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As the number of confirmed cases in an E. coli outbreak at Calgary daycares has grown to 231, including 26 people in hospital, parents are searching for answers and reeling at discovering that the kitchen believed to be the source of the outbreak has been cited for multiple violations in recent years.

Twenty-one of the infected patients have severe illness or hemolytic uremic syndrome, a dangerous complication of the subtype of E. coli at the root of the outbreak, Alberta Health Services confirmed on Monday. Another 11 patients have been treated in hospital and released since the outbreak began.

“There’s no greater trust you can put in someone than to watch your child. And this is a betrayal of that trust,” said John Greenhow, whose 2½-year-old son has attended the Fueling Brains Academy New Brighton location since last September.

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Alberta Premier Danielle Smith has asked the province’s health minister and children and family services minister to “do a full assessment” of the outbreak. While the source has yet to be confirmed, Alberta Health Services (AHS) has said it is “highly likely” that a central kitchen shared by several daycares in Calgary is the source.

AHS declared the E. coli outbreak on Sept. 4 for six locations of the Fueling Brains daycare and five additional sites that share a central kitchen. All 11 were ordered closed.

AHS confirmed on Sunday that four of the daycares that were ordered closed could open at their discretion on Monday, while the other seven would have their closing orders lifted on Tuesday.

But five of those locations won’t be reopening on Tuesday, Fueling Brains Academy management told parents in an email Monday night, a copy of which was obtained by The Globe and Mail. The email said reopening dates were dependent on staff and students receiving their “rescind letters” — documents confirming they’ve tested negative for E. coli — from AHS, as well as “other considerations to ensure a safe reopening.”

The kitchen that provided food for the daycares remains closed.

The kitchen, Fueling Minds, was in compliance with health regulations at the time of the outbreak, officials say.

But AHS inspection reports dating back to 2021 note some violations, including a lack of sanitizer in the kitchen and food not being stored at safe temperatures.

Mr. Greenhow says if he had known about those violations he might have enrolled his son at a different daycare.

“It definitely would have been something we would have taken into consideration,” he said.

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Aleasha Loblaw’s two children, aged 3½ and 21 months, both attend the New Brighton location. Both of them were experiencing vomiting and bloody diarrhea when she took them to the hospital last Monday, where they tested positive for E. coli.

“One of our friends had gone in and the doctors there were telling them to tell anyone with symptoms to come in because we hadn’t heard anything about E. coli from the daycare yet,” she said.

Ms. Loblaw opted to enroll her children at the Fueling Brains Academy in part because of its food program.

“The food was one of the things that drew us there. They advertised it being healthy, nutritious, balanced, fresh meals, all that,” she said.

A class-action lawsuit against all the daycares involved in the outbreak was filed on Friday alleging “as a result of negligence, unsanitary and unsafe food storage, preparation and handling practices, it resulted in these students suffering.”

As the investigation into the outbreak continues, parents say they are frustrated by the lack of communication from their child-care providers.

“They’ve really destroyed trust. And I don’t feel like over the last week they’ve made really any serious concerted effort to restore that trust through the way they’ve communicated or taken any responsibility, frankly,” Mr. Greenhow said.

The Fueling Brains Academy was originally founded as Kids U in 2012. It now serves more than 20,000 children in Calgary, Saskatchewan and the United States. The company did not respond to an e-mail on Monday requesting an interview.

Kyla Herman, whose four-year-old daughter, Cameron, attended the Braeside location of Fueling Brains Academy, said she noticed a change for the worse when her daughter’s daycare changed from the Kids U brand to Fueling Brains.

“I feel as though it has gone downhill,” Ms. Herman said. “The lack of communication is the big thing.”

Ms. Herman sent her two-year-old son to a different daycare and was planning to move Cameron there beginning Oct. 2.

Cameron contracted E. coli in the outbreak and was admitted to Alberta Children’s Hospital on Sept. 4. She remained there on Monday while doctors monitored her bloodwork and kidney function to determine if she needed a blood transfusion, her mother said.

The family received the good news on Monday morning that some measures of Cameron’s health were stable, while others were moving in the right direction for the first time since the little girl’s ordeal began.

Dr. Susan Cake, chair of Child Care Now Alberta, an advocacy organization, says there needs to be more oversight of companies providing food to daycares.

“Part of providing quality child care is providing quality food. Obviously, that has failed somewhere along the line,” she said. “If this means that we need to have more checks and balances for daycares, we should do that because Alberta’s children are worth it.”

Mr. Greenhow says the outbreak has shattered his trust in sending his child to daycare.

“You want to believe that they’re in the right place, that they’re safe and that you’ve made an investment in something that’s going to be enriching for their life. This is the exact opposite of that.”

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