covering sister facility

I need advice. I provide "fill-in" coverage for a child day care with medically fragile children.when the nurse is out. Every time I go there I find issues, such as clogged feeding tubes, improperly documented medications, or orders written wrong. The cna staff don't have needed info on how to provide care such as for catheters and g-tubes. I have spoken to the program manager and he doesn't "get " my frustration because he is not medical person. the higher ups all don't understand why i don't just fix the problems I find. They do not see a problem with this nurse. Is it just me? Any advice on my next step would be greatly appreciated.
If management will not address your concerns.. you only have 2 options.Talk to the nurse or report this to the appropriate state agency.Good luck.