Regulation 19 — Health, welfare and development of child
(1) The following care practice was observed not to meet the needs of children: (b) The interaction strategies used by a staff member were observed to be negative and demonstrated an unrealistic expectation of the stage of behaviour development of the children in the care room. This was not in line with the service policy on Behaviour Management. Children require positive, strengths-based interaction strategies modelled by staff to facilitate them to develop their own appropriate age and stage- based behaviour strategies
Provider's corrective action:
(1) (b) A training and mentoring programme was implemented by management in agreement with the staff member. This is ongoing with monitoring of progress
Regulation 23 — Safeguarding health, safety and welfare of child
Infection Control: 1. The disposal of nappies was not in line with appropriate infection control and potentially increased the risk of infection. The following was observed: • The bin in the nappy change area was not lined with a bag or bin liner. • Staff were observed not to use a nappy bin, but to carry the nappy through the service and place in the bin outside. Although it is acknowledged the nappy was placed in a nappy bag, the repeated handling of this bag increased the potential risk of cross contamination. Fire Safety: 2. The fire evacuation route from the outdoor area by the side of the premises to the assembly point at the front of the premises was observed to be partially obstructed. This can restrict the safe evacuation of children from the premises in the case of an emergency. Action submitted by the Registered Provider
Provider's corrective action:
Infection Control: 1. Staff were updated on appropriate practice in a staff meeting and the service reviewed and updated their nappy changing policy. Management report they will carry out spot checks during nappy changing time on a biweekly basis, to ensure good practice is maintained. Fire Safety: 2. The service reports the bins have been moved from the side of the creche, to the front of the building, where they are not obstructing the evacuation route, and will ensure that during the monthly fire drills the fire officer will also check that exits and evacuation routes are unobstructed
Found compliant: Regulation 9, 11, 16, 21, 25, 26.
Inspection of 13 September 2023 — Inspection Report
Immediate action notice. An Immediate action Notice was issued to the registered provider on the 13 September 2023 in relation to
Regulation 23 — Safeguarding health, safety and welfare of child
General Safety: 1. The water temperature in the wash hand basins used by the children in the care rooms exceeded the recommended temperature of 43oC. The following temperatures were recorded: Room Time Temperature in °C Required Temperature °C Ground floor sanitary accommodation 11.25am 63.9°C ≤43°C Rainbow Room Sink 1 – art area. Sink 2 – rest area. 10.16am 10.25am 55.8°C 60oC This posed a scald risk to the children. An Immediate Action Notice was issued during the inspection to the registered provider with regards to this risk, and steps were immediately taken to reduce the water temperature. 2. In the little inventor’s room cleaning supplies were stored on an open shelf within reach of children. This posed a potential risk of poisoning. 3. In the outdoor play area, a plastic toy with a broken door had a sharp jagged edge posing a potential risk of injury to children. Infection Control: 4. The practice observed regarding bed linen was not in line with service policy or effective for infection prevention and control. For example: • Bed linen used for sleep was not stored individually and was stored in one communal basket. • There was no record available for the cleaning and changing of bed linen. Service policy states that linens will be stored hygienically, labelled for each child and will be laundered weekly. 5. Pools of stagnant water was observed in the outdoor play space in two plastic toys which were accessible to children. This increased the risk of infection. 6. Appropriate hygiene procedures were not observed to be carried out during nappy changing practices. For example: • A staff member was observed carrying a nappy to the outside bin for disposal and returning to a care room without hand washing. • During a nappy change staff did not change gloves after removing a soiled nappy before putting on a fresh nappy and redressing the child. This was not in line with best practice hygiene measures and increased the risk of contamination. Administration of Medication: 7. The administration of medication was not sufficient to support effective safe practice. • There was no care plan available for children who required a specific type of medication. • Staff were not aware of the practice around the administration of the medication. • Expired medication remained in a room for a child who had previously left the service. This was not in line with service policy that stated unused medication would be returned to the parent and expired medication would be returned to the pharmacists. Action submitted by the Registered Provider
Provider's corrective action:
General Safety: 1. Corrective Action: The plumber was called immediately and attended on Friday 15th of September. He checked and adjusted the thermostats on each handwashing basin. Preventive Action: The service has introduced a checklist for the water temperature of hand washing basins, which is completed morning and afternoon, daily. 2. Corrective Action: The cleaning product was removed immediately and stored out of children’s reach. Preventive action: All staff were reminded to carry out risk assessments in their classrooms and in the gardens. All staff received training on the safe storage of cleaning products and garden risk assessment and cleaning. 3. Corrective action: The toy was disposed of immediately and a new kitchen was ordered to replace it. Preventive action: All staff were remined to carry out risk assessments in their classrooms and in the gardens. All staff received training on the safe storage of cleaning products and garden risk assessment and cleaning. Infection Control: 4. Corrective Action: Bedlinen is now stored individually. Washing and changing records are kept on the service software application. Preventive Action: Record keeping and cleaning checks by management. 5. Corrective action: The toys with the stagnant water have been removed as they were also broken. Preventive action: Regular staff retraining and discussions during staff meetings on infection control, and nappy changing hand hygiene, and risk assessments for both outdoor and indoor areas. 6. Corrective action: All staff have undergone training on hand hygiene and infection control. Preventive action: Regular staff retraining and discussions during staff meetings on infection control, and nappy changing hand hygiene, and risk assessments for both outdoor and indoor areas. The Infection Control policy has been updated and a copy provided to each staff member, who have replied to say they have read, understood and will apply the policy and procedure. Administration of Medication: 7. Corrective Action: the service has created a care plan for children requiring them. Every staff member has received a copy of the care plan. Staff who have children requiring a care plan in their care have completed a copy of the care plan, for each child. The out-of-date medication was disposed of immediately. All staff have received training on medication administration and care plans for children with additional requirements. All staff have received and replied to say they read and understood the updated Medication Administraiton policy and the Care Plan for Children with a diagnosis. Preventive Action: The care plans will be reviewed and updated every term. The manager will randomly check the expiry dates on medications and the medication administration records. Ongoing staff training and discussions during staff meetings
Regulation 25 — First aid
(1) A review of the staff roster showed that the registered provider did not ensure that a person trained to First Aid Responder level was available to the children at all times during the operational hours of the service. It is acknowledged that two staff members trained in paediatric first aid were available at all times
Provider's corrective action:
(1) Corrective action: the person in charge has reviewed the staff rooster and was able to make one simple change to ensure that there is a FAR trained member of staff on duty at all times. There are currently 4 staff members trained. Preventive action: the service intends to have all full-time staff trained in FAR to ensure that even when staff are on holidays, there is always a member with FAR training present
Regulation 29 — Premises
(d) The service was not maintained and repaired as required. 1. A section of the floor in the Rainbow room was incomplete, exposing a surface that was unsealed which prevented adequate cleaning. 2. There was a hole cut out in the wall beside the nappy changing unit in the upstairs sanitary accommodation, exposing piping. This prevented adequate cleaning of the area
Provider's corrective action:
(d) Corrective and Preventive Action Corrective action: A maintenance person fitted wood flooring to fill in the gap in the Rainbow room. He also fitted a washable box around the exposed pipes. Preventive Action: the person in charge will inspect areas after work has been carried out, and record any risks which will be dealt with in a timely manner
Regulation not named in the report text
(3) The registered provider did not notify the agency of the change of the person in charge in the service
Provider's corrective action:
Corrective Action: The service has submitted the Change in Circumstances form and have received notification from Tusla that the Change of person in charge has been approved. Preventive Action: The service has created a Change in Circumstances policy and procedure