Well it sounds like you are beyond frustrated. you have two options, you can confront her all your issues with her and tell her you need to see a change or you will find a new sitter, and then if no change do it, or you can just find a new sitter now. I would not replace the powder, she was the one who had it and lost it, by not supervising effectively. Yes, more than one kid is tough and things will happen, BUT it is still her responsibility. I would explain that to her and let her know that you understand things happen, but that it happened on her watch and in her care, so she would need to replace it. If she is unwilling find a new sitter, because this is just common courtesy. I worked as a Nanny for many years both in my home and theirs. And if something happened even in their home, and I was the one in charge, I replaced it. Yes, things happen and that can't be helped we are all human. Now the boogers thing bothers me a lot too, but I too am a clean Mom and I hate when i find I missed a spot on my kids faces. I am always wiping, wiping and wiping, and once they are old enough to wipe themselves I supervise their wiping. So I understand your frustration with that I would ask her to keep him clean, especially if he sensitive skin and possible allergy as shown by the rash. Now the rash could be she is leaving him dirty too long after eating, or it could be an allergy to something in her home/facility. I would have him tested to be sure he is not having allergic reactions to things. Before doing that, you can ask her to make a list of everything he comes in contact with at her home/facility so you can figure out if something could be bothering him. Look at the list and see if anything is different than your house. Have her include detergents and all cleaning products he comes in contact with as well as food and other environmental things such as pets, etc. Good luck and I wish you the best. It is so hard to find the perfect sitter for your child.