Regulation 19 — Health, welfare and development of child
1. The registered provider did not ensure that the care practices around sleep for younger children were suitable for their individual needs, and practices varied from the service Policy on Sleep, for example. • Staff in Wobbler room 1 did not respond in a timely manner to children’s sleep cues; Between 11:03am and 11:53am two children were observed crying, rubbing their eyes and appeared tired. One child refused to eat dinner during this time. Staff acknowledged the children were tired however they did not respond appropriately, and the children were not put to bed until 11:59am. A delay in recognising and responding to children’s sleep cues can cause upset for young children. • A child who had been placed to sleep was awoken and brought to the care room to receive prescribed medication as it was not administered prior to the sleep routine having commenced. This did not adequately ensure the sleep needs of the child were met while also posing a risk of a potential medication error or missed dose. 2. Staff did not adequately manage transitions in the service, for example. • Children in Wobbler 1 were observed to sit at the tables in preparation for dinner at 11.22am. The meal arrived in the room at 11:29am and was not served to the children until 11:35am. During this time children were observed to show an interest in the food, getting off their chairs, pointing to the food and becoming vocal. Transitions should be managed appropriately to prevent long periods of waiting for children. • A child was observed to arrive in the service during the transition from dinnertime to sleep. Due to the busyness of the room at that time, the child did not have adequate support to settle into the service and was observed to become upset. Although the service followed its settling in policy the timing of the arrival during a busy period was no conductive to ensuring a relaxed transition into the care room
Provider's corrective action:
1. The registered provider has ensured that management will provide support and monitor transition times daily. Communication boards have been commenced within the care room. 2. The registered provider has stated that a team meeting was held to re-educate staff on quality care practices to include transitions and daily care needs within the centre. The manager will continue to review settling in times for new families in a partnership approach. Communication boards have been commenced within the care room and a revision of policies undertaken
Regulation 23 — Safeguarding health, safety and welfare of child
Infection Control: 1. Effective handwashing technique was not consistent across the service. For example, in Wobbler Room 1: • Not all children’s hands were not washed in a timely manner upon return from outdoor play. • Staff were inconsistent in washing their hands after nappy changing. • Staff were not noted to wash their hands between cleaning table surfaces, soothing children and giving medication. It is acknowledged that gloves were used during these practices however effective consistent handwashing practice is necessary to prevent the risk of cross contamination and therefore the risk of infection. Safe Sleep: 2. The registered provider did not ensure adequate completion of the required paperwork in relation to children aged under two years of age who have transitioned to a low-level bed in line with Tusla’s “Guidance for the Early Learning and Care sector on sleep provision for children under 24 months”. The following was observed; • Individual sleep care plans were available for two children under 2 years old who had transitioned to a low-level bed however the plan did not clearly identify how the service established that the children were developmentally ready to move from a cot to a low-level bed in line with the guidance. Children should only be considered for transition to a low-level bed once the service has identified clear developmental markers that suggest the child is developmentally ready to transition. • Appropriate risk assessments detailing the potential risks to the children sleeping on low level beds were not available. It is acknowledged that while risk assessments were available for these two children these assessments did not detail any identified hazards or risks to the children while sleeping in a low bed. Detailed risk assessments must be carried out in line with the guidance detailing both the identified risk to the child from sleeping in a cot but also the risk posed when the child sleeps in equipment other than a cot. Action submitted by the Registered Provider
Provider's corrective action:
Infection Control: 1. The registered provider has ensured that management have undertaken handwashing re-education with staff to include effective handwashing and hygiene practices, practical demonstrations were also undertaken. Management will monitor handwashing. Safe Sleep: 2. The registered provider has ensured that all children less than two years have access to a cot, with a consideration being given for risk assessments for children less than 2 years requiring a low-level bed
(4) Evidence was not available to show that a qualification held by one staff member was deemed eligible by the Department of Children and Youth Affairs
Provider's corrective action:
(4) The staff member has applied to the DCEDIY, for qualification recognition for work in the Early Learning and Care sector. Our recruitment staff will ensure that staff qualifications are listed on the current ‘DCEDIY Early Years Recognised Qualifications’ document. When required, an application to the DCEDIY will be submitted and confirmation of eligibility to practice will be placed on the staff member’s file
Regulation 19 — Health, welfare and development of child
1. In Wobbler room 1 a child was observed to be put down for a nap wearing leggings and socks which were soiled and had wet patches following dinner. The other children were observed to have all outer wear removed prior to nap time. Damp or soiled clothes should be removed from children as soon as possible to ensure the comfort of the children. 2. The bookshelf in Toddler room 1 was not adequate for the number of books held and impeded a child in their attempts to tidy up before dinner time when a child was observed attempting to tidy two books onto the shelf at clean up time, the books were observed to fall repeatedly to the floor as there was not space for them. The child attempted a number of times and sought adult help to fix the issue before wandering away and leaving the books on the floor. The child’s independence and autonomy was not supported by the equipment provided. (b) 3. Staff did not seek assistance from available cover staff when required to ensure the needs of the children in their care were adequately met for example; • In Wobbler room 1 between 11:56am and 12:20pm two staff were caring for eight children two of whom were still settling into the service. One staff member was caring for one child who was upset and observed crying while the other staff member completed some cleaning tasks following dinner and prepared the children for naptime. A second child was observed to be upset at different intervals during the time, one child was eating dinner at the table while the other children wandered around the room. A child was observed taking food from the child who was eating, and the staff member had to put the child they were helping to settle down to remove the child who was taking food from the table, this increased the level of upset the child was experiencing and they began to cry more. The child who had been taking food was then observed sitting on the floor eating food which had not been cleaned up. At 12:20pm the service manager arrived in the room to support staff. The individual needs of the children present were not adequately met during this time additional staff were required during this transition. • In Toddler room 1 the inspector observed an odour when they entered at 11:18am. Moments later a staff member was observed looking for a wedge to hold the door open and stated that a child had a soiled nappy and needed to be changed. The children proceeded to tidy up and were asked to sit at the table in preparation for dinner which they did. At 11:27am the staff member approached a staff member who was passing the care room and asked that they get the service manager, who arrived in the care room at 11:28am to cover ratios during the nappy change. The manager was observed a number of times in the hallway outside of the care room between 11:18am and 11:25am. • In Toddler room 2 a child who does not sleep was observed engaging in quiet activities in a darkened room from 12pm until 12:44pm while eight children were settling to sleep. Staff advised that the child normally goes to the Preschool room 1 at 12pm however they could not leave as they were needed in ratio. It is acknowledged that during these time periods additional staff were available to provide support to the care rooms
Provider's corrective action:
1. To refresh the key components of ‘Quality Care Practices’, a team meeting was held with both the management and staff team. This included the importance of mealtime transitions, daily care needs and safe sleep. The centre management team and the centre QLP, will actively monitor quality care practices within the centre. Bi-monthly team meetings will include training topics to support and promote awareness of quality practices. 2. The library unit was replaced with a larger unit, immediately after the inspection had taken place. The centre management team will actively monitor that furniture within the care room, are appropriate and purposeful for the age and stage of development. 3. Additional staff have been assigned to the junior care rooms to support their mealtimes and preparation for sleep. All staff are reminded to call on the support staff or a member of the management team, when required throughout the day. Cover staff will be assigned to care rooms on the weekly staff roster, internal room phones will be used where needed to call on support
Regulation 23 — Safeguarding health, safety and welfare of child
Infection Control: 1. The nappy changing mat used by children in Toddler room 2 was observed to have dirt and debris underneath and posed an infection control risk. 2. Staff did not ensure adequate cleaning and hygiene practices in the sanitary area used by the children in Toddler room 2 and Preschool room 2 which posed a risk of cross infection for example; • One toilet was observed to be soiled and remained uncleaned for a period of 20 minutes. Children continued to use the toilet during this time. • A child was observed to return to the care room without washing their hands having used the toilet. 3. Warm water was not available in two sinks which were available for handwashing; the temperature of the water in the sink in Wobbler room 2 was 7.5℃ at 10:32am while the water in the sink in the sanitary area used by Toddler room 2 was 8.1℃ at 11:27am. Warm water is required to support adequate hand washing and prevent the spread of infection. 4. In Toddler room 1 a wicker pouf seat was observed in the cosy area. The wicker was torn and frayed, and the unit could not be adequately cleaned for infection control purposes. This presented and potential risk of injury to the children and also an infection control risk. Safe Sleep: 5. The registered provider did not ensure that children aged under two years of age were provided with adequate sleep facilities in line with Tusla’s “Guidance for the Early Learning and Care sector on sleep provision for children under 24 months”. The following was observed; • In Toddler room 1 seven children aged 21-23 months and in Wobbler room 2 two children aged 19-20 months were observed to sleep on low level stackable beds at nap time. A mattress with a minimum 6cms depth is required for children under 2 years to ensure the children’s comfort while they sleep. • While individual sleep plans were available for eight of the nine children these did not identify the individual developmental and cognitive milestones which the child had reached to support the transition from a cot to a low-level bed; an identical generic statement was input on each form stating the child has met the developmental and cognitive milestones inline with the guidance. Individual sleep plans should recognise the individual child’s development to ensure the needs of the children are appropriately met. • The sleep care plans reviewed indicated that a daily risk assessment would be conducted to ensure the safety of the children following the move to a low-level bed. A review of the risk assessment in Toddler room 1 showed that it did not adequately identify the potential risks to the children sleeping in the room. For example, the risk assessment did not reference low level beds instead referencing cots and identifying the risks to children in cots. While observing the children in toddler room 1 between 12:32 and 1pm a child was observed to leave their bed and climb onto the bed of a sleeping child; such risks were not identified in the risk assessment. Detailed risk assessments must be carried out in line with the guidance detailing any identified risk to the child from sleeping in a cot but also the risk posed when the child sleeps in equipment other than a cot. 6. Physical sleep checks and recording of same were observed to not be completed in line with best practice or the service policy. For example; In Toddler room 1: • One child was observed to be asleep at 12:23pm followed by a second child at 12:32pm. Staff were not observed to conduct a physical check of either child between the time the inspector observed them to be asleep and 1pm. • Staff were observed to begin the written record of sleep checks at 12:50pm and a review of these at 1pm showed that they were completed retrospectively for both children above beginning at 12:30pm. • Two children were observed to be asleep at 1pm however no record of this had been recorded on the sleep log. In Toddler room 2: • At 12:47pm one child who was asleep was not recorded on the sleep check log. Staff were unaware of this when it was brought to their attention. Fire Safety: 7. In Wobbler room 1 the attendance records were not completed contemporaneously for example at 10am the attendance of one child who staff advised had been present for approximately two hours had not been recorded in the attendance log. This posed a potential risk to the child in the event of an emergency evacuation. Action submitted by the Registered Provider
Provider's corrective action:
Infection Control: 1. The changing mat was addressed immediately on the day of inspection. The centre management team are actively monitoring all sanitary areas throughout the day, to ensure high levels of cleanliness and infection control. 2. All staff were retrained in the Supervision Policy and are aware of the requirement to actively supervise the use of toilets on an ongoing basis. The centre management team are actively monitoring all sanitary areas throughout the day, to ensure high levels of cleanliness and infection control. 3. The heating valves on both sinks were replaced the day after the inspection took place. Daily water records are completed each morning, and where issues arise the maintenance team will be contacted. 4. The wicker pouffe was removed from the care room immediately after the inspection had taken place. Staff will remove damaged materials from the care environments where necessary and inform a member of management to organise its replacement. Safe Sleep: 5. Three of the seven children have since turned two and continue to sleep on portable beds. The children in both wobbler rooms have access to a cot for sleep. Foldable cots are available for the remaining four children in the Toddler room and will be in use until they turn two years of age. Further review of the children’s individual risk assessments has taken place. Foldable cots will be accessible to all children under 2, until 6cm depth mattresses can be sourced for our existing portable beds. 6. All staff were retrained in our safe sleep policy, and the centre management team are actively monitoring the sleep rooms, and the completion of supporting paperwork. The centre management team will actively monitor the completion of sleep charts and attendance records, to ensure that they are accurate. Fire Safety: 7. All staff were retrained in our supervision policy, and the requirement of children being signed in and out on attendance records when entering and exiting the care rooms. The centre management team will actively monitor the completion of sleep charts and attendance records, to ensure that they are accurate