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The toddler at the heart of a Luzerne County Children and Youth licensing downgrade died of bleeding in the brain, a newly-obtained state report shows.The state Department of Human Services report, which identifies the victim as 21-month-old Anthony Puscavage, said the maternal grandmother who had custody of the child attributed his injuries to a fall from the couch and/or banging of his head when he had temper tantrums.The medical professionals who treated Puscavage that day said neither explanation was plausible, according to the report, which is part of a review required by state law in all suspected child abuse cases that result in fatalities or near fatalities.The report did not name other family members.Another state summary of the case that did not identify Puscavage by name says the 21-month-old died as a result of physical abuse and indicated the state Department of Human Services Office of Children, Youth and Families determined the child&#8217;s maternal grandmother was the &#8220;perpetrator.&#8221;This summary said the toddler was taken by ambulance to Geisinger Wyoming Valley Medical Center in Plains Township on Jan. 11 after being found unresponsive in the grandmother&#8217;s home.The child had what appeared to be burn marks on his legs, different stages of bruising on his back, bruises on his head, a blown-out pupil and scratches on his face. A hospital scan showed old and new brain bleeds. The child underwent surgery to remove blood clots from his brain and died in the operating room.Seeking answersCathleen Palm, of The Center for Children&#8217;s Justice, said Wednesday she is trying to find out why nobody was charged because the state report provides a detailed description of injuries. The state report said the manner of death was ruled accidental.&#8220;There are still pieces of the puzzle that are missing to really understand what happened in this case and how different key parties arrived at very different decisions about this child&#8217;s death,&#8221; said Palm, who targets child abuse through the Bernville, PA-based organization.&#8220;When you look at the state report, you get a strong sense that there was no question this was physical abuse,&#8221; she said.County Coroner William Lisman said his office investigated the case along with the county district attorney&#8217;s office and Plymouth Police Department.&#8220;An autopsy was performed, and the final manner of death was ruled an accident. As far as the coroner&#8217;s office is aware, the case is closed,&#8221; Lisman said.County District Attorney Stefanie Salavantis could not immediately be reached for comment Wednesday.Lisman was not aware of the state reports but said a thorough review was completed after the child&#8217;s death.&#8220;We base our determinations on the best information we have at the time and are always willing to reopen an investigation if new information is provided,&#8221; Lisman said. &#8220;Death certificates can always be amended with new information.&#8221;The toddler&#8217;s death and another case where seven siblings were relocated to another county with their mother instead of placed in foster care here as recommended prompted the state to conduct a series of inspections that led to the agency&#8217;s downgrade to a provisional license through at least March 2016.The state said its review revealed &#8220;some serious concerns&#8221; in agency practice and regulatory violations.Case detailsAccording to the state summary regarding the 21-month-old:The boy and his sibling were residing with the maternal grandfather and step-grandfather since November 2014, when both were removed from their parents&#8217; care.The parents had been investigated by Children and Youth between October 2010 and January 2014 due to referrals involving two older half-siblings. These allegations were deemed unsubstantiated, though the parents participated in a parenting program.Another referral in March 2014 prompted Children and Youth to conduct ongoing investigations that led to the November 2014 placement of the boy and his sibling with the maternal grandparents. The two half-siblings were in the custody of the grandparents at that point.The complaints about the parents included the condition of their home, their partying and allowing people to stay at their house drinking and playing loud music, fighting between the mother and father, developmental delays of the children, inappropriate dressing of the children and the children&#8217;s frequent illnesses.The state report cited the county&#8217;s failing to check the background of the maternal grandmother before the boy and his sibling were placed in her care. Information in agency case files and historical knowledge of experienced caseworkers and supervisors &#8220;would raise question as to the maternal grandmother&#8217;s ability to safely care for the children as an approved kinship caretaker.&#8221;During the state investigation, it was determined the boy&#8217;s surviving sibling had a fractured clavicle and lower back bruising, and neither grandparent could provide an explanation for these injuries. Both caregivers were found to be responsible for the sibling&#8217;s injuries.The surviving sibling and two half-siblings were placed together in a foster home after the boy&#8217;s death.The parents are working with county Children and Youth to regain custody of the youngest surviving child.Services are being provided to the maternal grandmother and maternal step-grandfather to determine if the older half-siblings can return to their care.Workers updatedCounty Manager Robert Lawton sent county council members an email Friday with the text of a memorandum county Children and Youth Services Director Krista McIlhaney issued to her staff.The provisional license allows the agency to continue full operation, and the agency has implemented a corrective action plan of program and operational changes to address concerns, she said. The state will work with the county to ensure it meets all licensing criteria, she said.The agency &#8220;welcomes&#8221; the state scrutiny, which will include frequent reviews and random checks of documentation and compliance with protocols and procedures, she wrote.&#8220;County management fully recognizes how difficult a job the employees of Luzerne County Children and Youth Services have and understands the challenges with which they are presented each day. Children and Youth Services will take full advantage of the state&#8217;s support during this process, which will ultimately make the agency an even stronger organization,&#8221; she wrote.<div class="metaInfo"><bylineMeta>By Jennifer Learn-Andesjandes@www.timesleader.com</bylineMeta></div><div class="metaInfo"><shirttailMeta>Reach Jennifer Learn-Andes at 570-991-6388 or on Twitter @TLJenLearnAndes.</shirttailMeta></div>

Details emerge about deceased toddler in Luzerne County Children and Youth case