Another child's short life

I've been posting case examples from the Representative for Children and Youth report Fragile Lives, Fragmented Systems.
Here's number three; the first two are in posts below.

Case Example Three
One of the infants resided with an adolescent mother and a grandmother in a motel. Over a two-month period, 10 individual service providers had some involvement with the mother and infant, including child protection social workers, hospital social workers, public health nurses, hospital workers and a family support worker.
A public health nurse had observed the infant’s living conditions and documented that the family was to be “observed” for emotional status, postpartum depression and family functioning; however, the nurse also recorded “no apparent problem” in the notes of the visit. A second nurse who visited also documented that the family should be observed for provision of a safe environment and support systems.
During at least one of the visits, the nurse noted that two adults were smoking inside the motel room with the infant present. It was also noted that the mother smoked and used marijuana. The nurse advised the mother to wait two hours after doing so before breastfeeding the infant. However, in a follow-up conversation with the child protection worker, the nurse expressed no concerns related to the infant’s care. The infant’s living conditions were not noted as a concern for the service providers.