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Tennessee Department of Children's Services Tennessee Child Abuse Hotline Summary Intake ID: Intake Taken By: 02/29/2016 10:15 AM Intake Date/Time: Investigation Track Assigned: Priority Assigned: 1 Screened By: Date Screened: 02/29/2016 Intake First County/Region 02/29/2016 12:04 PM Date/Time Assigned : First Team Leader Assigned: Date/Time First Case Manager Date/Time 02/29/2016 12:00 AM 02/29/2016 12:00 AM Investigation ID: Investigation Alleged Victim Age Allegation Severe ? Alleged Perpetrator Relationship to Alleged Victim Allegations CSEM ? 2 Yrs 1 Mos Lack of Supervision No Birth Mother Deceased Lack of Supervision No Birth Mother Deceased Abuse Death Yes Birth Mother 3 Yrs Lack of Supervision No Birth Mother Referent Name: Role to Alleged Victim(s): Referent Address: Referent Phone Number: Notification: None Type of Contact: I-3 Phone Referent(s) Narrative: ****The child is not in DCS custody Family Case IDs: Yes ( Open Court Custody/FSS/FCIP: No Page 1 of 8 Form Id CS 0680 11/18/2016 11.26 Case # 2016.024

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Page 1: Case · Tennessee Child Abuse Hotline Summary Intake ID: Intake Taken By: Intake Date/Time: 02/29/2016 10:15 AM Track Assigned: Investigation Priority Assigned: 1 Screened By: Date

Tennessee Department of Children's ServicesTennessee Child Abuse Hotline Summary

Intake ID:

Intake Taken By: 02/29/2016 10:15 AM Intake Date/Time:

InvestigationTrack Assigned: Priority Assigned: 1

Screened By:Date Screened: 02/29/2016

Intake

First County/Region

02/29/2016 12:04 PMDate/Time Assigned :

First Team Leader Assigned: Date/Time

First Case Manager Date/Time 02/29/2016 12:00 AM

02/29/2016 12:00 AM

Investigation ID:

Investigation

Alleged Victim Age AllegationSevere ? Alleged Perpetrator Relationship to

Alleged Victim

Allegations

CSEM ?

2 Yrs 1 Mos Lack of SupervisionNo

Birth Mother

Deceased Lack of SupervisionNo

Birth Mother

Deceased Abuse DeathYes

Birth Mother

3 Yrs Lack of SupervisionNo

Birth Mother

Referent Name: Role to Alleged Victim(s):

Referent Address:

Referent Phone Number:

Notification: None

Type of Contact: I-3 Phone

Referent(s)

Narrative: ****The child is not in DCS custody

Family Case IDs: Yes (

Open Court Custody/FSS/FCIP: No

Page 1 of 8Form Id CS 0680 11/18/2016 11.26

Case # 2016.024

Page 2: Case · Tennessee Child Abuse Hotline Summary Intake ID: Intake Taken By: Intake Date/Time: 02/29/2016 10:15 AM Track Assigned: Investigation Priority Assigned: 1 Screened By: Date

Tennessee Department of Children's ServicesTennessee Child Abuse Hotline Summary

Closed Court Custody: Yes/ Begin date: 7-10-13 / End date: 9-17-13

/ Begin date: 7-10-13 / End date: 9-17-13/ Begin date: 7-10-13 / End date: 9-17-13

Open: No

Substantiated: YesBegin date: 9-8-08 / Investigation / / PHA / Allegation and Perpetrator Substantiated / End date: 11-7-08

Death: NoNumber of Screen Outs: 4

History (not listed above): YesBegin date: 5-28-13 / Assessment / / LOS / No Services Needed / End date: 8-30-13Begin date: 7-9-13 / Assessment / / ENN, NUN / Services Recommended and Accepted / End date: 8-30-13Begin date: 10-21-14 / Assessment / / LOS / No Services Needed / End date: 1-7-15Begin date: 1-9-12 / Assessment / / PYA / No Services Needed / End date: 2-15-12Begin date: 6-2-07 / Investigation / / SRSA, SEE / Allegation and Perpetrator Unsubstantiated / End date:6-26-07Begin date: 3-29-07 / Assessment / / ENN / No Services Needed / End date: 4-30-07Begin date: 2-3-14 / SIU / / PHA / Allegation and Perpetrator Unsubstantiated / End date: 4-3-14Begin date: 8-5-11 / Assessment / / ENN / Services Recommended and Accepted / End date: 9-28-11Begin date: 9-17-10 / Investigation / / PHA / Allegation and Perpetrator Unsubstantiated / End date: 2-27-11Begin date: 9-8-08 / Investigation / / PHA / Administrative Closure / End date: 11-7-08Begin date: 10-6-15 / Assessment / / DEC / Unable to Complete / End date: 1-15-16

Pending: NoAwaiting Screening: NoSubmitted: No

County: Notification: NoneSchool/ Daycare/Dismissal: None; currently with the grandmother (Unknown) at ERNative American Descent: NoneDirections: N/A

Reporter's name/relationship:

Reporter states: ****The child is not in DCS custody

(3), (2), and (1) live with their mother, (26), andfather, (26), in County, TN.

is now deceased. passed away this morning (02/29/2016). The child's time of death is unknown. Thedeath occurred roughly about an hour ago.

The mother had just dropped the father off at work ( in The three (3) children were in the backseat in car seats, but the three (3) car seats were not restrained. The mother's brother (Unknown) called her on thephone, so she got out of the car and went off talking to him on the phone. The mother didn't state how far awayfrom the car she was or how long she was on the phone with her brother. While the mother was away, gotout of his car seat. somehow got a hold of his

Page 2 of 8Form Id CS 0680 11/18/2016 11.26

Case # 2016.024

Page 3: Case · Tennessee Child Abuse Hotline Summary Intake ID: Intake Taken By: Intake Date/Time: 02/29/2016 10:15 AM Track Assigned: Investigation Priority Assigned: 1 Screened By: Date

Tennessee Department of Children's ServicesTennessee Child Abuse Hotline Summary

mother's gun. shot himself in the head in front of the other two (2) children. According to the mother, whenshe heard a "pop", she threw the phone down, went and grabbed out of the car, and called 911. The childwas transported by ambulance to Hospital. Paramedics attempted to do CPR at the scene and on the wayto the hospital. It's unknown if he was still alive when paramedics arrived, but the child was officially pronounceddead at the hospital. You could see the bullet hole going through the front of his right cheek through the back of hisskull. The child does not have any other injuries. This incident just happened, so an autopsy probably hasn't beencompleted yet. The other children are too young to be interviewed. was "visibly frightened." It is thoughtthe youngest child was "too young" to know what had happened. The grandmother (Unknown) and two (2) youngerchildren are currently at the hospital. The mother and father are still at the scene of the accident. Detectives arecurrently speaking to the parents.

The mother claimed that the gun was locked in the glove box. Law enforcement has not yet had a chance to checkthe gun. It's still in the car.

There has been prior domestic violence between the parents "for as long as the referent can remember." Thefather has been arrested a couple of times for domestic violence, and it is thought the mother has been arrested atleast once. On one occasion, the father has assaulted a police officer, so he was also charged for that. It'sunknown when the most recent incident occurred. To the referent's knowledge, the parents don't have any othercharges aside from the domestics. It's unknown if the parents have mental health issues or drug/alcohol issues.

Law enforcement is currently at the home. There are a bunch of animals on the property, including goats andchickens. There are 5 pens in the yard. In one pen, there are several dead pigs. You can tell the goats have tried toget into the pen. There is "garbage everywhere" outside the home. The home is locked currently. There are abunch of dogs in the house. If the home is still in the condition it was when the referent last saw it, the home is"filthy." The referent last saw inside the home about a year ago. There was garbage and animal feces everywhereinside at that time. There were no known safety hazards. It's unknown if the utilities are currently working.

A local CPS case manager ( Unknown) is on the way to the hospital.

Special Needs or Disabilities: None knownChild's current location: ERPerpetrator's current location: scene of accident: Home addressAny other safety concerns for responding worker: Law enforcement is present a ton of animals several dead pigsthroughout the property. There are goats, chickens.Is there any Domestic Violence in the home: Yes

Per SDM: Investigative Track, P1 - , CM3, on 2-29-16 at 11:33 a.m.

Email sent to TV notification group.received on 2-29-16 and 11:42 a.m.

Email sent to and Regional Administrator TN ValleyRegion

Page 3 of 8Form Id CS 0680 11/18/2016 11.26

Case # 2016.024

Page 4: Case · Tennessee Child Abuse Hotline Summary Intake ID: Intake Taken By: Intake Date/Time: 02/29/2016 10:15 AM Track Assigned: Investigation Priority Assigned: 1 Screened By: Date

Tennessee Department of Children's ServicesTennessee Child Abuse Hotline Summary

Participant(s)

Name:

Partipant ID:MaleGender: Date of Birth:

2 Yrs 1 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 4 of 8Form Id CS 0680 11/18/2016 11.26

Case # 2016.024

Page 5: Case · Tennessee Child Abuse Hotline Summary Intake ID: Intake Taken By: Intake Date/Time: 02/29/2016 10:15 AM Track Assigned: Investigation Priority Assigned: 1 Screened By: Date

Tennessee Department of Children's ServicesTennessee Child Abuse Hotline Summary

Name:

Partipant ID:MaleGender: 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 5 of 8Form Id CS 0680 11/18/2016 11.26

Case # 2016.024

Page 6: Case · Tennessee Child Abuse Hotline Summary Intake ID: Intake Taken By: Intake Date/Time: 02/29/2016 10:15 AM Track Assigned: Investigation Priority Assigned: 1 Screened By: Date

Tennessee Department of Children's ServicesTennessee Child Abuse Hotline Summary

Name:

Partipant ID:MaleGender: Date of Birth:

DeceasedAge:SSN: WhiteRace:

Address:

02/29/2016Deceased Date:

NoAlleged Perpetrator:

NoDCS Foster Child:

School/ ChildCare Comments:

External History Search Results:

DCS History Search Results:

DCS Intake Search Results:

Contact:

Contact Type: CELL

Contact Comments: mother & father

Page 6 of 8Form Id CS 0680 11/18/2016 11.26

Case # 2016.024

Page 7: Case · Tennessee Child Abuse Hotline Summary Intake ID: Intake Taken By: Intake Date/Time: 02/29/2016 10:15 AM Track Assigned: Investigation Priority Assigned: 1 Screened By: Date
Page 8: Case · Tennessee Child Abuse Hotline Summary Intake ID: Intake Taken By: Intake Date/Time: 02/29/2016 10:15 AM Track Assigned: Investigation Priority Assigned: 1 Screened By: Date

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 8 of 8Form Id CS 0680 11/18/2016 11.26

Case # 2016.024

Page 9: Case · Tennessee Child Abuse Hotline Summary Intake ID: Intake Taken By: Intake Date/Time: 02/29/2016 10:15 AM Track Assigned: Investigation Priority Assigned: 1 Screened By: Date
Page 10: Case · Tennessee Child Abuse Hotline Summary Intake ID: Intake Taken By: Intake Date/Time: 02/29/2016 10:15 AM Track Assigned: Investigation Priority Assigned: 1 Screened By: Date

Tennessee Department of Children's ServicesChild Protective Service Investigation Summary

and Classification Decision of Child Abuse/Neglect ReferralCase Name : Investigation ID:

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

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

11/18/16 11:27 AMPage 2 ofCS - 0740 2

Case # 2016.024

Page 11: Case · Tennessee Child Abuse Hotline Summary Intake ID: Intake Taken By: Intake Date/Time: 02/29/2016 10:15 AM Track Assigned: Investigation Priority Assigned: 1 Screened By: Date

Tennessee Department of Children's ServicesCase Recording Summary

Case Id: Case Name:

Case Status: Close Organization:

Recording ID: Status: Completed

Contact Date: 08/05/2016 Contact Method: Correspondence

Contact Time: 05:00 PM Contact Duration:

Entered By: Recorded For:

Created Date: 08/05/2016

Completed date: 08/05/2016 Completed By:

Location:

Purpose(s): Permanency,Safety - Child/Community,Service Planning,Well Being

Notification of Classification

Contact Sub Type:

Case Recording Details

Children Concerning

Participant(s)

Contact Type(s):

Narrative Details

Deputy Director of Investigations (DDI) has approved the classification submitted by CPSI andapproved the case for closure. The allegations are as follow:ASPS - where was the ACV and (mother) was the AP for Lack of supervision.ASPS - where was the ACV and (mother) was the AP for Lack of supervision.ASPS - where was the ACV and (mother) was the AP for Abuse Death.This case was reviewed by DDI RID , IC and LI and it wasfound that there was enough evidence to support the classifications. CPSI has completed all necessary investigative tasks for thisinvestigation. The 740 was completed and a copy along with classification has been sent to DCS legal, Juvenile Court and to theDA's office.

**All documentation forms and ETC was uploaded into TFACTS. There is no hard file.

Entry Date/Time: 08/05/2016 04:04 PM Entered By:Narrative Type: Original

11/18/16 11:26 AMPage 1 ofCR - Summary 28

Case # 2016.024

Page 12: Case · Tennessee Child Abuse Hotline Summary Intake ID: Intake Taken By: Intake Date/Time: 02/29/2016 10:15 AM Track Assigned: Investigation Priority Assigned: 1 Screened By: Date

Tennessee Department of Children's ServicesCase Recording Summary

Case Id: Case Name:

Case Status: Close Organization:

Recording ID: Status: Completed

Contact Date: 07/15/2016 Contact Method:

Contact Time: 02:00 PM Contact Duration:

Entered By: Recorded For:

Created Date: 07/20/2016

Completed date: 07/20/2016 Completed By:

Location:

Purpose(s): Service Planning,Well Being

Administrative Review

Contact Sub Type:

Case Recording Details

Children Concerning

Participant(s)

Contact Type(s):

Narrative Details

CPSLI and CPSI staffed this case CPIT- for child death. This case was classified and substantiated. CPSLI and CPSI discussedupdating this case for review for closure. CPSI will need review notes and interviews of collateral and update dictations this weekand submit for review.

Entry Date/Time: 07/20/2016 09:48 AM Entered By:Narrative Type: Original

11/18/16 11:26 AMPage 2 ofCR - Summary 28

Case # 2016.024

Page 13: Case · Tennessee Child Abuse Hotline Summary Intake ID: Intake Taken By: Intake Date/Time: 02/29/2016 10:15 AM Track Assigned: Investigation Priority Assigned: 1 Screened By: Date
Page 14: Case · Tennessee Child Abuse Hotline Summary Intake ID: Intake Taken By: Intake Date/Time: 02/29/2016 10:15 AM Track Assigned: Investigation Priority Assigned: 1 Screened By: Date

Tennessee Department of Children's ServicesCase Recording Summary

Case Id: Case Name:

Case Status: Close Organization:

the car door and saw her son with a gunshot wound to his face. She then called her husband and then 911.

CPSI interviewed Mr. and he reported that he worked at a local Restaurant d in TN. Hestated that he returned home immediately upon being notified of the incident. CPSI noted that Mr. appeared tobe in shock as he was quiet and withdrawn,; nonetheless, Mr. continuously walked back and forth around the property tocheck on his son, as he was being cared for by a neighbor in her home.

(" brother, and cousin, were in the family's van at the time of the incident. Theywere not age appropriate to be interviewed at this time.

There are two older children/siblings in this home, (AKA: and They were at school at the time of the incident.Since they were not present they were not interviewed as witnesses.

DCS policy Work Aid 1, Child Death is defined as:Any unexplained death of a child when the cause of death is unknown or pending an autopsy report; any child death caused byabuse or neglect resulting from direct action of the parent or caretaker that resulted in the death of the child. Child deaths arealways treated as severe child abuse; any child death caused by abuse or neglect resulting from the parent or caretaker's to stopanother person's direct action that resulted in the death of the child.

The case was presented before County Child Protective Investigation Team (CPIT) on 03/16/2016. This case wasclassified as Allegations Substantiated Perpetrator Substantiated (ASPS) after it was discussed with the team that included; LawEnforcement, Juvenile court, County Children's Advocacy Coordinator, Medical staff, CPS Lead Investigator, and CPS I.

As a result of the interviews safety placements outside the home were made for the children of and Thecousin who was present was allowed to go home with her parent.

There is a preponderance of evidence to substantiate the allegation of Abuse Death due to the mother's lack of supervision in thatshe left a loaded gun in the presence of minors and as a result her 3 year old son fatally shot himself.

The case will be closed and classified as Allegation Substantiated Perpetrator Substantiated for the allegation of Abuse Death.

Narrative Type: Addendum 1 Entry Date/Time: 08/04/2016 11:54 AM Entered By:The Medical Examiner's report was completed by MD, Office of County Medical Examiner, on 3/1/2016. Theprobable cause of death was listed as "Gunshot wound to the head" and comment on the form read "shot himself while playing with agun". The body was released to funeral home on the same date of the ME's report.

11/18/16 11:26 AMPage 4 ofCR - Summary 28

Case # 2016.024

Page 15: Case · Tennessee Child Abuse Hotline Summary Intake ID: Intake Taken By: Intake Date/Time: 02/29/2016 10:15 AM Track Assigned: Investigation Priority Assigned: 1 Screened By: Date

Tennessee Department of Children's ServicesCase Recording Summary

Case Id: Case Name:

Case Status: Close Organization:

Recording ID: Status: Completed

Contact Date: 06/16/2016 Contact Method:

Contact Time: 10:00 AM Contact Duration:

Entered By: Recorded For:

Created Date: 06/20/2016

Completed date: 06/20/2016 Completed By:

Location:

Purpose(s): Service Planning,Well Being

Administrative Review

Contact Sub Type:

Case Recording Details

Children Concerning

Participant(s)

Contact Type(s):

Narrative Details

CPSLI and CPSI staffed this case upon return form leave to discuss what was needed for closure due to this case is overdue.This is a child death case and it was classified at CPIT over a month ago. This case will need to be sent to Central Office forreview prior to closure. CPSI will need to update dictations and upload all document by 6/22/16 so this can be sent for review on6/23/16.

Entry Date/Time: 06/20/2016 11:34 AM Entered By:Narrative Type: Original

11/18/16 11:26 AMPage 5 ofCR - Summary 28

Case # 2016.024

Page 16: Case · Tennessee Child Abuse Hotline Summary Intake ID: Intake Taken By: Intake Date/Time: 02/29/2016 10:15 AM Track Assigned: Investigation Priority Assigned: 1 Screened By: Date

Tennessee Department of Children's ServicesCase Recording Summary

Case Id: Case Name:

Case Status: Close Organization:

Recording ID: Status: Created In Error

Contact Date: 05/15/2016 Contact Method:

Contact Time: 08:00 AM Contact Duration:

Entered By: Recorded For:

Created Date: 07/21/2016

Completed date: 07/21/2016 Completed By:

Location:

Purpose(s): Permanency,Safety - Child/Community,Service Planning,Well Being

Notation

Contact Sub Type:

Case Recording Details

Children Concerning

Participant(s)

Contact Type(s):

Narrative Details

Please note, CPSI will be on extended medical leave during the month of May and is scheduled to return to work midJune 2016.

Entry Date/Time: 07/21/2016 11:33 AM Entered By:D.

Narrative Type: Original

Narrative Type: Created In Error Entry Date/Time: 08/03/2016 11:52 AM Entered By:Invalid entry.

11/18/16 11:26 AMPage 6 ofCR - Summary 28

Case # 2016.024

Page 17: Case · Tennessee Child Abuse Hotline Summary Intake ID: Intake Taken By: Intake Date/Time: 02/29/2016 10:15 AM Track Assigned: Investigation Priority Assigned: 1 Screened By: Date

Tennessee Department of Children's ServicesCase Recording Summary

Case Id: Case Name:

Case Status: Close Organization:

Recording ID: Status: Completed

Contact Date: 04/12/2016 Contact Method:

Contact Time: 10:00 AM Contact Duration:

Entered By: Recorded For:

Created Date: 05/02/2016

Completed date: 05/02/2016 Completed By:

Location:

Purpose(s): Service Planning,Well Being

Administrative Review

Contact Sub Type:

Case Recording Details

Children Concerning

Participant(s)

Contact Type(s):

Narrative Details

CPSLI and CPSI staffed this case. This case was presented at CPIT this month and substantiated for childneglect death where the mother was the AP. The ACV's were at one point placed with the maternal grandmother but when themother was arrested the ACV's went into DCS custody. The parents are working there plan with foster care. This is the secondtime the ACV's have been in DCS custody dealing with some of the same issues. This case need to be closed by 5/2/16.

Entry Date/Time: 05/02/2016 09:37 AM Entered By:Narrative Type: Original

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Case # 2016.024

Page 18: Case · Tennessee Child Abuse Hotline Summary Intake ID: Intake Taken By: Intake Date/Time: 02/29/2016 10:15 AM Track Assigned: Investigation Priority Assigned: 1 Screened By: Date

Tennessee Department of Children's ServicesCase Recording Summary

Case Id: Case Name:

Case Status: Close Organization:

Recording ID: Status: Completed

Contact Date: 03/17/2016 Contact Method:

Contact Time: 10:00 AM Contact Duration:

Entered By: Recorded For:

Created Date: 05/02/2016

Completed date: 05/02/2016 Completed By:

Location:

Purpose(s): Service Planning,Well Being

Administrative Review

Contact Sub Type:

Case Recording Details

Children Concerning

Participant(s)

Contact Type(s):

Narrative Details

CPSLI and CPSI staffed this case. This case is CPIT for child neglect death, LOS and due to the conditions ofthe home according to CPSI EN will need to be added. CPSI will need to update dictations, complete the FAST, SDM andestablish by 3/31/16.

Entry Date/Time: 05/02/2016 09:26 AM Entered By:Narrative Type: Original

11/18/16 11:26 AMPage 8 ofCR - Summary 28

Case # 2016.024

Page 19: Case · Tennessee Child Abuse Hotline Summary Intake ID: Intake Taken By: Intake Date/Time: 02/29/2016 10:15 AM Track Assigned: Investigation Priority Assigned: 1 Screened By: Date

Tennessee Department of Children's ServicesCase Recording Summary

Case Id: Case Name:

Case Status: Close Organization:

Recording ID: Status: Completed

Contact Date: 03/08/2016 Contact Method: Face To Face

Contact Time: 03:00 PM Contact Duration:

Entered By: Recorded For:

Created Date: 07/21/2016

Completed date: 07/21/2016 Completed By:

Location: Other Community Site

Purpose(s): Permanency,Safety - Child/Community,Service Planning,Well Being

ACV Interview/Observation,Notation,Sibling Interview/Observation

Contact Sub Type:

Case Recording Details

Children Concerning

Participant(s)

Contact Type(s):

Narrative Details

03/08/2016- and were REMOVED and placed into the custody of e Dept. due to severeallegations of Abuse Death and ongoing Environmental Neglect concerns.

The family's foster care case is assigned to FSW -

CPSI transported that family to a DCS foster home on this date at 930pm.

The pre-lim regarding the removal has been set for 03/11/2016 at 9am.

Entry Date/Time: 07/21/2016 11:26 AM Entered By:Narrative Type: Original

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Case # 2016.024

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Tennessee Department of Children's ServicesCase Recording Summary

Case Id: Case Name:

Case Status: Close Organization:

Recording ID: Status: Completed

Contact Date: 03/07/2016 Contact Method: Face To Face

Contact Time: 04:00 PM Contact Duration:

Entered By: Recorded For:

Created Date: 07/21/2016

Completed date: 07/21/2016 Completed By:

Location: DCS Office

Purpose(s): Permanency,Safety - Child/Community,Service Planning,Well Being

ACV Interview/Observation,Parent/Caretaker Interview,Sibling Interview/Observation

Contact Sub Type:

Case Recording Details

Children Concerning

Participant(s)

Contact Type(s):

Narrative Details

03/07/2016- FSTM-NCPP (03/07/2016 at 4pm)

CPSI again met with the family to include mother father MGM andthe the surviving three children, and to discuss the Non-Custodial Permanency Plan as Ms.

has been granted custody through Co Juvenile Court.

The purpose of the plan was to discuss the adequate supervision of the children while in the presence of their parents and theongoing environmental issues regarding the family's home. Additionally, ongoing counseling was established for the family toissues of separation and grief.

(ARREST of mother)

Prior to the adjournment of the FSTM, Det. arrived to report on his presentation of his investigation that was presentedto the Grand Jury & an indicted came back giving him probable cause to arrest the mother for criminally negligent homicide andchild neglect on this date.

Mom was arrested and booked on a $500,000 bond.

Entry Date/Time: 07/21/2016 11:14 AM Entered By:Narrative Type: Original

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Case # 2016.024

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Tennessee Department of Children's ServicesCase Recording Summary

Case Id: Case Name:

Case Status: Close Organization:

Recording ID: Status: Completed

Contact Date: 03/07/2016 Contact Method:

Contact Time: 09:00 AM Contact Duration:

Entered By: Recorded For:

Created Date: 07/21/2016

Completed date: 07/21/2016 Completed By:

Location: Court

Purpose(s): Permanency,Safety - Child/Community,Service Planning,Well Being

Notation

Contact Sub Type:

Case Recording Details

Children Concerning

Participant(s)

Contact Type(s):

Narrative Details

03/07/2016- Legal Advisement

CPSI met and conferred with DCS Regional Counsel to discuss the legalities of this investigation now thatthe mother has been charged in the death of three year old advised that she researched the legal casehistory regarding the family and after doing so she met with Regional Administrator, to discuss the potential fordisruption of the children as they were previously placed with maternal grandmother and there were several problems among thefamily member in which DCS had to intervene prior to the children's return to parents.

Regional General Counsel, advised that the Dept had exigent circumstance to place the three surviving siblings intothe custody of the Dept.A petition was drafted and filed by the Dept in Co Juvenile Court on this date.

Entry Date/Time: 07/21/2016 11:20 AM Entered By:Narrative Type: Original

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Case # 2016.024

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Tennessee Department of Children's ServicesCase Recording Summary

Case Id: Case Name:

Case Status: Close Organization:

Recording ID: Status: Completed

Contact Date: 03/04/2016 Contact Method:

Contact Time: 08:00 AM Contact Duration:

Entered By: Recorded For:

Created Date: 07/21/2016

Completed date: 07/21/2016 Completed By:

Location:

Purpose(s): Permanency,Safety - Child/Community,Service Planning,Well Being

Notation

Contact Sub Type:

Case Recording Details

Children Concerning

Participant(s)

Contact Type(s):

Narrative Details

03/04/2016- Notation

Funeral Services of was observed on this date. On this same date the maternal grandparents were awardedcustody by Co Juvenile Court.

CPSI and DCS General Counsel met to discuss and plan of action regarding the legalities of thisinvestigation, mainly the ongoing criminal legalities of his investigation and how this could possibly affect the current case plan ofaction regarding the children/family.

Entry Date/Time: 07/21/2016 11:12 AM Entered By:Narrative Type: Original

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Case # 2016.024

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Tennessee Department of Children's ServicesCase Recording Summary

Case Id: Case Name:

Case Status: Close Organization

Recording ID: Status: Completed

Contact Date: 03/02/2016 Contact Method: Face To Face

Contact Time: 11:00 AM Contact Duration:

Entered By: Recorded For:

Created Date: 07/21/2016

Completed date: 07/21/2016 Completed By:

Location: DCS Office

Purpose(s): Permanency,Safety - Child/Community,Service Planning,Well Being

Sibling Interview/Observation

Contact Sub Type:

Case Recording Details

Children Concerning

Participant(s)

Contact Type(s):

Narrative Details

Date: 03/02/2016Time: 11aType of Contact: Sibling InterviewLocation of Contact: DCS OfficePrimary person(s) to be interviewed and relationship: " sibling

CPSI spoke with whom is referred to by the family as " appeared quite as he reported that he wasaware that his "baby brother" had died and he was sad about it. stated that he was happy at home and that his parents oftendid fun things together like play outside, take care of their pets, and play video games.

reported that knew his parents owned a gun but that neither he nor his siblings were ever allowed to pay with the gun.

When asked about if he helped to keep his room clean, he stated that their home was messy because the family had recently hadrelative over and they played most of the time leaving "a mess" for his mother to clean.

had no visible marks or bruising.

Date: 03/02/2016Time: 11aType of Contact: Sibling InterviewLocation of Contact: DCS OfficePrimary person(s) to be interviewed and relationship: /sibling

a small child for her age did not sit to speak with worker. CPSI sat with while she played with the toys inthe play room. She repeatedly told worker that her birthday was coming soon and she wanted a "cell phone" for her birthday.

had no noted marks or bruising.

Entry Date/Time: 07/21/2016 11:08 AM Entered By:Narrative Type: Original

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Case # 2016.024

Page 24: Case · Tennessee Child Abuse Hotline Summary Intake ID: Intake Taken By: Intake Date/Time: 02/29/2016 10:15 AM Track Assigned: Investigation Priority Assigned: 1 Screened By: Date

Tennessee Department of Children's ServicesCase Recording Summary

Case Id: Case Name:

Case Status: Close Organization:

Neither nor gave any disclosure of abuse.

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Case # 2016.024

Page 25: Case · Tennessee Child Abuse Hotline Summary Intake ID: Intake Taken By: Intake Date/Time: 02/29/2016 10:15 AM Track Assigned: Investigation Priority Assigned: 1 Screened By: Date

Tennessee Department of Children's ServicesCase Recording Summary

Case Id: Case Name:

Case Status: Close Organization:

Recording ID: Status: Completed

Contact Date: 03/01/2016 Contact Method: Face To Face

Contact Time: 11:30 AM Contact Duration:

Entered By: Recorded For:

Created Date: 07/21/2016

Completed date: 07/21/2016 Completed By:

Location: DCS Office

Purpose(s): Permanency,Safety - Child/Community,Service Planning,Well Being

Notation,Parent/Caretaker Interview

Contact Sub Type:

Case Recording Details

Children Concerning

Participant(s)

Contact Type(s):

Narrative Details

A CFTM was held on 3/1/2016.

CPS Allegation: Abuse Death, Environmental Neglect and Lack of SupervisionRisk and Safety Level: HighRecommendations to Decrease or Alleviate Risk: Immediate removal of the surviving children from the home of and

Continue to cooperate with law enforcement in concluding the criminal investigation as it relates to the currentinvestigation.

FSW facilitated the initial CFTM on behalf of and.

In attendance were mother father MGM MGF Neighbor PGM PMG TL TL CPSI and of

placement.*Ground Rules were established and the Tenn Care Appeals Rights were explained and given to the parents.

Issue Addressed:Abuse Death as well as CPSI observation of the current deplorable conditions of the home as the children waspreviously in DCS custody for the same allegations of Environmental Neglect.

This family has an extensive history with DCS and the three older children were in custody about 3 years ago due to theenvironmental conditions of the home. It was stated that was the TL and was the FSW at that time.

The current investigation brought the family back to the attention of CPS due to 3 year old shooting and killing himself whilesitting in the family van at the family home. The incident took place 2-29-16.

CPSI also informed the team that the family home has severe environmental neglect issues. CPSI describedthe home as having a terrible odor of feces and urine. Animal feces were found in the floor. Toys and dirty clothes wereeverywhere.

Entry Date/Time: 07/21/2016 11:07 AM Entered By:Narrative Type: Original

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Tennessee Department of Children's ServicesCase Recording Summary

Case Id: Case Name:

Case Status: Close Organization:

CPSI presented pictures of the kitchen with dirty dishes all over, trash in the floor, old food left on counter tops and allaround the house.

CPSI reported that she kept seeing piles of berries in the floor throughout the home only to discover that was piles ofgoat feces all over. There were 4 baby goats inside the home, several puppies, 2 dogs, 1 cat and 1 iguana.

Animal control had to be called to the home to remove 2 dead pigs from the yard that had been there for several days. This courseof action was also needed during the first custody episode due to the living conditions of the animals the family owned at that time.

It was confirmed that parents didn't comply with CPS/DCS to keep the home clean and free of environmental hazards to keep thechildren safe as established during their initial exit from custody in 2013.

CPSI reported the death of 3 year old concerns for the health, safety and wellbeing of the other children, lack ofsupervision and severe environmental neglect as the major factors in this case.

A&D:The parents denied using or being addicted to alcohol or drugs but weren't tested during the CFTM to confirm.

Medical:Mrs. reported that her children are overall healthy and only has allergies to eggs and takes Zyrtec at night.Mrs. described as being slightly overweight.The other children are without medication or known health related issues.The children attend Peds for primary care and Art of Dentistry for dental care.

Mental Health:The mother informed the team that she has anxiety and panic attacks. She was prescribed Ativan but hadn't taken any lately untillast night when she took one.The mother has no mental health provider or receives counseling.The father denied having any mental health concerns.

Domestic Violence:The parents have a history of domestic violence and were recommended to having domestic violence counseling to address theirissues during the first custody episode.Mr. was also indicated by CPS for physically abusing 10 year old " when he was younger. birth father, was also indicated for physically abusing him.

is described as very quiet and withdrawn.

Education: attends Elem. as a 4th grader. He is a regular education student but behind a grade level.

attends Elem. as a kindergarten student.

The younger children don't attend daycare or preschool.

/neighbor who is also a teacher at Elementary is a support to the family and described the situation as heartwrenching. Ms. stated that she wanted to do something to help so she agreed to have the 4 remaining children to resideat her home last night.She stated that she could keep them as long as needed. She stated that the mother stayed with her last night in trying to comfortthe children and get them to rest and sleep.

She also stated that the children attended school daily; they were always clean and nicely dressed. She stated that the childrenare well behaved and very sweet and good kids.

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Tennessee Department of Children's ServicesCase Recording Summary

Case Id: Case Name:

Case Status: Close Organization:

The MGF, informed the team that he was willing to care for the children but the animals could not come into hishome.

MGM also informed the team that the children were placed with her for about 6-8 months during their first custodyepisode. Ms. has since suffered a stroke and doesn't drive. She may not be able to care for the children physically.

Information was taken on all relatives and friends in attendance.

Notation:Immediately after the meeting CPSI consulted with legal regarding the decision to take custody.

It was determined that MGM or MGF, would petition for legal custody.

CPSI was also advised the family and potential petitioners that the mother, would not be able to live in thehome of either MGM or MGF if the children were placed there.

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Case # 2016.024

Page 28: Case · Tennessee Child Abuse Hotline Summary Intake ID: Intake Taken By: Intake Date/Time: 02/29/2016 10:15 AM Track Assigned: Investigation Priority Assigned: 1 Screened By: Date

Tennessee Department of Children's ServicesCase Recording Summary

Case Id: Case Name:

Case Status: Close Organization:

Recording ID: Status: Completed

Contact Date: 02/29/2016 Contact Method:

Contact Time: 01:00 PM Contact Duration:

Entered By: Recorded For:

Created Date: 03/05/2016

Completed date: 03/25/2016 Completed By:

Location:

Purpose(s): Safety - Child/Community

Notation

Contact Sub Type:

Case Recording Details

Children Concerning

Participant(s)

Contact Type(s):

Narrative Details

Environmental Neglect Observations:

Upon arriving to the home on the family home, which is a two bedroom trailer, with a largeyard and long gravel driveway, CPSI observed several types of animals roaming the yard and coming in and out of thehome. To the left of the drive and close to the home there was a small pin that had a rotting smell coming from it. CPSI observed two small pigs which have expired and had flies around them. The sidewalk to the front door was covered in goat fecesbecause the family owns more than 4 goats (just born and adult). The goats were observed walking in and out of the home asCPSI entered the home. A small baby goat was free to run in the home as well. Other animals included chickens androosters, an iguana in an aquarium tank, cats, and dogs.

Other observations from this home included at least one used diaper in the floor in the living room, clothes, animal beds, and othertrash items were littered on the floor in all rooms of the home. There was a strong animal urine smell, however, due to thecircumstances the family suggested that the animals had been locked inside for the majority of the day. The general cleanliness ofthe home, including dirt and trash, was poor.

Animal Protection Services were contacted by police (complaint number: ) and and decided to let them take many of their animals since they were becoming an environmental issue for their children to live in.

Due to the above aforementioned conditions of the home CPSI contacted, Lead Investigator After discussinginvestigative findings, it is apparent that the home is not suitable for the surviving siblings.

This decision was immediately communicated to the parents.

Together, CPSI and the parents developed an Immediate Protection Agreement (IPA) with a long timeneighbor and teacher at the older children's school, Elementary. Mrs. who happened to be home sick on this datehas been caring for Jr as law enforcement and Office of Child Safety complete their

Entry Date/Time: 03/05/2016 02:45 AM Entered By:Narrative Type: Original

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Tennessee Department of Children's ServicesCase Recording Summary

Case Id: Case Name:

Case Status: Close Organization:

initial investigative tasks.

IMMEDIATE PROTECTION AGREEMENT (IPA)

With the directive of DCS attorney an IPA was developed to ensure the safety and protection of the surviving childrenresiding in the home. The IPA is handwritten in detail to be uploaded into TFACT prior to the completion of thisinvestigation.Mrs. neighbor has agreed to provide the care and supervision of the children until a formal Child and Family Team(CFTM) meeting can be held with the family and their support team.

*After conferring with all parties involved the CFTM has been scheduled for 1:30p on 03/01/2016 in the Office of ChildSafety's local office (

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Tennessee Department of Children's ServicesCase Recording Summary

Case Id: Case Name:

Case Status: Close Organization:

Recording ID: Status: Completed

Contact Date: 02/29/2016 Contact Method: Face To Face

Contact Time: 12:30 PM Contact Duration:

Entered By: Recorded For:

Created Date: 03/04/2016

Completed date: 03/25/2016 Completed By:

Location: Family Home

Purpose(s): Permanency,Safety - Child/Community,Service Planning,Well Being

Alleged Perpetrator Interview,Parent/Caretaker Interview

Contact Sub Type:

Case Recording Details

Children Concerning

Participant(s)

Contact Type(s):

Narrative Details

Date: 02/29/2016Time: 12;30pType of Contact: Parent Interview/alleged Perp InterviewLocation of Contact: Family's home/Primary person(s) to be interviewed and relationship: motherOther persons present at the contact and relationship: father

Content and Observations:CPSI approached mother as she sat on the ground still covered in blood. Mrs. who had just beennotified that her son had been pronounced dead upon arrival to Hospital prior to being introduced to worker by Det

was clearly upset as she was shaking and crying while chain smoking cigarettes. CPSI immediately offered thismother her condolences, and tactfully explained the Dept role in what is a joint investigation with law enforcement official(s) withthe Co Sheriff Dept. to ensure the safety of all involved.

Mrs reported that she had returned home from dropping her husband, off at work at in the area of Co. Mrs. reported that she had gotten an "upsetting" phone call from her brother. Mrs.

whom reports, she "does not like to argue in front of her kids" stepped out of the car to complete her phone call with herbrother. She stated that within minutes she heard a load noise and upon opening the door to her vehicle she discovered her youngson age three, with a gun shot wound to his face. Mrs. stated that she called her husband then called 911.

(Interview with , Sr)Mr. reported that he worked at a local located in He stated that he returned home immediately uponbeing notified of the incident.

CPSI noted that Mr. too appeared to be in shock as he was quite and withdrawn, nonetheless, Mr. continuously walked back and forth around the property to check in on young as he was being cared for by a neighbor inher home.

Entry Date/Time: 03/04/2016 11:47 PM Entered By:Narrative Type: Original

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Tennessee Department of Children's ServicesCase Recording Summary

Case Id: Case Name:

Case Status: Close Organization:

Parents reported that their two older children, whom the family calls " and were at school at the time of theincident.

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Case # 2016.024

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