Inspection of 8 April 2026 — Inspection Report
Regulation 9 — Management and recruitment
- (2)(a), (b) There were no written validated references for one adult. Two adults had only one reference which had not been validated. A second reference provided for two adults were from unsuitable sources. See Statutory Notice section in relation to Improvement Notice IN 0101 served. (3) Documentation reviewed evidenced that the procedures specified above under 9(2) had not been carried out prior to three adults commencing employment in the service as detailed above. (7)(a) There was no written evidence available to demonstrate what training had been completed by the registered provider for eight adults who had been employed to work directly with the children since the last inspection on the 16 September 2024. This is not in line with the service’s staff training and induction policy, which states that “a staff induction record form will be completed for all new staff.” Furthermore, the policy specifies that supervision meetings will be held on a monthly basis, with records maintained by the supervisor. No such records were available for review
Provider's corrective action:
- (2)(a)(b) The one adult in question now has two reliable validated references on file. The two adults in question now have two reliable validated references on file .The two adults who had one reference from an unsuitable source now have the correct reference on file from a reliable source which has been validated. A checklist is now made for all staff and students to be filled in prior to starting in the service, where the checklist must be met before they start with us. (3) The registered provider has made a checklist for all staff and students to be filled in prior to starting in the service, where the checklist must be met before they start with us. A new checklist for college/TY students who are working directly with the children will now have to meet the checklist requirements to coincide with Tulsa Regulation. (7)(a) All staff training has been renewed and been recorded and is now kept on file to coincide with our policy. Supervision meetings will be recorded on a monthly basis and kept with the staff training records. Staff training records will now be signed before the staff training concludes. Supervision meetings will be held every 4 weeks 17/04/2026, 12/05/2026, 12/06/2026. Before leaving a supervision meeting, staff will be given the time and date of their next supervision meeting. All dates will be recorded in a yearly diary, to make sure no meetings are missed
Regulation 23 — Safeguarding health, safety and welfare of child
- General Safety: See Statutory Notice section in relation to Improvement Notice IN0103 served. 1. In the outdoor play area used by the Busy Bee and Butterfly rooms the heavy protective covering on the wall was torn exposing the concrete wall posing a potential safety risk. 2. The fridge door was broken posing a potential safety risk. 3. In the sanitary area serving the Ladybird and Caterpillar rooms, the water temperature was observed to fluctuate and was not thermostatically regulated. Temperatures recorded exceeded the recommended maximum of 43°C, posing a potential safety risk. Infection Control: 4. In the Butterfly room the laminate cover was torn and could not be cleaned effectively. 5. In the outdoor area used by the Caterpillar and Ladybird rooms, a sensory-style table and a bean bag were observed to contain stagnant water and leaves, presenting a potential infection control risk. It is acknowledged that these items were promptly removed following the inspector drawing this to the attention of a staff member. Administration of Medication: 6. Emergency medication required for a child identified with a medical condition was found to be expired in January 2026. This poses a potential risk to the child’s health and safety, as this medication may not be effective in the event of an emergency. Action submitted by the Registered Provider
Provider's corrective action:
- General Safety: 1. The outdoor play areas heavy protective covering in question has now been covered and the concrete is no longer exposed. The registered provider will maintain the safety checklist completed every morning, ensuring any issues noted by any staff are fixed immediately. The registered provider will be more vigilant to our outdoor spaces for the health and safety of all children, as soon as we notice any risks these will be fixed immediately. The service are renovating our back gardens and have purchased new padding for the walls and the rubber floor tiles. 2. The fridge in question has been removed from the room. 3. The thermostat connected to the running water in the sanitary area has been turned down to the correct temperature. The service has a checklist now displayed on the wall in the sanitary area. This is now filled in every morning by management to ensure the right temperature is adhered to. Infection Control: 4. The Laminate covering on the tables in the butterfly room have been removed and replaced with new covering. The registered provider is in the process of purchasing new tables. 5. The bean bag was removed from the garden promptly following the inspector drawing this to the attention of the staff member. The sensory-style table has been thoroughly cleaned and staff have been reminded that they must empty the sensory style tables each day after use and keep the covering lid on it. The bean bag has been removed from the garden and only toys adequate for the garden will be in the garden. Every morning when the safety checklists are completed, all staff will make sure that the garden is safe and clean prior to the children using the garden. Anything that needs to be cleaned and fixed will be completed immediately. Administration of Medication: 6. The parent of the child was contacted immediately when this was brought to management's attention and the parent was informed the child will not be allowed to return to the creche until we had two Epi Pens. The parent brought two new Epi Pens into the service on 09/04/2026 with an expiry date of 06/2027. The registered provider has taken note in the diary highlighting the expiry date of the medication and a reminder 1 month prior so this gives time to organize the replacement of the expired medication
Found compliant: Regulation 11, 19, 25, 26.