More than 2,000 HSE pre-school reports trawled for information
The scope of the request meant the response from the HSE would not be overnight. In some cases, third parties objected to the release of reports and were informed by the HSE of a right to appeal to the Office of the Information Commissioner prior to the release of information. Some did. In the end, it was six months before all the reports were received by the Irish Examiner.
The final tally was more than 2,000 inspection reports, all of which were trawled by the Irish Examiner.
Because we have no legal privilege under the Freedom of Information Act, it was not possible for us to reproduce the 2,000 reports. What we have included is an outline of some of the more serious breaches that came to our attention during the course of our research.
Some of the findings of the reports were questioned by the crèche owners and as is evident from the responses to those reports, the majority of crèches featured in our article have addressed the issues raised.
Because of the year-long scope of the request — with the exception of Galway, Mayo and Roscommon, where reports covered the period August 2006 to November 2006 — we received, in some instances, the outcome of more than one inspection of a premises. In some cases, breaches outlined in the previous report had been addressed. In some, they had not. An extreme example of this involved one particular crèche in the Cavan/Monaghan area which failed, on five different inspection occasions, to produce an insurance certificate, despite repeated requests for same. The crèche is now the subject of legal proceedings.
To be as fair as possible to all involved, we used the most recent inspection report supplied by the HSE to us in all cases. Where just one inspection of a premises was carried out during the time frame covered by the request, details of that report will appear. The HSE itself has decided, in the interests of transparency and accountability, that inspection reports of pre-schools will shortly be published on their own website. This is due to take place in January when the HSE launches its new website.
The HSE’s approach to compiling pre-school inspection reports has not been consistent, something they are addressing with the introduction in April this year of a standardised inspection tool. Using the new pre-school inspection form inspectors will, for the first time, assess every facility against a standard set of criteria. However, this form was not in use during the period covered by our FOI request. This is evident from reading the reports. Some HSE areas highlighted the strong points of particular crèches, as well as the weaknesses, others focused solely on the shortcomings.
Where both positive and negative points were raised in a report, we strove to include aspects of both. In some counties, inspectors seemed pre-occupied with child development, in others with fire safety or record keeping or outdoor play or the nutritional value of food, and again their preoccupations are reflected the reports we published.
Because the inspection process is a rolling one, it would not be possible to have, on any given day, a synchronised update of reports from all over the country. We had to choose a cut-off point.
Inspection date: May 2006
“Since our last inspection you have been providing a full day care service without informing the preschool team. This facility is not suitable for such a service as pointed out on our inspection report of 9th December 2004. You are in breach of the Child Care (Pre-School Services) Regulations 1996 and you must address this immediately.
“On commencement of our visit many staff members were observed smoking outside the main entrance door and a large number of cigarette ends were scattered in the immediate area. Please remove all cigarette ends. “The kitchenette in the premises is of limited size and is therefore not suitable for the preparation and cooking of full meals. This practice must be discontinued immediately. This kitchenette may only be used for storing and preparing children's snacks and drinks. Televisions were stored in slanted positions on wall brackets. These units must be checked regularly and provided with more suitable brackets/shelves if necessary.
“A container of sand was stored in front of the fire exit door on inspection. The door into the play-school room located to the rear of the premises is difficult to open and must be addressed immediately.”
In response, Catherine Maher, service provider said: “We took on board the recommendations made in that report and everything has now been dealt with. We did cease providing a full day care service and have returned to running a sessional service (up to 3.5 hours per day). The staff smoking issues have been dealt with.
“The inspectors visited us again since that report was compiled and everything was ok,” Ms Maher said.
Inspection date: May 2006.
“Twenty-four pre-school children were brought together in two small rooms upstairs for lunch, they were not occupied in any way and were very noisy, restless and bored. (I acknowledge that the inspection team arrived which may have delayed the serving of dinner). All the children’s dinners were served together downstairs and by the time they were ready to be taken up stairs they were cold. Salt should not be added/included in the pre-school child’s diet.
“The exit from the front door was blocked with toys. The doorway in the playroom upstairs was blocked with high chairs at lunchtime. Four of the pre-school children upstairs were very young and at least one was unable to walk. Two pre-school children under two years were sleeping in the playroom upstairs. Two babies were sleeping in rock-a-tots downstairs. Linen was not changed after each child’s use of cots.”
In a written response to the HSE inspectors, Lazy Days service providers — Orla Shaughnessy and Gillian Treacy — said extra staff had been taken on. They said children are seated as dinner arrives and dinners are served at the required temperature.
In relation to waste disposal, they said bins are provided and emptied after each change. They also said that doorways are clear and all cleaning items out of reach. They said stair gates had been fitted at the top and bottom of the stairs and the lead dangling from the TV made secure.
They also said the fire safety door was clear and all children upstairs are aged one and a half and are walking. They said babies under two are put in to cots and individual linen provided.
Inspection date: July 2006.
“There are a number of serious breeches outlined of immediate concern. There was no staff available to supervise the out-of-school child, therefore the supervision and care of all the children in the facility was compromised.
“On the day of the inspection there were seven pre-school children including babies and one out-of-school child in the sitting room watching television.
“There were five pre-school children and babies in the playroom. “A second television was turned on in that room.
“Space available is insufficient to accommodate the number of pre-school children attending the facility. There are no suitable sleep/rest facilities for the pre-school children.
“The kitchen, dining area and sanitary accommodation are being used by residents living in the house, staff working in the service and by at least 13 children attending the service. This level of activity in a small domestic space increases the risk of accidents occurring.
“There was evidence to suggest that cigarette smoking was taking place on the premises. There was a smell of cigarette smoke in the house. There were cigarette butts and cigarette ashes noted in the fire place. There were also ash trays seen on the premises. This issue has been referred to the Senior Tobacco Officer.
“There were carpets on the floors in the playroom and sittingroom which is an unsuitable and unhygenic surface for pre-school children.
“The nappy changing unit was identified as being unstable and therefore unsafe. Children in both rooms watched television/videos for over one hour during the inspection. It is acknowledged that the children did play outside in the back garden during the latter part of the inspection unsupervised.
“In light of the findings of the inspection conducted on July 12, 2006, the facility currently notified as a full day care service falls below the standards expected. The location of this service in a small domestic space is not suitable for the type and scale of service provided.”
In a written response to the inspection report, Ms Kirwan said she was “very disappointed at the report that has been carried out at my home. You have outlined serious breaches which I personally feel that I have not done”. She said a third staff member had come on duty in the afternoon. She said the TV was only on for about one hour per day, and is not on on dry days. She said criticism of the floor covering was “a first” in any HSE report. Ms Kirwin said all children in her care were supervised. She said she was “not one bit happy” with the findings, adding “I feel that since I have been notified to the HSE for childminding, I have been victimised and I am not happy with this as other childminders can get away with almost anything and all reports coming to me have something different”.
A review visit of her service in November 2006 found the child/adult ratio was again not adhered to because when the inspectors arrived, one staff member was looking after 10 children under the age of six, five of whom were under the age of three. The inspectors also said the space available to 10 children was insufficient.
However, on April 19 this year, the inspectors wrote to Ms Kirwin acknowledging that since the dates of both inspections listed above “you have acted on the recommendations of inspectors and in particular, you have re-notified your service as a childminding service, whereby the number of children now being minded by you has been appropriately reduced”.
Inspection date: May 2006
The inspectors said registration forms were incomplete, including details of authorisation for collection of pre-school children and details of any illness, disability or allergy.
“At present, there are 18 children attending the playschool however, the premises can only cater for 10.
“Previous warnings regarding this have been consistently ignored and therefore we strongly recommend the numbers attending the playschool be reduced.
“At the time of the inspection a number of hazards were observed. Old gas canisters, planks of wood were located where the children were running. Rigid fence wiring was jutting out and deemed unsafe.
“Children were gaining unsupervised access to the garden and to the shed where the greyhounds were located. These animals pose a serious risk to children. Also, children were observed playing on “the swinging bench” unsupervised which could result in a child falling and seriously injuring themselves.”
In her response, Eileen Murphy, the owner of the preschool, said she had been inspected again since May 2006, (the date of the report mentioned above) and “anything they found fault with has been rectified”.
“I was inspected in June 2007, and have reduced the numbers that I cater for to 12. If I was to pay another person to come in and help it would mean the service was no longer viable for me.
“The inspectors didn't find anything wrong the last time except in the registration forms where I had forgotten to include the words "illness or disability”. Those two words have been put in now.”
Inspection date: July 2006
“Staff were pleasant and friendly towards the children. A greater amount and wider range of toys, suitable play equipment and materials is required particularly in the baby and toddler areas. The daily programme of care and activities should be regularly reviewed and adapted to the changing needs and development of the children.
“The adult/child ratio was satisfactory.
“There were no records available to demonstrate the testing of the smoke detectors or fire alarm system. The fire exit in the conservatory area was blocked during the inspection. A fire exit sign outside the nappy changing room directs potential evacuees into a dead end.
“Ventilation was very poor throughout the occupied rooms of the creche. The baby walker must be removed, they are not recommended as they are unsafe and do not facilitate early walking.
“A secure outdoor play area has been provided.”
In response, manager of the preschool, Rev John Fasan, said they had addressed the inspectors fire safety concerns at the time and had since moved into a newly-built extension, with more space for the children. He said the old part of the building was now used as a changing facility and for sanitary accommodation.
Inspection date: March 2006.
“Good interaction was noted between your staff and the children. The adult/child ratio was satisfactory.
“The pre-school must have a policy of only releasing children to persons authorised by a parent/guardian to collect them and the full names of these people should be listed on each child’s registration form.
“The playroom on the first floor was not maintained in a satisfactory and safe condition. Chairs were stacked on top of a table, seven large boxes of toys were stored on top of a stack of two tables and the room was in a cluttered and disorganised state.
“The unstable shelving units in the pre-montessori room to be stabilised or replaced. Many of the toys and the play equipment throughout the premises appeared grubby and worn.
“As discussed at the time of inspection, two of the cots in the baby room were unstable and were swaying/rocking to an excessive extent.
“The outdoor play area is not satisfactory in its present state. All hazardous objects that are stored in the outdoor play area, including a washing machine to be removed immediately. The miscellaneous objects stored at rear play area adjacent to car parking constitute harborage for pests.
“Outdoor play equipment to be thoroughly cleaned and examined for faults prior to the children utilising same. A secure exit at the end of the play area is required.”
In response, owner Barbara Horan said the playroom where the chairs and toys had been stacked was not in use at the time of inspection. She said the inspector's claim that the window in the pre-Montessori room was in an unacceptable condition was “in his opinion” and not hers.
She said the cots referred to as “unstable” were regularly rocked manually by staff to aid children who had difficulty going to sleep and who were used to being rocked to sleep at home. “In our opinion, they are not dangerous to use and not all the cots are ‘rocky’ cots. There’s only one or two to rock some babies to sleep,” she said.
Ms Horan said all other issues raised in the report had been addressed. She was critical of the "personal preferences" shown by different sets of inspectors each of whom highlighted new shortcomings or highlighted issues previous inspectors had no issue with. She said one inspector had reduced her to "a quivering idiot”, in his treatment of her service.
Ms Horan also forwarded a number of subsequent inspection reports to the Irish Examiner. On foot of the most recent inspection carried out in August 2007, the inspectors acknowledged that the layout of the baby rooms had been reorganised to provide more free floor space and clearly defined areas of interest had been developed. It said all costs in the baby room were not stable and steady. A secure fence was in place in the outdoor play area. However it did find that a number of doors throughout the premises were not proper fire doors. Also inspectors said shelving in the play room on the first floor and in the baby room in the basement was unstable “and needs to be properly secured to the wall or removed.”
Inspection date: August 2006.
“The toddler and wobbler areas would benefit from the introduction of further play equipment and materials. “Good interaction, observation and supervision was noted between the staff and the children on the day.
“The door in the sleep room is jamming. It is essential that the door to this room closes and opens properly as it is a fire door.
“The window blinds in many rooms are not appropriate to use in a creche as they present the risk of entanglement, have long cords which are a hazard to children. Long blind cords present a strangulation hazard for children. Cut the curtain cords to take them out of children’s reach or preferably replace the blinds altogether.
“There are sharp metal edges and bare wood on the battens used to mount the room divider in the baby/wobbler room.
“The fence surrounding the play area is poorly finished in places, with rough, splintered edges to the plywood and protruding nail heads evident. It was noted that a shed to the rear of the play area was being utilised by some staff for smoking. Smoking is not permitted in any part of your pre-school premises.
Overall project manager Elaine Diver said any problems with doors had been addressed. She said they took on board the advice about the blinds, even though someone from the HSE had previously said the blinds in use were acceptable. Since the inspection, all cords hanging from the blinds had been tied up and were now out of reach of children.
“We still intend to replace them though, they are on a list of things to do,” she said. She said nail heads had been dealt with and they had gone through the report step-by-step to address the breaches, including the issue of smoking. “We are learning as we are going along,” Ms Diver said.
Inspection date: November 2006
“An extensive variety of play, work and Montessori was available. Good interaction and supervision was noted between the staff and the children. The adult/child ratio was satisfactory.
“We were informed at the time of inspection that members of staff had not received formal fire safety training. “Fire evacuation notices were not posted in all rooms as required. Fire doors were propped open throughout the building. It is essential that all fire doors are kept closed when not in use, to prevent the uncontrolled spread of smoke and flames in the event of a fire.
“Very few windows were open during our visit and consequently in most rooms air was stale and stuffy.
“Plug sockets in the ’wet play’ room were not fitted with safety covers. This is particularly important where moisture may come into contact with electrical fittings.
“Storage cabinets in many rooms were left open and accessible to children.
“Please review the selection of planting in the outdoor play area. A cursory examination of this area identified some poisonous species and some plants with thorny and sharp stems.
“Adequate toys, play equipment were present (in the outdoor play area) on the day of inspection.”
In reponse general manager Bernadatte Anderson said they had requested a list from the environmental health officer on how to plan out the garden and they had also employed gardeners since the inspection to exchange the offending plants with alternative plants.
“The children are supervised anyway and they wouldn't have been in the area that the plants are in. One or two of the plants weren't child-friendly,” Ms Anderson said.
Inspection date: June 2006
“The children were colouring at the tables and playing with blocks on the floor.
“The television was on most of the time. The toddler did not participate in any play activities and withdrew to one of the beds and went to sleep for a good part of the morning. Some of the children’s lunches were stored in bags on the floor of the fire place and cups were stored on shelves around the room. There was no break for a snack during the morning. We were informed by staff that the children ask for a drink when they are thirsty.
“One small child was heard to request a drink but no staff member responded to him at the time. Some of the toys were found to be very grubby.
“Quilts and pillows without covers which are used for sleep purposes were stored in a pile in the corner. The environment did not meet all the developmental needs of the children attending the service.
“The guard protecting the children from the fireplace in the care room was not suitably sturdy enough. One of the children’s toilets did not have direct access to a wash hand basin. A plastic bag was sellotaped to the fireguard in front of the open fireplace, which was used as a bin.
“No small break for refreshments took place during the morning
“The side gate leading from the play area to the front driveway was not locked.
“On the day of inspection one toddler was sleeping on the low-level sleep mat covering a board on the floor, along the side of the room. This is a resting area for the pre-school children. The toddler had a bib tied around his neck and was still wearing his shoes.
“All the other children were playing in the room and the television was turned on. This was not a suitable sleep facility for a toddler. A number of the above matters are breaches in legislation, which have been brought to your attention on previous occasions and are prosecutable offences.
If this is not ensured, we may recommend the initiation of legal proceedings to the Health Service Executive, Dublin North East against you in this matter.
Owner Gretta Twyford said she has been 30 years in the job and was "more interested in minding kids than in what colour paint was on the door”. She said she had issues with the inspectors because they had asked children questions and she had sought clarification from them about their entitlement to question children under the age of 12.
She said the children did not watch a lot of TV and that she had thought about removing it “but it settles some of the kids when they arrive in the morning”.
In relation to where children were sleeping, she said “a kid will sleep if it's tired. There's one kid here and he won't sleep anywhere but on the floor.” She said the nappy changing unit was not used to store toys. She said the quilt and pillows on the floor of the playroom were "washed and ready to go”. She said she was considering changing her service to an after-school service where she would not have to deal with regulations.
She said the inspector had been warning her of legal proceedings for year: “If there were so many breaches, how come we were never summonsed,” she asked.
Inspection date: September 2006
“Two staff members and 11 children were present in the pre-school on arrival of inspection team. As outlined in previous report this does not provide adequate cover to maintain correct adult/child ratios if a staff member requires to leave their designated room for any reason.
“The stair way next to the cloakroom adjacent to Montessori room needs to be closed off to prevent access by children. Previous attempts to install such a gate have failed (outstanding item since the last inspection). Redundant heating water pipes were protruding from the floor in the sanitary accommodation. These pipe’s should be removed or rendered safe, leaving the floor smooth (outstanding item since the last inspection).
“The surface of the play area was dirty and an accumulation of litter was evident.
“Steps leading from the play area to a laneway via a courtyard were accessible to children who would use the play area. These steps also present a security risk by way of unauthorised access. The play area needs to be secured while still allowing use as an evacuation route. (outstanding item since the last inspection).
“There are missing balusters on the steps from the play area that need to be replaced. Due to our observations during the follow up inspection we require a meeting with you, as proprietor, to discuss how you intend to address the issues brought to your attention in the inspection reports dated 10th May 2006 and 27th September 2006. Failure to comply with the Child Care (Pre-School Services) Regulations 1996 may result in advice being sought on the initiation of legal proceedings.”
In her response, owner Sarisha Chetty said she had taken over the premises over two-and-a-half years ago and while it was a lovely Montessori school with a lovely ethos, the basement needed a huge amount of work.
“Obviously that report was a while ago (September 2006) and both of my premises (she has a a nursery on Merrion Square) are beautiful.
"A lot has happened since that report, I was given grant approval and have done a lot of work. I know that report wasn't flattering but in my latest report three-four months ago, any breaches were minor. We have taken a lot of time and effort to bring the facility up to standard, down to a fingerprinting system on the door.
“I have waiting lists on both my premises and I am definitely one of the leading childcare providers now.”
Inspection date: August 2006
“There were no staff records available for inspection. The attendance records for the children attending the service on a full day care basis were disorganised. The overall management and operation of the service requires improvement.
“The floor carpet and floor in the full day care room was in a dirty condition. The toilet seats were broken and must be replaced. Separate toilet facilities are not provided for staff. This includes the staff handling of food. “There was inadequate training and supervision of the food operation. Food storage was disorganised and likely to lead to cross contamination. Raw rashers and cooked foods were stored together in the freezer and in such a manner that they were likely to lead to cross contamination.
In her response, Fitzone manager Clodagh Kilmurray said the service was under new management since the report mentioned above. "Previously Fitzone Childcare was managed separately, but now it's part of the Westwood Health and Fitness Club and everything is being done above board.
“It has the same standards as the rest of the club. We are now members of the National Children's Nurseries Association (NCNA) and have been independently assessed. We wouldn't have been accepted by the NCNA if the quality of care had not improved.”
Ms Kilmurray said an external company, Little Dinners, was supplying the food to high standards.
Inspection date: April 2006
“There were five babies (aged five months-one year) and two staff present in the baby room at the time of inspection. The room is bright and spacious
“At the time of inspection all of the babies were awake. Three of them were crying and unsettled making it difficult for two staff members to comfort them and also attend to the other two babies.
“Two babies (the youngest was aged five months) were lying almost flat in rock-a-tots, bottle feeding themselves with supervision from the staff. This is unsafe practice and must be discontinued. In general the cleanliness of the premises was very poor.
“The cots in the two sleep rooms were in a dirty condition. There was a hole in the wall of the large cot room with exposed electrical wires. Heating pipes were exposed in the baby room and the Montessori room. The table and bench set in the toddler room was not suitable.
This set was also in the dining area and are considered not suitable for the older children to sit at as the children are too big.
“Medicines were stored on the table in the hall and were within each reach of the children. The baby area was overcrowded with equipment.
“The shelving in the toddler room was not adequate. A toddler opened the press and the contents fell out on top of her.
“At the time of inspection, sausages, potatoes and soup were served to the children for lunch. The menu consisted of many high salt, sweet and processed foods such as sausages, jam sandwiches, packet soup and cakes. Some healthy food was available but the variety was minimal.
In her response, owner Pauline Fitzmaurice said any recommendations made by the inspectors had been complied with. She said there had not yet been a follow-up inspection.
Inspection date: July 2006
“During the inspection there were two babies and 25 pre-school children on the premises.
“The baby was comfortable and there was a good choice of toys.
“The facilities provided for the children in the toddler room, ie. toys, play equipment and activities was limited.
“There was little choices to occupy busy active children. There were no equipment or materials for creative and imaginative play.
“There were no chairs provided for the children. There were 13 children in the playroom and high-scope room. It was stated that a “summer camp” was being provided for these children. However, there were no programme of activities in place.
“The toddler room is overcrowded. It was also noted that the first floor room is being used as a playschool and high-scope room with a maximum of 30 children at any one time. The number of children permitted is 20 at any one time.
“There was build-up of cigarette buts and children’s toys beneath the fire escape stairs beside the outdoor play area.
“The changing mat provided in the nappy changing area (off the baby room) was in a dirty condition. The sections of the vertical blind provided on the window in the toddler room were loose.
The children were wrapping themselves in the blinds. This practice may be a potential hazard, a child may accidentally get entangled.
“It was stated that the sleep mattresses and sheets provided for the toddlers and tweenies are not individual for each child.
“In the baby room the wire flex from the radio was falling loosely from the window sill to the wall socket.
“A staff member was observed heating a bottle milk feed in a microwave oven. “There was overcrowding of children in the outdoor play area. The slide in the outdoor play area was damaged exposing sharp edges.
“The children had access to the washing machine and tumble dryer (in the lobby area of the children’s toilets on the first floor) as they were not enclosed behind cupboard doors."
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