Nursery refusing care due to allergy ?

[OwlyLady]

Hello,

Over the weekend we discovered our DS is allergic to fish (He's in process of being weaned). We ended up in hospital as he was struggling to breath but he managed to recover swiftly on his own without any medical intervention. The DR gave us some prescribed Piriton and an epi-pen (just in case but he said he doubts we would ever need it) along with an Allergy Action Plan to give to nursery.

I went into nursery early the day DS was due and informed the office manager of the incident. She made me fill out a load of forms then happily accepted DS. I left them with the required medication.

Half hour later I received a phone call from nursery saying I had to collect DS as it was Fish Day and they didn't feel comfortable with him there. They claimed I had to take DS to my GP and have them prescribe the medicine and the hospital wasn't sufficient.

I completed this and sent them photos along with an email outlining my concerns and confusion over how they are treating his allergy. They replied saying this still was sufficient as they weren't happy with the prescription labels. (Not sure what they wanted?) My GP was very confused by Nursery's behaviour and couldn't assist any further.

I explained all this and now they have turned around and said it is actually because they do not have qualified staff to deal with allergies and so will not be able to take DS on until they have obtained this.

We have said we will look for new care providers now but where does this leave me with the nursery fees I have paid up front for next couple weeks? Also is it right for a nursery to be unable to deal with all needs? Especially when they claim on their website to be "all inclusive"?

Forget claims of "all inclusive". Nursery is effectively telling you that they are not confident that they can keep your LO safe. They should refund the fees if they cannot provide the service.

If your child is prescribed an Epipen the staff have to have the training to take him until they do they may feel they can not safely care for him. Why is the doctor saying its an allergy to fish but probably will never have it again? Surely your child needs to undergo allergy testing before they can safely say what he's allergic to and the treatment he needs? Then should Lo come into contact with that allergen again he is likely to have a more sever reaction. In my area allergy testing is a separate appointment and a series of tests.

We are awaiting for the blood test to come back.

I grew out of my fish allergy (pretty common as you can build up immunity).

The DR said epi-pen there as a precaution but reaction wasn't severe enough to be a worry about the likelihood of using it and often babies react most severely first time and then start coping better.

Sounds like this has been handled badly all round! Giving an epi pen to someone who didn't need medication to recover is strange in my experience! The nursery also should have been honest and explained the can't care for a child who needs and epi pen without the relevant training!

From thier perspective a doctor has decided you child might need this medication to save his life they need to be trained in how to safely give this.

As for where you go from here are the nursery willing to have training? If not then yes the claim to be all inclusive is wrong and I would think as they are unable to care for child you should get a refund! If they are prepared to get the training I think it might be more tricky.

If breathing is effected during allergic reaction then epipen will b prescribed. This is classed as a severe reaction if airways compromised

Luckily debate due back for further consultations with the DR so will ask for more information etc.

Nursery hasn't responded to my request of a full refund yet nor to my recommendation that they update their policies and "all inclusive" label.

We have found a child minder who actually works out £10 A day cheaper and already looks after a little girl with a fish allergy too. Might work out for the better

We had this when we applied to nursery, I turned up on the first day after multiple conversations and they finally stated that they had no one qualified to administer epipens. Find another Nursery, often ones linked to schools are better - not worth the risk and report them to Ofstead.

Your DS has had a severe reaction to fish and should be referred to an allergic consultant at your local hospital. Breathing difficulty is very severe. You need 2 allergy kits, one for home and one for nursery consisting of Piriton, 2 epipens in each (just in case one doesnt do the job - now recommended advice) and copy of the allergy plan. I also get labels made with allergy warning and emergency contacts details on to stick on the pack.

My DS has 3 severe allergies and we found out at weaning, he is now 8.

Yeah he is already under the hospital consultant as we went straight to A&E, stayed over night there and met with the allergy team next day. We have an appointment to go back (already have had one). Had Had been given Allergy Action Plan along with prescribed medications.

Epi-pens are classed as invasive nursing, so all staff responsible for the care of your child must be trained in how to administer it. The clarity you need is from the Dr - they prescribed it, so must consider it a risk, in which case, based on a medical professions opinion, Nursery would be fools to look after your child until they are trained. They were however wrong not to be upfront about this.

I think you were being unreasonable to just turn up at the nursery with an epipen. The nursery staff won’t feel confident about using it. Did you not ask whether anyone had had training to use the epipen before you left him?

You did not give them any time at all to prepare. Perhaps they wouldn’t have fish if they knew your son may react to it. I know my dd’s breakfast club have peanut butter on the days she is not there.

My dd was not prescribed an epipen when her allergy was diagnosed but had to have one pescribed when we were flying through Dubai where you aren’t allowed to take antihistamine so now we have to have one forever which is a total pain.

The overall feeling of your OP is that the nursery are awkward and are overreacting whereas to me it seems like you are being too relaxed about it all. Most people are worried about leaving their allergic dc without a person who knows what they are doing.

What's the wording of the sentence that has the phrase 'all inclusive'?

In some contexts yes that will mean including children with disabilities and allergies and special educational needs. In which case they would be misrepresenting themselves as they can't include your ds.

However all-inclusive is also used eg of holidays where your meals and drinks and entertainment are all included in your package. If the nursery provide nappies and meals and day-trips without you having to pay extra for them, then the all-inclusive could be referring to that.

Morally they should refund your fees but they will still have the same expenses and won't be able to fill the place instantly so I doubt that they will.

I think some of the responses are missing the point here. Yes, of course staff need to be trained to administer this medicine. But why did the manager not say that immediately when the OP met with her after the incident? Why all the palaver with filling in forms, sending her to the GP, fuss about prescription labels etc, only then to admit that they couldn’t administer the epipen?

I agree that morally they should refund the fees, but likely won’t.

The office manager was probably out of her depth and got OP to fill in the standard ‘administering medication’ forms. You’d be surprised how few people know what anaphylaxis is. Or epipens. Especially as there are lots of brands and so some of them aren’t epipens at all.

They probably havehave rules against administering medication that is not prescribed by a GP.

Yes, she probably was out of her depth. But then she should have said so, if she didn't understand what she was being told - or what was being given to her, in the form of the epipen. The way the OP writes the encounter, though, it seems to suggest that the manager knew it was an allergy issue, since they called her 30 minutes later and said to collect him because they were serving fish that day. Why bother with all the fuss with the GP and the labels etc if the bottom line was that nobody knew what an epipen was, or how to administer it. I guess I am a bit surprised at that, given the prevalence of nut allergies and nut-free environments these days. Of course, absolutely, if training is needed, then it is needed.

But anyway, in a way, I suppose this is indeed beside the point. The manager handled it badly, and the OP has secured alternative care. I don't think the 'all-inclusive' thing necessarily has to include allergies. I hope that there is some refund, since the reason the service cannot be provided is from the nursery's side. But I am sure there won't be.

An office manager may not be the nursery manager who knows what is needed for Ofsted and safeguarding it maybe that she just des the paperwork and has a junior (or not) helping her and only when she passed the information on to the childcare manager did they know that currently no staff have up to date Epi-pen training. If you brought a child in needing tube feeding the setting would say okay I can take them after my staff have had relevant training that is acceptable and is inclusive it is not inclusive to say no we cant take a child because of a medical need look elsewhere they have to be willing to make reasonable adaptations and staff training....bearing in mind the needs of all the children in their care.

Having said that I would be contacting the management explaining what had happened and asking for a refund assuming I have not mistaken what I've been told. If the setting was happy to do the training and take the child then they are not refusing a child so a refund is debatable depending if you gave reasonable time for them to source and do training.

For clarity all inclusive in their statement is about how they are able to look after all children whatever their needs (they don't even provide breakfast for babies let alone nappies etc).

I asked them when we first went in for introduction sessions if they are fully trained to deal with allergies as we've just started the weaning process and they said Yes, they are all trained and even explained their procedure of how they have red plates, a special medical bag and warning signs if there was a child with an allergy.

This nursery isn't a small, independent nursery but rather a chain so I believed them when they said they had the ability to look after all children.

I even mentioned that I had an allergy to fish and we didn't know whether DS had one yet but would introduce him to fish before he would start there. They just Calum said to let them know if he is.

Surely all staff should be aware of policies of the nursery? (I didn't read in the policies that they aren't epipen trained though!) Also I didn't leave DS with the Office Manager but the Room Leader who was also present when I filled out all the paper work and left them with the epi pen etc. Neither said it was a problem.

I am just surprised at how it wasn't until late Wednesday afternoon that I received the email stating DS would not be welcome to the Nursery. Leaving me having to scramble around trying to find someone to have him rest of the week and the following week.

It was their misleading information coupled with them turning DS away that makes me feel I should be entitled to a refund of this month's fees as they have only looked after him for 30 minutes?

They can fill that place easily as they are already empty and over staffed due to their poor Ofsted Performance (should have let that be a warning I guess but the place had such a lovely feel to it when we viewed and the staff reassured me that they shall turn that rating around by next Report).

That nursery has behaved terribly.
OP - I have been working in nurseries for a decade. We currently have children with epipens- 1 for nuts, one for bee stings and one for about 5 things (dairy and eggs causes child to stop breathing - its so severe). We of course have a medical plan for the children and we require 2 pens on sight. Of course they are prescribed - you cant just buy them! We do have a policy of prescription meds only but thats not really the point here.
This nursery should be taking your child in and the fact that noone is trained is beyond worrying and a potential for Ofsted failure. Report them. There are laws on numbers of practitioners that have to be first aid trained and Epipen training should be added into that (it take 5 bloody minutes!)
Different meals are prepared and steps are taken to avoid contamination. Child in question has a sterilizer we keep bowls and cups in etc just for him to minimise contamination risk. A staff member sits with him if they have an alternative meal. We have red plates and placemates with different colours to remind staff theres a high risk and to double check with the cook. Any good nursery can demonstrate they do this. It can be nerve wracking but if staff are on the ball there shouldnt be an issue. The child with multiple allergies has never had an issue in the 2 and a half years they have been at our nursery.
Fight for your money back if they wont take your son in, ask what they are doing to train staff (your child wont be the last with an epipen) and if they appear to be doing nothing then drop Ofsted a line.
I hope your child is ok. That must have been a shock.

Thank Fairy. I think I will be dropping Ofsted a line. X

We were trained how to use them during our first aid course. We’d need a care plan in place but all the staff are trained to deal with allergies at our setting. I’m surprised this isn’t the same in all settings as there are so many different allergies.

It may be that they've had first aid training, which includes recognising signs of anaphylaxis, but they haven't had epipen training. They should have been able to find someone who could talk you through how soon they can get the training and to write up a care plan though.

The Epipen training given on a 12 hour course is quiet quick a full Epipen and allergy course is a stand alone one of about 2 to 3 hours in my area and is needed on top of 12 hour paediatric if you have a child needing and Epipen We also have an Asthma stand alone course.

The nursery have done nothing that warrants a call to ofsted
They don't have to accept your child if the risk assessment shows the risk is unacceptable
They may have spoken to their insurance company and been advised not to accept your child
I do think you should have given them more warning and not just turned up with an epipen
That wasn't fair of you

Think it wasn't fair of them to not tell us we couldn't do that when we were introduced to the nursery. Especially when they made a point about being all inclusive and staff had all the training needed etc.and I previously mentioned I had a fish allergy?

I also didn't just turn up on that first day without warning them. I asked someone who works there the day before if it would all be okay and she assured me it would be fine too.

If I turned up that first day and they said there and then that they didn't have the qualified staff then that would have been acceptable. They could have told us a care plan and how they would get qualified asap etc.

But instead they made up a load of stuff that we had to go and do, We kept doing what they asked but it was never good enough. Until they eventually told us it was actually because no one had epi pen training and so our DS can't be accepted.

It's the goose chase coupled with the misleading information and the very last minute telling us we couldn't take him there anymore that has shocked me.

Also surprised at how no one there seems to know their own Nursery's policies? Surely everyone should? Then again, didn't mentioned anything in the policies they gave us about not being epi pen trained. In fact gave us completely different view that they'd be able to cope with anything.

There are a dozens of different types of allergies, food intolerance, healthcare conditions, care plans, disabilities, children with various needs and conditions and you expect that a nursery will be able to turn on a 5 p pence and accommodate every single one of them, with no notice? I think you are dreaming.

As a childminder, I do my absolute best to accommodate children with allergies, and other medical needs. I have been trained in the various types of epi-pen (although now it's mostly just one type), and have strict procedures in place, as well as training for diabetes and other medical conditions.

However, if a child starts with me, I will request a number of things - forms, care plan, action plan and the child will not start until everything is in place. And it can take weeks. If you expected the nursery to be ready overnight, I think it's a bit much to ask.

And by the way, I had to pay for the medical training (except for the training for diabetes, that was provided by a GP/Nurse for free). It wasn't cheap.

As I said in my previous post,

I asked the day before so they could have warned me then. They could have told me when I turned up on that day. They could have told me on any of the introduction days when I asked about allergies too.

They kept merrily chiming about how they were all prepared for anything and are all inclusive.

I'm annoyed at how they sent us on a wild goose chase and misled us.