus relief bottle located close to the pills. There was a bottle that had fallen to the side of the crib railsand mattress as well as a bottle lying on a bed located in the bedroom. The room was in disarray as evidenced by piles ofclothes observed to be scattered, roaches throughout the room and walls, a container with cleaning supplies sitting besidethe bed, and other miscellaneous items.While speaking with Ms. further, Ms. denied that had any medical concerns or had been

    3/22/19 2:45 PMPage 2 ofCS - 0740 3

    Case #2018.058

  • Child Protective Service Investigation Summaryand Classification Decision of Child

    Abuse/Neglect Referral

    Case Name : Investigation ID:

    Summarize witnesses’ descriptions of what they saw and what they believe indicates child abuse/neglect:

    Summarize any other evidence or factors that support the investigative finding(s) for the allegation(s) ofabuse/neglect:

    Distribution Copies: Juvenile Court in All CasesDistrict Attorney in Severe Child Abuse CasesRegional Supervising Attorney

    sick recently. Investigator observed at times, Ms. would close her eyes when responding to the questions.Ms. apologized she was not reacting in a way some might, claiming she will cry at times, but then wouldn't. Ms.

    admitted she is currently prescribed three anti-depressants through her OBGYN, and had taken these medicationsprior to going to sleep the previous night. Investigator inquired if Ms. had taken any other illegal narcoticsand Ms. denied that she had. Ms. submitted to a urine drug screen at that time, but Ms. stated shewas unable to urinate. Ms. was then transported back to the residence where Investigator met with heragain. Ms. did give consent and provided a sample which was positive for amphetamine, methamphetamine, andecstasy. Ms. denied that she had used these substances recently, admitting to her last known use beingapproximately one month prior.

    Investigator made contact with Mr. legal father of who had been in Ms. residenceas well as caring for the children prior to death. Initially, Mr. refused a urine drug screen. During a courtproceeding on May 21, 2018, Mr. submitted to a urine drug screen and was positive for amphetamine andmethamphetamine.

    Investigator also spoke with a relative who also stays in the home, who reported on the evening ofApril 26, 2018, he came home between 10:30 p.m.-11:30 p.m. and found Ms. to be crawling around the home onher hands and knees. According to Investigator Mr. stated it appeared that Ms. was not caring forthe children and he located and in the back bedroom. Mr. reportedly changed the children'sdiapers, gave them a bottle, and put them to bed

    3/22/19 2:45 PMPage 3 ofCS - 0740 3

    Case #2018.058

  • Tennessee Department of Children's Services

    FAST 2.0 Assessment Summary Report

    CPS Case ID:

    Event Type: CPS Case Assessment Date: 04/30/2018

    Assessment Type: FAST

    OVERVIEW

    Assessor: W.

    Safety Level:Immediate Intervention Recommended

    Risk Level: High Need/Risk

    Assessed at Location:DCS Office

    Event Start Date: 07/19/2018

    Assessment Status: Approved

    Date Approved: 04/30/2018

    Last Assessed Date:

    Approver: A

    PARTICIPANTS

    Name Age Role Gender PersonIDTraumaScore

    CSEMRisk

    (AP) 39 Yrs Caregiver M N/A N/A

    Jr., 31 Yrs Caregiver M N/A N/A

    (ACV) 1 Yr 7 Mos Youth F 2 Low

    (ACV) 7 Yrs Youth M 4 Low

    (ACV) 2 Yrs 11 Youth F 2 Low

    (AP) 26 Yrs Primary Caregiver F N/A N/A

    Assessment Summary 3/22/19 2:45 PM1Page 1 of

    Case #2018.058

  • Tennessee Department of Children's ServicesFAST 2.0 Assessment Detail Report

    Assessment Date: 04/30/2018

    Assessment Type: FAST CPS Case ID:

    Event Type: CPS Case

    indicated Ms. was under the influence on the previousevening due to her observed behaviors. There were pills and otherhazards located in the home which was observed by CPSI

    Page 2 of 13Assessment Detail Report 3/22/19 2:45 PM

    Case #2018.058

  • Tennessee Department of Children's ServicesFAST 2.0 Assessment Detail Report

    Assessment Date: 04/30/2018

    Assessment Type: FAST CPS Case ID:

    Event Type: CPS Case

    1It was reported is not in the home and actively

    engaged in caring for his children, appropriately.Involvement in Caregiving

    Functions

    0 No area of concern at this time.Knowledge of Child and Family

    Needs

    Page 4 of 13Assessment Detail Report 3/22/19 2:45 PM

    Case #2018.058

  • Tennessee Department of Children's ServicesFAST 2.0 Assessment Detail Report

    Assessment Date: 04/30/2018

    Assessment Type: FAST CPS Case ID:

    Event Type: CPS Case

    0 No area of concern.Knowledge of Child and Family

    Needs

    Page 7 of 13Assessment Detail Report 3/22/19 2:45 PM

    Case #2018.058

  • Tennessee Department of Children's ServicesFAST 2.0 Assessment Detail Report

    Assessment Date: 04/30/2018

    Assessment Type: FAST CPS Case ID:

    Event Type: CPS Case

    0 No area of concernDevelopmental

    1This is being scored as an area of concern due to the child losing two

    siblings; and will be explored for further assessment.Mental Health

    0 No area of concernSubstance Use

    0 No area of concernHigh Risk Behavior

    Page 9 of 13Assessment Detail Report 3/22/19 2:45 PM

    Case #2018.058

  • Tennessee Department of Children's ServicesFAST 2.0 Assessment Detail Report

    Assessment Date: 04/30/2018

    Assessment Type: FAST CPS Case ID:

    Event Type: CPS Case

    0 No area of concernMental Health

    0 No area of concernSubstance Use

    0 No area of concernHigh Risk Behavior

    Page 11 of 13Assessment Detail Report 3/22/19 2:45 PM

    Case #2018.058

  • Tennessee Department of Children's ServicesFAST 2.0 Assessment Detail Report

    Assessment Date: 04/30/2018

    Assessment Type: FAST CPS Case ID:

    Event Type: CPS Case

    0 No area of concernMental Health

    0 No area of concernSubstance Use

    0 No area of concernHigh Risk Behavior

    Page 13 of 13Assessment Detail Report 3/22/19 2:45 PM

    Case #2018.058