Regulation 23 — Safeguarding health, safety and welfare of child
Safe Sleep: 1. Safe sleep practices were not always implemented in the Preschool room in-line with Tusla’s safe sleep guidelines for children under 24 months. • A child under 24 months was placed to sleep on a floor mat. This is at variance to the guidelines which outline the required sleep equipment for children under 24 months. • A sleep plan was not in place for this child. This is at variance to the guidelines that state a child can sleep in an approved alternative to a cot provided it is agreed with parents, and a sleep plan is established and signed. Action submitted by the Registered Provider
Provider's corrective action:
Safe Sleep: 1. The registered provider stated individual sleep assessments have been compiled in light of the recent inspection in line with the Tusla Early Years Inspectorate Guidance for Early Learning and Care Sector on Sleep Provision for Children Under 24 months. This has been shared with staff to view and familiarise themselves with along with a PDF copy of the guidance document. Sleep pods have been purchased in order to support sleep time in the preschool room in line with Tusla Guidance. As a preventive action the registered provider will ensure staff and management follow the Guidance for Early Learning and Care Sector on Sleep Provision for Children Under 24months. A discussion with staff took place in relation to sleep times and how we will implement new sleep assessments for children attending the service in line with guidance
Immediate action notice. 20/06/24 An Immediate Action notice was issued to the service in relation to the following:
Regulation 16 — Record in relation to pre-school service
(j) On review of two available medicine administration records, information was missing on one form. • The amount of medicine administered to the child was not recorded. • The surname of the child was missing. • Parent pre-consent signature on the medication administration form was missing. (k) On review of 10 accident and incident forms information was missing as follows: • The surname of the child was missing on two forms. • Date of birth of the child was missing on four forms. • The date of the parent’s signature was missing from two forms
Provider's corrective action:
(j) A staff meeting was held with all staff and Senior Management around the process of completing Medical Administration Forms and all staff assured management that in going forward the correct process would be followed which included the form to be as accurate as possible and factual. If a child has a temperature this should be recorded accurately on the medical administration form and be re- checked accordingly, the staff nurse should be phoned and the child’s parent informed. The manager/senior staff will do checks on all forms and re-check forms to ensure completion of each form is fully complete. The preventative action going forward will be; 1. Ongoing staff discussions and supervision in regard to the importance of the accuracy when completing forms. 2. Regular staff Meetings. 3. Template forms have been provided to guide staff and set the expectation in recording information diligently going forward. 4. Policies and Procedures to be followed at all times. 5. Checks to be provided regularly by management team in relation to staff recording accurate information and data of children. (K) 1. All Accident and Incident forms have been updated and correctly amended. 2. The process of filling Accident/Incident Report forms correctly was discussed thoroughly with staff. Each staff member was encouraged to fill in a template form to ensure they understand the process and demonstrated competency in relation to accurate recording of information. 3. All staff have been asked to read and sign off on the Accident and Incidents policy. 4. The service record accidents and incidents internally through our online network system and through manually recorded forms- the accident and incident book. All accidents and incidents are stored and reviewed by the Board and the senior management teams every 3 months. In relation to manually recording, staff are reminded to ensure all accidents/incidents forms are completed with diligence and are presented to management team upon completion. 5. The policy in relation to Accident/Incidents has been reviewed by staff and expectations for recording of information has been explained and supported through; discussions, supervision meetings and by providing templates as a future reference. 6. The management team will not sign off on accident/incident forms that are incomplete. Supporting Documentation Submitted (j) Photographic Evidence and copy of Medication Management Policy. (k)Photographic Evidence Summary Comment Under Regulation 16, the non-compliances outlined above have been addressed
Regulation 23 — Safeguarding health, safety and welfare of child
General Safety: 1. The temperature of the baby care room and baby cot room was not maintained within the recommended temperatures. It is acknowledged that it was a warm day and staff had ensured that the care rooms windows were open and on discussion with the inspectors, at 10.54am, the deputy designated person in charge requested a staff member to introduce a small air conditioning unit, this was in place at 10.56am. Temperatures recorded were as follows: Room Time Air Temperature Recommended Temperature Baby Cot room @10.53am 23.8 0C 16 to 20 0C @11.05am 22.2 0C 16 to 20 0C @11.26am 24.1 0C 16 to 20 0C @12.31pm 23.00C 16 to 20 0C Baby room @10.51am 24.0 0C 18 to 22 0C @11.12am 23.5.0C 18 to 22 0C @12.34pm 25.3 0C 18 to 22 0C Preschool room @11.36 am 24.5oC 18 to 22 0C @11.49am 24.9oC 18 to 22 0C An Immediate action Notice was issued for warm temperatures. 2. Garda vetting was available for nine staff members. However, for one staff member, their vetting disclosure was not dated within the previous three years in adherence to with the Early Years Inspectorate Regulatory Notice ‘EYI-RN12.3 Renewal of Garda Vetting. 3. The kitchen area was open and accessible to the children, at 10.07am the inspectors observed the door of the kitchen open and two children were in the kitchen with one staff member, posing a risk of injury. 4. In the Baby room cot room, two uncovered foam mattresses used by children attending the service were observed to be unsuitable as no safety label was present, leading to a risk of safety. 5. The finger guard on the door of the Baby room was broken, leading to a risk of injury. 6. In the Baby room sanitary facility, there was an unstable shelf, leading to a risk of injury. 7. In the outdoor garden area, a broken play kitchen, broken plastic watering can, a broken wooden bridge and litter were present, leading to a risk of safety. Infection Control: 8. In the Baby room, bottles of infant formula milk for three babies were not refrigerated and were stored at room temperature in the care room, leading to poor infection control. 9. In the Preschool room, handwashing was not completed, leading to poor infection control, for example. o at 11.36am after outdoor play o at 11.56am the inspectors observed two children taking objects out of a lidded pedal bin. While it acknowledged that staff invited them to wash their hands, this guidance was not followed through and the two children did not wash their hands. 10. In the Preschool sanitary facilities, the toilet paper was not stored in a holder and was observed to be sitting the back of the toilet, making it difficult for the children to access, leading to poor infection control. Safe Sleep: 11. In the Baby room cot room, a sleeping baby under the age of one years old was observed to sleep with outer clothing and socks on, while lying on a fleece blanket with a cellular blanket over them, this leads to a risk of overheating and is at variance with best practice guidelines. 12. In the Baby room, a pillow was present on one cot, which on discussion with staff, it was confirmed it was used for one baby under the age of one year old. This is at variance with best practice guidelines and could lead to a risk of suffocation. Action submitted by the Registered Provider
Provider's corrective action:
General Safety: 1. Actions taken in response to Immediate Action Notice, taken by the service: • All staff have been provided with Tulsa’s Guidance Document for Early Years Services ‘Keeping Children Safe During Hot Weather’. • An education session will be held by the Early Years Manager and Team Leader on Monday 24 th of June 2024 on the importance of ensuring temperatures are within the required range of 16 – 20 degrees in sleep areas and 18 -22 degrees in all other areas. The education session will be based on Tu sla’s Regulatory Framework, Tusla’ s Guidance Document for Early Years Services ‘Keeping Children Safe During Hot Weather’ and the HSE ‘Safe Sleep for Your Baby’ Guidelines. • Training has been scheduled on Safe Sleep for all childcare staff with an external company . • Thermometers are installed in each room within the creche service. Staff will continuously monitor the temperature within the service in each room to ensure the temperature is within the required range. On the sleep sheet, staff will record the room temper ature every two hours during creche operational hours. Where temperatures are exceeding the required temperature, children will be removed from the service. • As a temporary cooling measure, a H EPA Filtered Cooling System has been purchased for the Creche Services in Ashleigh House. In addition to the HEPA Filtered Cooling System, an air conditioning unit will be installed as soon as possible. Air conditioning companies were contacted on the 21/06/2 024 and will be visiting Creche Services to review the specifications required. Two suppliers will visit the creche services on the 21/06/2024 and will provide a quote by end of business 21/06/2024 and 2 additional suppliers will provide a quote by Tuesday 25/06/2024. • Ashleigh House Creche Services will follow Tu sla’s Guidance Document for Early Years Services ‘Keeping Children Safe During Hot Weather’. Where there are periods of warm weather, in addition to ensuring room temperatures are within the required range, Ashleigh House Creche will: • Ensure that children are hydrated, ensuring that children and babies receive enough fluids and that cold drinks are readily available and frequently offered and encouraged. • Open windows before children arrive to service, allowing stored heat to escape from the windows. • Monitoring of cot room temperature every ten minutes when children are sleeping. • Ensure children do not sleep in direct sunlight. • Ensure children sleep in light clothing and bedding. • Ensuring children’s safety when playing outdoors in warm weather, by following Tusla’s Guidance Document ‘When the roof is the sky’ for services operating outdoors. • Taking regular breaks from the sun when playing outdoors. Follow up actions: • As a temporary measure to control the room temperature, cooling air conditioning units were used in the Baby Room to ensure the correct temperature levels were recorded and maintained in line with regulatory requirements. This effectively reduced the temperature of the sleep room to safe temperatures. • As a permanent action, the service requested additional funding from our Board of directors. This has resulted in the installation of an air conditioning unit for baby’s sleep room. Consequently, the sleep room has been effectively cooled and safe sleeping temperatures maintained. • All staff have been provided with Tulsa Early Years Inspectorate “Keeping Children Safe During Hot Weather” (TUSLA, 2023). When there are periods of warm weather all staff will ensure: - Ensure that children are hydrated, ensuring that children and babies receive enough fluids and that cold drinks are readily available and frequently offered and encouraged. - All staff will open the windows before children arrive to the service, ventilating the rooms adequately and allowing stored heat to escape. - Monitoring of cot room temperature every ten minutes when children are sleeping. - Ensure children do not sleep in direct sunlight. - Ensure children sleep in light clothing and Cellular blankets are provided to all children. - Ensuring children’s safety when playing outdoors in warm weather, by following Tusla’s Guidance Document ‘When the roof is the sky’ for services operating outdoors. - Taking regular breaks from the sun when playing outdoors and providing adequate shade on hots days. • Additionally, staff have engaged with an information session, facilitated by the management team on Monday 24th of June 2024. This information session aimed to educate staff further on maintaining safe temperatures in the provision and highlighted staff responsibilities in relation to reporting hazardous temperatures to the management team, on a consistent and ongoing basis. • The following frameworks and documents have shared with staff and can be accessed in the service as reference going forth. This includes: - Tusla Early Years Inspectorate Quality and Regulatory Framework Full Day Care and Part-time Day Care Service - Tusla Early Years Inspectorate, Guidance for the Early Learning and Care Sector on sleep provision for children under 24 months - Tusla Early Years Inspectorate, Keeping children Safe During Hot Weather. - HSE ‘Safe Sleep for Your Baby’ Guidelines. - will be all available for staff to reference on a ongoing bases. • Training has been scheduled on Safe Sleep for all childcare staff with an external provider. • Thermometers are installed in each room within the childcare provision. Staff will consistently monitor the temperatures in the children’s room. Temperatures exceeding the recommended 16 – 20 degrees (sleep room) and 18-22 degrees (children playroom), will be reported to the management team in a timely fashion. • The sleep sheet staff will record the room temperature when placing a child down to sleep and will be monitored every ten minutes while the children are sleeping. 2. The staff members Garda Vetting was renewed in line with regulations. Human Resource Department and the Early Years team will ensure all Garda Vetting is updated and renewed every three years of service in the setting. 3. A lock has been secured and fitted on the kitchen door to ensure children do not have access to the kitchen area. Staff will ensure that the latch is always locked, minimising access to kitchen area and eliminating unnecessary exposure to identified risks and hazards. Lock fitted on kitchen door, staff to supervise access to the room and ensure the lock is secured, at all times. 4. Two new cot mattresses were purchased for the cots in the Baby Room. Both are adequately labelled with safety tags in place. The management team will implement a bedding audit to ensure all sleeping equipment such as, blankets, sheets, mattresses and mattress covers are numbered and itemised going forward. Staff will implement daily checks every am and pm to ensure the correct cot mattresses are present with safety labels visible. Mattress protectors have been purchased for each of the individual cots and will checked on a daily basis. 5. A new finger guard was purchased and fitted on the door in the baby room to replace the old damaged fingerguard. All accessible doors will be fitted with finger guards and checked on a daily basis. All staff will report to management when fingers guards are identified to be damaged or faulty. 6. The shelf has been removed from the bathroom, a new changing unit was fitted, and we now have a communal changing area for the preschool and baby room. The Baby changing room is now used as a staff bathroom, shelf removed. 7. The items were removed from the garden. Our caretaker will do a daily morning check to ensure hazards are identified and dealt with and litter is removed prior to the children accessing the service. The grounds caretaker will implement a risk assessment/check every morning prior to the children’s arrival. All identified risks and hazards will be dealt with in line with health and Safety policy and reported to the management team daily. Staff will ensure all hazards identified during the children’s sessions are removed and dealt with in a safe, timely manner and in-line with our Health and Safety Policy. Infection Control: 8. The baby room and preschool room have been equipped with a fridge, ensuring safe storage of formula milk. In addition to this, all formula is stored and clearly labelled with the child’s name. To support this, parents will be expected to place their child’s bottle in their allocated container, located in the baby room fridge. The infection control policy and infant feeding policy has been reviewed by all staff and will be monitored by spot checks, facilitated by management team on a regular basis. The infection control Policy will be reviewed yearly and updated in light of new recommendations and requirements. A baby room fridge has been installed and will be maintained in accordance with the Infection control and Infant Feeding policy. All staff will be responsible for ensuring their key children are adequately resourced for the day. This includes, checking the child’s bottles and ensuring there are ready to warm, clearly labelled and stored using robust systems to prevent poor infection control and feeding practices. 9. All staff members were given a copy of the Infection Control Policy to review in their non-contact and staff team meetings. The HSE’s handwashing technique is displayed in the bathroom area along with Safe Food’s “Wash your hands with Rufus”. All staff are to be observed maintaining good hygiene rituals and routines throughout the day and when required. Additionally, all staff are expected to follow hand washing protocols displayed in the Infection Control Policy. 10. A toilet roll holder was purchased and fitted in the bathroom to promote independence and reduce the risk of poor infection control. Ensure there is an adequate toilet roll holder in the bathroom at all times to support the children with this process. In addition to this, ensuring the toilet roll holder accessible for the children at all times. Safe Sleep: 11. All staff have recently completed Safe Sleep training and have access to always ensure the follow best practice guidelines outlined in the “Tusla Early Years Inspectorate, Guidance for the Early Learning and Care Sector on sleep provision for children under 24 months and “Safe Sleep for Your Baby” (HSE Guidelines). The Safe Sleep Policy was discussed at length during staff supervision meetings and their roles and responsibilities outlined clearly. In addition to this, all staff are asked to ensure they fully understand their roles and responsibilities in relation to maintaining Safe Sleep practices/regulations for each child. To ensure Safe sleep training is provided to all staff on a regularly basis. This will be supported through the HR training matrix. Refresher training will be implemented for identified staff on an ongoing basis. Management will supervise safe sleep practices and any identified gaps in practice will be supported through supervision and appraisal systems. 12. A Staff Meeting was held where we discussed at length the policies and guidelines in relation to Safe Sleep. Staff are requested to ensure pillows are for children over the age of one years old. In addition to this staff engaged with: - Revising the Policy for Safe Sleep - Revising Tusla Early Years Inspectorate Quality and Regulatory Framework Full Day Care and Part-time Day Care Service and Tusla Early Years Inspectorate, Guidance for the Early Learning and Care Sector on sleep provision for children under 24 months and, HSE ‘Safe Sleep for Your Baby’ Guidelines. Training was provided to all staff, management will monitor to ensure best practice is followed in relation to Safe Sleep