Tài liệu Model Child Care Health Policies pptx

Providers who work inchild care centers, small and large family child carehomes, programs for ill children, facilities that servechildren with special needs, school-age child carefacilit

Model Child Care

Health Policies

Introduction

In 1991, the Pennsylvania Chapter of theAmerican Academy of Pediatrics (PA AAP)organized a process to write a set of model healthpolicies for out-of-home child care A group ofpediatric nurses worked with policies submitted byover 100 child care programs (centers and familychild care homes) as part of a study conducted bythe Early Childhood Education Linkage System(ECELS) of the PA AAP Also, the authors usedthe recommendations for written health policies inthe 1992 publication of the American PublicHealth Association and American Academy of

Pediatrics called Caring for Our Children, National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs.

Since the publication of the 3rd edition of the

Model Child Care Health Policies in 1997,

thousands of copies have been in use in the field

Where child care providers and health als suggested revisions, these have been consideredfor the 4th edition This edition reflects the currentstandards as published in the 2002, 2nd edition of

profession-Caring for Our Children The standards are posted

on the Internet at <http://nrc.uchsc.edu>

Child care facilities of any type can use thesemodel child care health policies by selecting theissues appropriate to the setting and revising theinstructions accordingly Providers who work inchild care centers, small and large family child carehomes, programs for ill children, facilities that servechildren with special needs, school-age child carefacilities, and drop-in facilities need to adapt themodel policies to their special requirements Forexample, many of the policies and sample forms aresuitable for use in both child care centers and familychild care homes However, some policies are notneeded in a family child care home setting where

fewer children are in care The model policies makethe job of writing site-specific health policies easier.Add, delete, and adapt policies from the model asneeded Where there are blanks with cue words,insert site-specific information

Child care programs operate under a variety ofdifferent federal and state regulations, funding andaccreditation requirements Be sure to modify themodel policies to comply with the rules that apply

to your program An electronic copy of the text is

is posted on the ECELS page of the PA AAP’sWeb site <http://www.paaap.org>

You may modify and photocopy Model Child Care Health Policies for any use other than resale.

To purchase a print copy of the model healthpolicies with the appendices, contact the NationalAssociation for the Education of Young Children at800/424-2460, extension 2001, or the AmericanAcademy of Pediatrics at 800/433-9016

Workable policies require input from thoseaffected by, those with expertise in, and thosewith authority over the issue being addressed

Have a health professional and an attorney whoworks with the facility review the completed, sitespecific, health policies These professionals cancheck whether the final policies are legally appro-priate and consistent with current child healthpractice Annually, have staff, families, and thesite’s health consultant review the policies also

Please send us your suggestions about how thehealth policies could be made more useful whenthey are revised again Let us know how you areusing them We look forward to hearing from youand wish you quality in your work in child care

Susan S Aronson, MD, FAAPDirector, ECELS

919 Conestoga Road, Suite 307Rosemont Business Campus, Building 2 Rosemont, PA 19010

610/520-3662 (phone)610/520-9177 (fax)e-mail: ecels@paaap.org

Child Care Health Policies

Table of Contents

Page Number

Introduction i

I Admissions 1

A Admissions Policy 1

B Enrollment 1

C Daily Record Keeping/Daily Health Checks 2

II Supervision A Principle 2

B Child:Staff Ratios 2

C Supervision of Active (Large Muscle) Play 3

D Family/Staff Communication 3

III Discipline A Philosophy of Discipline 3

B Permissible Methods of Discipline 4

C Prohibited Practices (Child Abuse) 4

D Suspected Child Abuse 4

IV Care of Acutely Ill Children A Admission and Exclusion 4

B Admission and Permitted Attendance 5

C Procedure for Management of Short-Term Illness 5

D Reporting Requirements 5

E Obtaining Immediate Medical Help 6

V Health Plan A Child Health Services 6

B Health Consultation 7

C Health Education 7

VI Medication Policy A Principle 7

B Procedure 7

VII Emergency Plan A First Aid Kits 9

B Emergency Phone Numbers 9

C Lost or Missing Children 9

D Child Abuse (See Discipline) 9

E Injuries or Illnesses Requiring Medical or Dental Care 9

F Serious Illness, Hospitalization, and Death 10

G Media Inquiries 10

VIII Security and Evacuation Plan, Drills, and Closings A Security Plan .10

B Evacuation Procedure 10

C Fire or Risk of Explosion 11

D Power Failures 11

E Closing Due to Snow/Storm 12

F Floods, Tornadoes, Hurricanes, Earthquakes, Blizzards or Other Catastrophes 12

IX Authorized Caregivers A Documentation of Authorized Caregivers 12

B Sign-in/Sign-out Procedure 12

C Policy for Handling an Unauthorized Person Seeking Custody 12

D Policy for Handling Persons Who May Pose a Safety Risk 13

X Safety Surveillance A Hazard Identification and Correction 13

B Review of Injury Reports 13

XI Transportation and Field Trips A Daily Transportation to and from the Program 13

B Vehicular Requirements 14

C Driver Requirements 14

D Seat Restraint Requirements 15

E Route Planning and Trip Safety 15

XII Sanitation and Hygiene A Handwashing 16

B Diapering 17

C Toileting 18

D Facility Cleaning Routines 18

E Pets 18

F Plants 19

G Toys 19

H Exposure to Blood and Other Potentially Infectious Materials 20

XIII Food Handling and Feeding Policy A Drinking Water 20

B Food Safety/Dishes, Utensils and Surfaces 20

C Food Brought from Home 22

D Food Prepared at or for the Facility 22

E Infant/Toddler Feeding 23

F Preschool/School-age Feeding 25

G Feeding of Children with Nutritional Special Needs 25

XIV Sleeping

A Area for Sleeping/Napping 25

B Handling of Sleeping Equipment 25

C Bed Linen 26

XV Smoking, Prohibited Substances, and Guns 26

XVI Staff Policies 26

A Pre-employment Requirements 26

B Benefits 27

C Breaks 27

D Ongoing Health Requirements 27

E Training 28

F Performance Evaluation 29

XVII Design and Maintenance of the Physical Plant and Its Contents 29

XVIII Review and Revision of Policies, Plans, and Procedures 29

References

A Application for Child Care Services

B Child Health Assessment

C Child Care Emergency Information

D Special Care Plan and Authorization for Release of Information

E Consent for Child Care Program Activities

F Child Care Agreement

G Family/Caregiver Information Exchange and Instructions for Daily Health Check

H Enrollment/Attendance/Symptom Record

I Staff Assignments for Active (Large Muscle) Play

J Symptom Record

K Sample Letter to Families about Exposure

to Communicable Disease

L Situations That Require Medical Attention Right Away

M Medication Consent and Log

N First Aid Kit Inventory

O Injury Report Form

P Evacuation Drill Log

Q Health and Safety Checklist

R Cleaning Guidelines

S Meal Pattern Requirements

T Refrigerator or Freezer Temperature Log

U Child Care Staff Health Assessment

APPENDICES

I Admissions

A Admissions Policy:

Name and address of facility

admits children from the ages of

to without regard to race,culture, sex, religion, national origin, ancestry, ordisability When the parent or legal guardian of achild identifies that a child has special needs,and the parent or legal guardian will meet toreview the child’s care requirements

does not discriminate on the basis of specialneeds The program accepts children with specialneeds as long as a safe, supportive environmentcan be provided for the child

To help the program staff better understand thechild’s needs, the staff will ask the parent or legalguardian of a child with special needs to complete

a “Special Care Plan” in conjunction with thechild’s health care provider(s) The program willattempt to accommodate children with specialneeds consistent with the requirements of theAmericans with Disabilities Act If the program isunable to accommodate the child’s needs asdefined by the child’s health care provider(s) orthe Individual Family Service Plan/IndividualEducation Plan without posing an undue burden

as defined by federal law,will work with the parent or legal guardian to find

a suitable environment for the child

B Enrollment:

Prior to the child’s attendance, a conferencewith the parent or legal guardian and the child isrequired to acquaint each new family with theenvironment, staff, and schedule for child care

During this visit, the parent or legal guardian willhave a personal interview with

and an tunity to review the “Family Handbook” and otherwritten materials maintained at the facility Each child will spend at the programwith a parent or legal guardian before remaining

oppor-in care without a family member

The following forms will be completed andsubmitted to

prior to the child’s first day of attendance Theinformation in these forms will remain confiden-tial and will be shared with other caregivers only

as required to meet the needs of the child:

1) Application for Child Care Services–

completed by parent or legal guardian

(Sample form in Appendix A)

2) Child Health Assessment–signed by the

child’s physician or certified registerednurse practitioner (CRNP)

(Sample form in Appendix B)

3) Child Care Emergency Information–

signed by a parent or legal guardian foreach child enrolled These forms will beupdated by a parent or legal guardianevery 6 months and whenever the infor-mation changes (Sample form inAppendix C)

4) Special Care Plan–When the parent or

legal guardian informs the facility staffthat a child has a disability, a special careplan will be completed by a parent orlegal guardian and/or health careprovider(s) for that child (Sample form

in Appendix D) A parent or legalguardian may be asked to authorizerelease of information from providers ofspecial services to help the child careprovider coordinate the child’s care

(Sample form in Appendix D)

5) Consent for Child Care Program

Activities–completed by a parent or legal

guardian (Sample form in Appendix E)

6) Child Care Agreement–completed by a

parent or legal guardian (Sample form inAppendix F)

All incomplete forms will be returned to theparent or legal guardian for completion prior tothe child’s first day of attendance If upon review

of a child’s health record it is determined that asignificant health service (e.g., vision, hearing, orimmunization) has not been done,

will notify the parent or legal guardian Health care referrals will be pro-vided when requested or needed The parent orlegal guardian will be given 6 weeks or

to obtain the required health services before the

child is considered for exclusion from the pro-gram When an outbreak of a vaccine-preventable disease occurs in the child care facility, the parent

or legal guardian may be asked to obtain special immunization In the event of an outbreak, all children whose immunizations are not up-to-date with the current recommended schedule of the American Academy of Pediatrics and the U.S

Public Health Service will be excluded from child care until properly immunized See section V

Health Plan, A Child Health Services regarding children who are not immunized due to religious

or medical reasons

Confidentiality of information about the child

and family will be maintained Enrollment forms and all other information concerning the child and family, compiled by the child care facility, will be accessible only to the parent or legal guardian, and

Information concerning the child will not be made available to anyone, by any means, without the expressed written consent of the parent or legal guardian

C Daily Record Keeping/

Daily Health Checks:

For each child, two forms will be completed daily:

1) Family/Caregiver Information Exchange

Upon daily arrival at the program site, each child will be observed by the caregiver for signs of illness/injury that could affect the child’s ability to participate in the day’s activ-ities (Instructions for Daily Health Check in Appendix G) The family will supplement these observations with an oral or written exchange of information with the child’s caregiver The written record of illness find-ings from these daily checks will be kept for

at least 3 months to help identify outbreaks

(Sample form in Appendix G)

2) Enrollment/Attendance/Symptom Record

The will complete the Enrollment/Attendance/

Symptom Record to log attendance and any illness/injury the child is known to have

(Sample form in Appendix H) The E/A/S Records will be reviewed by

to identify patterns of illness

II Supervision

A Principle:

No child will be left unsupervised while attend-ing the program At least 2 staff will always be available if more than 6 children are in care Caregivers will directly supervise infant, toddler, and preschool children by sight and hearing at all times, even when the children are sleeping Children will never be left without a caregiver on the same floor-level as the children School-age children will be permitted to participate in activi-ties outside of the program and to visit friends off premises as approved by their parent or legal guardian and by their caregiver

Caregivers will regularly count children on a scheduled basis, at every transition, and whenever leaving one area and arriving at another to confirm the safe whereabouts of every child at all times Counting systems, such as a reminder tone that sounds at timed intervals, will be used to help staff remember to count

will assign and reassign counting responsibility as needed Staff will assess the environment for opportunities to improve visibility and hearing of child activities with such devices as convex mir-rors and baby monitors

B Child:Staff Ratios:

Child:staff ratios followed by this program will always comply with the following requirements according to state regulations:

Our goal is to maintain the following national standards for child:staff ratios which are recom-mended by the American Academy of Pediatrics and the American Public Health Association whenever children are in care:

Maximum

0 - 12 months 3:1 6

13 - 30 months 4:1 8

31 - 35 months 5:1 10

3-year-olds 7:1 14

4-5-year-olds 8:1 16

6-8-year-olds 10:1 20

9-12-year-olds 12:1 24

staff and/or family member

Staff title/name

child care director, child care provider, health/social service coordinator, health counsultant, person designated by the state licensing department to review

records for licensing, validator from the National Association for the Education of Young Children (NAEYC) [choose applicable individuals and list names, if possible.]

Staff title/name

child:staff ratios required by state regulations

When there are mixed-age groups in the sameroom, the child:staff ratio and group size will beconsistent with the age of the majority of the chil-dren when no infants or toddlers are in the mixed-age group When infants or toddlers are in thegroup, the child:staff ratio and the group size forinfants and toddlers will be maintained

Child:staff ratios for family child care homes,for swimming, transporting, caring for ill childrenand children with identified special needs requir-ing more supervision, will comply with nationalrecommendations of the American Academy ofPediatrics and the American Public Health

Association as identified in Caring for Our Children.

A substitute may be employed or a volunteerassigned to assure that the required child:staffratios are maintained at all times Substitutes andvolunteers will work under direct supervision andnot be left alone with a group of children at anytime A substitute who is regularly employed as acaregiver by the facility and who is well-known bythe children in the group will be considered staffand may function in the same way as the caregiverfor whom the substitution is being made

C Supervision of Active (Large Muscle) Play:

Observation of active (large muscle) play inindoor and outdoor spaces will be as follows:

1) High-risk play areas (i.e., climbers, slides,swings and water play) will receive the moststaff attention

2) All children using playground or indoor playequipment will be supervised No childrenwill be permitted to go beyond a caregiver’srange of direct supervision Child:staff ratioswill be at least as stringent as for other childcare activities Every child will be specifi-cally assigned to a caregiver to be regularlycounted to confirm their safe whereabouts atall times

3) A written schedule will be prepared by

and used to assign staff to supervise high riskareas (Sample Form in Appendix I)

4) When swimming, wading or other grossmotor play activities in collected water arepart of the program, there will be 1:1 super-

vision of infants by adults, at least 2:1 vision for toddlers, 4:1 supervision ofpreschool age children and 6:1 supervisionfor school-age children Pushing, forcedsubmersion of a child, or running shall beprohibited Children shall not be allowed tobring non-water toys and flotation devicesinto the water play area

Caregivers will write notes for families on a dailybasis for infants and toddlers, no less than weeklyfor preschool and kindergarten children, and noless than monthly for school age children Staffwill use these notes to inform families about thechild’s experiences, accomplishments, behavior,sleeping, feeding, and other issues related to per-sonal care such as wet diapers and bowel move-ments for infants and toddlers

III Discipline

A Philosophy of Discipline:

Caregivers will equitably use positive guidance,redirection, planning ahead to prevent problems,encouragement of appropriate behavior, consistentclear rules, and involving children in problemsolving to foster the child’s own ability to becomeself-disciplined Where the child understandswords, discipline will be explained to the childbefore and at the time of any disciplinary action

Caregivers will encourage children to respectother people, to be fair, respect property, and learn

to be responsible for their actions

Caregivers will guide children to develop control and orderly conduct in relationship topeers and adults Aggressive physical behaviortoward staff or children is unacceptable

self-Caregivers will intervene immediately when achild becomes physically aggressive to protect all

of the children and encourage more acceptablebehavior Caregivers will use discipline that isconsistent, clear, and understandable to the child

Staff title/name

B Permissible Methods of Discipline:

For acts of aggression and fighting (e.g.,

biting, hitting, etc.) staff will set appropriateexpectations for children and guide them in solv-ing problems This positive guidance will be theusual technique for managing children with chal-lenging behaviors rather than punishing them forhaving problems they have not yet learned tosolve In addition, staff may:

1) Separate the children involved

2) Immediately comfort the individual who wasinjured

3) Care for any injury suffered by the victiminvolved in the incident

4) Notify parents or legal guardians of childreninvolved in the incident

5) Review the adequacy of caregiver sion, appropriateness of facility

supervi-activities, and administrative correctiveaction if there is a recurrence

Physical restraint will not be used except as

necessary to ensure a child’s safety or that ofothers, and then in the form of holding by anotherperson as gently as possible only for as long as isnecessary for control of the situation

Medicines or drugs that will affect behavior

will not be used except as prescribed by a child’shealth care provider and with specific writteninstructions from the child’s health care providerfor the use of the medicine

Time-out will be used if other management

techniques are ineffective “Time-out” or removal

of a child from the environment may be usedselectively for children over 18 months of agewho are at risk of harming themselves or others

The period of “time-out” will be just long enough

to enable the child to regain self-control As ageneral rule this period will not exceed oneminute per year of age Caregivers will monitorthe effectiveness of “time-out” and seek the help

of a mental health consultant when approvedbehavior management strategies do not seem to beeffective

C Prohibited Practices (Child Abuse):

Caregivers will not use physical punishment orabusive language

D Suspected Child Abuse:

All observations or suspicions of child abuse orneglect will be immediately reported to the childprotective services agency no matter where theabuse might have occurred

will call to report suspected abuse or neglect

will follow the direction of the child protectiveservices agency regarding completion of writtenreports If the parent or legal guardian of the child

is suspected of abuse,will follow the guidance of the child protectiveagency regarding notification of the parent or legalguardian Reporters of suspected child abuse willnot be discharged for making the report unless it

is proven that a false report was knowingly made Staff who are accused of child abuse may besuspended or given leave

pending investigation of the accusation Suchcaregivers may also be removed from the class-room and given a job that does not require interac-tion with children Parents or legal guardians ofsuspected abused children will be notified.Parents or legal guardians of other children in theprogram will be contacted by

if a caregiver is suspected of abuse so they mayshare any concerns they have had However, noaccusation or affirmation of guilt will be madeuntil the investigation is complete Caregiversfound guilty of child abuse will be summarilydismissed or relieved of their duties

IV Care of Acutely ill Children

A Admission and Exclusion:

The decision to exclude a child from care will

be based on whether there are adequate facilitiesand staff available to meet the needs of both the illchild and the other children in the group (Checkspecific state regulations that may supersede thenational standards on which this policy is based).The child care provider, not the child’s family,makes the final determination about whether theacutely ill child can receive care in the child careprogram Children will be excluded if:

1) The child’s illness prevents the child fromparticipating comfortably in activities that

Staff title/name phone number/agency name

Staff title/name

Staff title/name

Specify with/without pay

Staff title/name

the facility routinely offers for well children

or mildly ill children

2) The illness requires more care than the childcare staff are able to provide without com-promising the needs of the other children inthe group

3) Keeping the child in care poses an increasedrisk to the child or to other children or adultswith whom the child will come in contact as

defined in Preparing for Illness.

(See Exclusion Guidelines in Preparing for Illness available from NAEYC 800/424-2460,

www.naeyc.org, and the American Academy ofPediatrics 800/433-9016, www.aap.org)

If the child care staff are uncertain aboutwhether the child’s illness poses an increased risk

to others, the child will be excluded until a cian or nurse practitioner notifies the child careprogram that the child may attend A child whoseillness does not meet any of these conditions listed

physi-above does not need to be excluded

B Admission and Permitted Attendance:

Specific conditions that do not require sion are:

exclu-1) Children who are carriers of an infectiousdisease agent in their bowel movement orurine that can cause illness, but who have nosymptoms of illness themselves Exceptionsinclude E coli 0157:H7, shigella orSalmonella typhi

2) Children with conjunctivitis (pink eye) whohave a clear, watery eye discharge and do nothave any fever, eye pain, or eyelid redness

3) Children with a rash, but no fever or change

symp-of illness (Sample form in Appendix J)

2) The caregiver and the parent or legalguardian will discuss treatment and develop

a plan for the child’s care The staff shouldcontact the child’s health care provider if thecaregiver has questions or does not under-stand the instructions provided by the healthcare provider

3) The caregiver will complete the symptomrecord during the period the child is in careand give a copy of the symptom record tothe parent or legal guardian when the childleaves the program for the day

If the child becomes ill during the time thechild is in care:

1) The caregiver will notifyand complete the symptom record

2) will determine if the child may remain in theprogram or is too ill to stay in child care

3) will call the parent orlegal guardian

4) The child’s symptoms will be treated asagreed upon with the parent or legalguardian The treatment will be written onthe symptom record The child will be reas-sured by the caregiver

5) The symptom record will be given to theparent or legal guardian so that the parent orlegal guardian has the information needed tocontinue the child’s care and, if necessary, toconsult the child’s health provider for man-agement of the child’s illness

6) If the child is too ill to stay in child care, thechild will be provided a place to rest untilthe parent, legal guardian or designated per-son arrives The child will be supervised atall times by someone familiar with the child

A child with a potentially communicable ness that requires that the child be sent homefrom child care will be provided care sepa-rate from other children with extra attention

ill-to hygiene and sanitation until the childleaves the facility

D Reporting Requirements:

Some communicable diseases must be reported

to public health authorities so that control sures can be used

mea-will obtain an updated list of reportable diseasesfrom the local or state health authorities annually

A copy of this list will be shared with each parentand legal guardian at the time of enrollment InSeptember, families and staff will be reminded tonotify

within 24 hours after the child or staff has oped a known or suspected communicable diseaseand to inform

devel-if any member of their immediate household has areportable communicable disease While respect-ing the legal boundaries of confidentiality of med-ical information,

will notify the appropriate health departmentauthority about any suspected or confirmedreportable disease among the children, staff, orfamily members of the children and staff

The telephone number of the responsible local

or state health authority to whom to report municable diseases is posted Families of children who may have beenexposed to a child with a communicable disease

com-or repcom-ortable condition will be infcom-ormed about theexposure according to the recommendations of thelocal health department (See Sample Letter inAppendix K)

E Obtaining Immediate Medical Help:

All caregivers will obtain immediate medicalhelp for the situations listed in Appendix L

V Health Plan

A Child Health Services:

(Check state regulations which may differ fromthe national standards)

Immunizations will be required according to

the current schedule recommended by the U.S.Public Health Service and the American Academy

of Pediatrics (see www.aap.org)

Every January,will check with the public health department orthe American Academy of Pediatrics for updates

of the recommended immunization schedule.regulations regarding attendance of children whoare not immunized due to religious or medical rea-sons will be followed Unimmunized childrenwill be excluded during outbreaks of vaccine pre-ventable illness as directed by the state healthdepartment

Routine preventive health services will be

required according to the current tions of the American Academy of Pediatrics.(see www.aap.org) Documentation of an age-appropriate health assessment should be obtainedbefore, but is required no later than, 6 weeks

recommenda-after the child starts receiving care Parents orlegal guardians are responsible for assuring thattheir children are kept up-to-date and that a copy

of the results of the child’s health assessment isgiven to the program

A visit to the doctor for a special health ment or new documentation is not required foradmission if documentation of an age-appropriatehealth assessment is provided Questions raisedabout the child’s health will be directed to thefamily or (with permission of the parent or legalguardian) to the child’s health care provider forexplanation and implications for child care

assess-will check annually with the public health department or the American

Academy of Pediatrics for updates of the schedulefor routine preventive health services

Children will not be excluded for failure to beimmunized if they have an appointment for immu-nizations and have their immunizations initiated

State health department/child care regulating body

program or state requirement, if different

Staff title/name

within one month A child whose immunizationsare not kept up-to-date will be dismissed afterthree written reminders to the parent or legalguardian over a 3 month period.

will check the facility’s records to be sure eachchild’s immunization and other routine preventivehealth services are current

will remind parents and legal guardians to provide documenta-tion of health assessments

B Health Consultation:

will provide ongoing consultation to the child carefacility and will help develop and approve allwritten policies relating to health and safety Thehealth consultant will visit the facility to reviewand give advice on the health component

.The health consultant will provide advice aboutaccommodations required for children with specif-

ic health problems, design and review surveillancesystems for injury and illness, assist with staff andfamily education, and be a source of contactswithin the health care community To serve ashealth consultants for child care, nutrition profes-sionals, oral health professionals, mental healthprofessionals and other health professionalsshould have pediatric credentials or advancedtraining in pediatrics

C Health Education:

Health education will be a part of the lum for staff, families and children Topic areasfor staff and families may include: nutrition, stressmanagement, exercise, child development,prenatal care, management of chronic disease,substance abuse, safety, first aid, control ofinfectious disease, HIV/AIDS, and other topicareas based on community needs and interests

curricu-Speakers and materials may be obtained fromcommunity hospitals, children’s hospitals, volun-tary health organizations, public health depart-ments, health consultants, drug and alcohol pro-grams, medical/oral health/nursing/mental healthproviders and organizations, health agencies, andlocal colleges and universities

All health education activities and materials forchildren will be developmentally appropriate

Health practices will be integrated into dailyroutines and focused on topic areas such as ChildPassenger Safety Week, Heart Month, Week of theYoung Child, and Fire Prevention Month Topicareas for children include: physical health, oralhealth, social health, emotional health, medicationand substance abuse, safety, first aid, and prevent-

ing infectious diseases (See Caring for Our Children for contact information on organizations

who provide health education materials.) Programs will notify parents and legalguardians if sensitive topic areas are included inthe health education plan Parents or legalguardians must notify the staff of the facility ifthey do not want their children to be involved inactivities related to a specific topic

VI Medication Policy

A Principle:

This facility will administer medication to dren with written approval of the parent and anorder from a health provider for a specific child or

chil-a specific condition for chil-any child in the fchil-acility forwhom a plan has been made and approved by

Because administration of medication poses anextra burden for staff, and having medication in thefacility is a safety hazard, medication administra-tion in child care will be limited to situationswhere an agreement to give medicine outside childcare hours cannot be made Whenever possible, thefirst dose of medication should be given at home tosee if the child has any type of reaction Parents orlegal guardians may administer medication totheir own child during the child care day

B Procedure:

will administer medication only if the parent or legal guardian hasprovided written consent, the medication is

Staff title/name

frequency of checking (at least annual; more often for younger children) Staff title/name

Name and phone number of Health Consultant who is child health physician,

certified pediatric or family nurse practitioner, Physician’s Assistant Registered Nurse, Public Health Nurse or other licensed health professional with pediatric training

Frequency of visits: If the facility is a child care center, the health consultant will make monthly visits if the children in care are under 2 years of age or at least quarterly

visits if all children are older than 2 or if the center is not open daily If the facility is a family child care home, the health consultant will make an annual visit with quarterly

telephone contacts or quarterly visits to the facility

Staff title/name

Staff title/name

available in an original labeled prescription ormanufacturer’s container that meets the safetycheck requirements in Appendix M The facilitymust have on file the written or telephone instruc-tions of a licensed clinician to administer the spe-cific medication (Sample form in Appendix M.)1) For prescription medications, parents or legalguardians will provide caregivers with themedication in the original, child-resistantcontainer that is labeled by a pharmacistwith the child’s name, the name and strength

of the medication; the date the prescriptionwas filled; the name of the health careprovider who wrote the prescription; themedication’s expiration date; and administra-tion, storage and disposal instructions Forover-the-counter medications, parents orlegal guardians will provide the medication

in a child-resistant container The tion will be labeled with the child’s first andlast names; specific, legible instructions foradministration and storage supplied by themanufacturer; and the name of the healthcare provider who recommended the med-ication for the child

medica-2) Instructions for the dose, time, method to beused, and duration of administration will beprovided to the child care staff in writing (by

a signed note or a prescription label) or tated over the telephone by a physician orother person legally authorized to prescribemedication This requirement applies both

dic-to prescription and over-the-counter tions

3) A physician may state that a certain tion may be given for a recurring problem,emergency situation, or chronic condition

medica-The instructions should include the child’sname; the name of the medication; the dose

of the medication; how often the medicationmay be given; the conditions for use; andany precautions to follow Example: chil-dren may use sunscreen to prevent sunburn;

children who wheeze with vigorous exercisemay take one dose of asthma medicinebefore vigorous active (large muscle) play;

children who weigh between 25-35 poundsmay be given 1 teaspoon of acetaminophen

160 mg/5cc (1 teaspoon) for up to two dosesevery four hours for fever A child with aknown serious allergic reaction to a specific

substance who develops symptoms afterexposure to that substance may receive epi-nephrine from a staff member who hasreceived training in how to use an auto-injec-tion device prescribed for that child (e.g.,Epipen®) A child may only receive medica-tion with the permission of the child’s parent

or legal guardian and when the staff personwho will give the medication has demon-strated to a licensed health professional theskills required

4) Medications will be kept at the temperaturerecommended for that type of medication, in

a sturdy, child-resistant, closed container that

is inaccessible to children and preventsspillage

5) Medication will not be used beyond the date

of expiration on the container or beyond anyexpiration of the instructions provided by thephysician or other person legally permitted

to prescribe medication Instructions whichstate that the medication may be used when-ever needed will be renewed by the physi-cian at least annually

6) A medication log will be maintained by thefacility staff to record the instructions forgiving the medication, consent obtainedfrom the parent or legal guardian, amount,the time of administration, and the personwho administered each dose of medication.Spills, reactions, and refusal to take medica-tion will be noted on this log (sample form

in Appendix M)

7) Medication errors will be controlled bychecking the following 5 items each timemedication is given:

a Right child

b Right medicine

c Right dose

d Right time

e Right route of administration

When a medication error occurs, theRegional Poison Control Center and thechild’s parents will be contacted immediate-

ly The incident will be documented in thechild’s record at the facility

VII Emergency Plan

A First-Aid Kits:

First-aid kits will be located

,kept inaccessible to children, and will be restockedfollowing use to maintain the supply of items list-

ed in Appendix N Additionally, the kit will tain an emergency dose of medication for anychild in the group who may require such medica-tion (e.g Epipen®, metered-dose inhaler for asth-

con-ma, antihistamine for allergic reaction) An priately supplied first aid kit will be taken on trips(walking or vehicular) to and from the facility

appro-will check the contents of the first aid kits and replace miss-ing or expired items monthly (Sample form inAppendix R)

B Emergency Phone Numbers:

All caregivers will have immediate access to adevice that allows them to summon help in anemergency

The telephone numbers of the Fire Department,Police Department, Hospital, and Poison Controlwill be posted by each phone with an outside line

Emergency contact information for each child andstaff member will be kept readily available

Telephone numbers for contractors who providespecific types of building repairs for this facilityare kept in .These contractors can be called by

for problems with electricity, heating, plumbing,snow removal, trash removal, and general mainte-nance The list of emergency telephone numbers,and copies of emergency contact information andauthorization for emergency transport will betaken along anytime children leave the facility inthe care of facility staff

Emergency phone numbers will be updated atleast every 6 months Emergency phone numberswill be verified by calling the numbers to makesure a responsive, designated person is available

C Lost or Missing Children:

1) To prevent lost or missing children, staff willcount children frequently while on a fieldtrip A staff person will be responsible forperforming a ‘sweep’ of the area or vehiclethe children are leaving to be sure that no

child is overlooked Staff will identify andimplement specific systems for speedyrecovery of missing children, such as uni-form, brightly colored T-shirts, accessibleidentification and contact information for thechildren, and instructions to older childrenabout what to do if they separate from thegroup Staff will not make the child’s namevisible to a stranger who might use thechild’s name to lure the child from thegroup See XI, E Route Planning and TripSafety 1–8, for related policies

2) If it is determined that a child is missing or

immediately notify the local police orsheriff, the program director, the parents orlegal guardian, and other authorities asrequired by state regulation If on a fieldtrip, the staff will notify the facility manage-ment to assist in the search for the child

D Child Abuse: (See Discipline)

E Injuries or Illnesses Requiring Medical or Dental Care:

1) The caregiver who is with the child and whohas had pediatric first aid training will pro-vide first aid See section XVI StaffPolicies, E Training for pediatric first aidcourse content

2) will activate the Emergency Medical Services

(EMS) system by dialing when immediate medical help is required

(See Appendix L for conditions requiringimmediate medical help)

will contact a parent or legal guardian or, ifthe parent or legal guardian cannot bereached, the alternate emergency contactperson The emergency facility used by theprogram is Prior to a specific medical emergency

will contact the emergency facility to findout what procedures are followed for emer-gency treatment of children not accompanied

by a parent or legal guardian Emergencytransport is provided by

.3) A staff member will accompany the childand remain with the child until the parent orlegal guardian assumes responsibility for the

location

Staff title/name

child Child:staff ratios will be maintained

at all times for the children remaining in thefacility

will substitute for the missing caregiver insuch emergencies

an injury report form (Sample form inAppendix O) as soon after the incident aspossible The form will be signed by the par-ent or legal guardian Copies will be distrib-uted to the parent or legal guardian, thechild’s record at the facility, and the facility’sInjury Log

5) Dental Emergencies:

are the licensed providers who have agreed toaccept emergency dental referrals of childrenand to give advice regarding a dental emer-gency unless otherwise indicated by the par-ent or legal guardian Dental injuries will begiven first aid as in 1 above If emergencydental care is required, a staff member willaccompany the child and remain with thechild until the parent or legal guardianassumes responsibility for the child

F Serious Illness, Hospitalization, and Death:

will immediately notify the

of a serious illness,hospitalization, or death of a child or staff memberthat occurs related to child care or during the childcare day

will plan and carry out communication with staff,families, children, and the community as

appropriate

G Media Inquiries:

Refer all media inquiries to

Do not allow access by the media to the facilityduring a crisis situation Media access will beprearranged at times when staff and families havebeen informed and when such visits will cause theleast amount of disruption to the program

VIII Security and Evacuation

Plan, Drills, and Closings

A Security Plan:

1) Entrances will be protected from rized access by keeping all doors into thefacility locked (to the outside)

unautho-2) In the event of an admission of an individualwho subsequently demonstrates threateningbehavior _ will be used tonotify another adult to call the police and allcaregivers to avoid the area where the threat-ening individual is located

build-• Method used for infants and toddlers:

• Method used for children withdisabilities:

15) Staff will give children clear, simpleinstructions about exiting the facility

Children will stop their activities ately at the sound of the alarm and proceed

immedi-to the exit door

location

16) will carry attendance and emergency contact informa-

tion from the facility to the and compare attendance at the

to the attendance sheet to be sure nochildren or staff have been left behind

17) To assure complete evacuation hasoccurred, the last person to leave each part

of the facility will conduct a final, thorough

‘sweep’ of all areas accessible to children(whether or not children are allowed inthose areas) The facility will post a list ofall areas to be checked as part of the

‘sweep’ in each part of the facility The lastperson to leave will use the list of accessi-ble areas to be sure each area is checked,then take the list to the

Each person who conducted a ‘sweep’ willsign the list of areas checked and give thelist to

If a child who should have been evacuatedwith the group is located as a result of afinal ‘sweep’ during an evacuation drill, thedirector will investigate the circumstancesthat led to the failure to evacuate that childand plan how to avoid such problems in thefuture

18) If reentry into the building is not possible,children will be evacuated to

Staff should remain calm and speak to thechildren in a reassuring manner

19) The temporary shelter will be stocked withsupplies and materials necessary for theprogram to take care of children until par-ents, legal guardians or designated personscan take the children home

10) Families will be notified by telephone orradio/television broadcast on

The radio station/television station call ters are also listed in the Family Handbook

let-11) Evacuation procedures will be posted in the

12) Evacuation drills will be held monthly Thetiming of the drills will be varied to includeearly morning, mealtimes, and nap times

Children will be appropriately prepared for

and reassured during drills

will complete the Evacuation Drill Log atthe end of each drill (Sample EvacuationDrill Log in Appendix P)

13) At least one drill per year will be observed

by a representative of the Fire Department

or equivalent emergency or disaster ning personnel

plan-14) All new staff will receive preservice ing on the evacuation plan

train-C Fire or Risk of Explosion:

1) Anyone who discovers smoke, fire or risk ofexplosion will pull the fire alarm located at

, and notify

by calling from a safe location after being sure that evacuation of thebuilding takes place

2) Staff will follow the posted EvacuationProcedures

3) The last person to leave a room will closethe doors of that room

4) are authorized to use the fire extinguisher where

necessary and safe

5) will report a fire or explosion to the child care

licensing agency within 24 hours

D Power Failures:

1) Caregivers will comfort the children, explainthe situation, and model for them how toremain calm

2) will discover if the power outage is confined to

the facility or includes the neighborhood orsurrounding areas

3) To activate the emergency lighting system inthis facility,

will check that a battery-operated system hasbeen automatically activated, or will usesome other system Flashlights are stored in

.4) Unless the power failure is accompanied by

an emergency situation requiring evacuation(e.g., fire, flood, etc.), children will be keptinside Should it be necessary to leave thebuilding, staff will follow emergency evacua-

location where evacuees will gather location where evacuees will gather

location where evacuees will gather

name and location of the temporary shelter to be used in emergency

station call letters/numbers Staff title/name

location Staff title/name

tion procedures Staff will look for andavoid any downed power lines.

E Closing Due to Snow/Storm:

1) If decides prior to opening hours not to open thefacility, families will be notified by tele-phone, radio or television broadcast on

.2) If the facility must close during operatinghours because of snow or storm,

will notify families by telephone, radio or televisionbroadcast on 3) If weather conditions prevent a parent orlegal guardian from reaching the facility torecover a child,

will care for the child (maintaining properchild:staff ratios) until such time as the par-ent or legal guardian can safely reclaim thechild If the parent, legal guardian, or emer-gency contact person cannot reclaim a childwithin , the child will be cared for at , where the child will receive food, warmth, and have aplace to rest If children must remain at thechild care facility, will use

a three-day supply of emergency food, water,clothes, blankets, flashlights, diapers andother necessary articles stored in

to care for such children

F Floods, Tornadoes, Hurricanes, Earthquakes, Blizzards or Other Catastrophes:

1) is responsible for contacting local Emergency

Preparedness Authorities and obtaining ten instructions for what to do in the event ofemergency that may occur in the region

writ-2) Anyone who learns about a significant health

or safety hazard will notify

by calling

so appropriate action can be taken

3) Staff will follow the appropriate, postedEmergency Procedures for the catastropheand wait for authorities to arrive

IX Authorized Caregivers

A Documentation of Authorized Caregivers:

will maintain in the files, written authorization by thechild’s parent or legal guardian of the names,addresses, and telephone numbers of individualswhom the parent or the legal guardian have approved

to care for the child, to pick up the child for them,and to take the child out of the facility on trips

B Sign-In/Sign-Out Procedure:

Caregiving adults who bring the child to,

or remove the child from, the facility will sign children in and out of the facility Thispolicy will be provided to families at the time ofenrollment and will be strictly enforced

C Policy for Handling an Unauthorized Person Seeking Custody:

1) will contact the custodial parent or legalguardian named on the Application for ChildCare Services

2) Telephone authorization to release a child tosomeone who does not usually pick up thechild will be accepted only in concert withprior written authorization from the custodialparent or legal guardian for such an excep-tional release The staff person who acceptssuch authorization will call the previouslydocumented phone number of the parent toverify that the parent is activiating a phoneauthorization for release of the child Thestaff person will document the results of thiscall in the child’s record, as well as the timeand to whom the custodial parent or legalguardian gave telephone authorization forrelease of the child

station call letters/numbers

station call letters/numbers

station call letters/numbers

Staff title/name

amount of time

Staff title/name insert location

3) No child will be released without the ence or permission of the custodial parent orlegal guardian.

pres-4) Any authorized person who is not nized by the staff will be required to providephoto identification such as a driver’slicense, work or school ID before the child isreleased The custodial parent or legalguardian may provide a photograph ofauthorized persons for pick up of the childwhich will be kept in the child’s record atthe facility

recog-5) will notify the police if an unauthorized person

seeks custody of the child

D Policy for Handling Persons Who May Pose a Safety Risk:

(Includes abusive parents or legal guardians andany adults who cannot take the child safely fromthe facility)

1) The child will not be released to anyone whocannot safely care for the child

2) will notify the police by calling

to manage an adult under the apparent ence of drugs/alcohol or an individual whoposes a safety risk

influ-3) will contact the emergency contact person to

make arrangements for the child’s transport

to a place of safety If no one is available tocare for the child,

will contact child protective services forguidance

to arrange for correction of hazardous conditionsidentified Written reports of the inspections andcorrections will be kept in the program files

(Sample site inspection checklist is in Appendix Q) 1) Escape Hazards:

will maintain and review with the staff annually alist of potential high risk locations/situationswhere a child might escape unnoticed from thegroup Staff will use this list to plan for increasedsupervision in these high risk locations and situa-tions If such a high risk escape hazard is identi-fied between annual reviews, staff will take actionimmediately

2) Evacuation Hazards:

will be responsible for establishing and updating achecklist of locations to be assessed duringevacuation to assure complete surveillance of thebuilding before an evacuation is declared com-plete The checklist will identify usual and likely-to-be-forgotten locations such as: under a cot,behind a sofa, in a toy bin, in a closet, kitchen, ortoilet room (See VIII Evacuation Procedure,

B 4)

B Review of Injury Reports:

Whenever an injury occurs, a copy of a pleted Injury Report Form will be filed in theInjury Log (Sample Injury Report Form inAppendix O) The Injury Log will be reviewed by

com-and by the health consultant at least every three months toidentify hazards for corrective action

XI Transportation and Field Trips

A Daily Transport to and from the Program:

All motor vehicle transportation provided byparents, legal guardians or others designated byparents or legal guardians will include use of age-appropriate, and size-appropriate seat restraints

Staff title/name, with assistance of the parent or legal guardian, and/or child group

(car seats and/or seat belts) If the parent or legalguardian does not provide appropriate seatrestraints or resists using them for their children,staff will remind them about the risk involved andany applicable laws that require use of restraintsfor transport of children Staff may arrange foreducation of families and staff by local publicsafety and emergency personnel with specializedtraining The trainer will be identified by theNational Highway Traffic Safety Administration(800/424-9393) as an individual who has the nec-essary training Restraints for children with spe-cial needs will be appropriate for the child

Car seats that belong to individual children may

be stored between arrival and departure in

Staff will encourage families to secure their chil-dren in seat restraints to assure that children arriveand leave the program safely

The number of adults and children transported

in the vehicle will be limited to the manufacturer’sstated capacity for the vehicle

4) The vehicle will be air-conditioned when thetemperature inside the vehicle exceeds 82degrees F and heated when temperatures dropbelow 65 degrees F

5) The vehicle will contain a two-way radio orcar phone to communicate to a dispatcher atthe facility

6) A backup vehicle will be available at

and can be dispatched immediately in case of an emergency

7) The following policy statements will be

post-ed prominently and enforcpost-ed in each vehicle:

“No Smoking,” “No Loud Radios or Tapes,”

and “Buckle Up! It’s the Law.”

8) Weekly will inspect all vehicles and passengerrestraint systems used by the facility to be

sure they are kept clean and safe (interior andexterior)

9) The vehicle will be equipped with a notebookcontaining a weekly safety checklist with cor-rections made, injury report forms, and a tripsheet to record destination, mileage, times ofdeparture and return, and a list of passengers

C Driver Requirements:

11) Requirements for drivers will apply to staffand any others who transport children onbehalf of the facility

12) Requirements for staff qualifications related

to child abuse and criminal records willapply to drivers

13) Drivers will hold a current state driver’slicense that authorizes them to operate thevehicle

14) Drivers will be certified in Infant/Child Aid (including choke saving and rescuebreathing for management of a blocked air-way) as required of other staff

First-15) Drivers will be instructed in child passengersafety precautions, including:

• use of safety restraints

• permissible drop-off and pick-up sites

• how to check the vehicle before and aftereach trip for children who might be hiding

in, under and behind the vehicle

• handling of emergency situations

• responsibility for supervision of children

in usual and unusual circumstances thatinvolve the vehicle or the passengers

16) Drivers transporting children with specialneeds will receive a minimum of 6 hourstraining annually in the transport of childrenwith special needs

17) Drivers will not be responsible for correctingthe behavior of children while operating thevehicle Other staff will accompany the chil-dren who require monitoring and willassume responsibility for supervision.(Drivers will pull over to the side of the road

to give children attention if necessary)

18) Drivers will be instructed in the completion

of the weekly safety checklists, injury reportforms, and trip sheets

19) Drivers will obey the signs posted in thevehicle, will not use earphones while

Staff title/name location

location

driving, and will not have used alcohol for atleast 12 hours prior to transporting children

or operating the program’s vehicles Driverswill not take any medications that willimpair their ability to drive The programwill require drug testing when necessary

10) Drivers will know and keep instructions inthe vehicle for the quickest route to the near-est hospital from any point on their route

D Seat Restraint Requirements:

1) Each child will be fastened in his/her ownindividual, correctly installed safety seat, seatbelt, or harness federally approved for thechild’s weight, height, and age until they are

at least 4 feet 9 inches tall and 80 pounds inweight Infants will ride rearward facing atleast until they reach 20 pounds and 12months of age Children in child seatrestraints will not ride facing a passenger sideairbag The safety restraint device must dis-play a label that says that the restraint meetsfederal Motor Vehicle Safety Standard 213

Car seat harness straps will be properlyadjusted to fit the child who uses the seat

2) Restraints will be installed and used according

to the instructions provided by the turer of the vehicle and the manufacturer ofthe seat restraint Since the method of instal-lation of car seats differs from one to another,car seats will be installed in vehicles underthe control of the facility only by staff whohave received training in the use of this equip-ment and in a manner verified as correct by

manufac-an NHTSA-certified car seat technicimanufac-an

3) Field trips will be limited to excursions whereparents can drive their own children or thechildren are transported in a vehicle undercontrol of the facility that is equipped withage-appropriate seat restraints for the childrenwho will be traveling in them The programwill not assume responsibility for arrange-ments made by parents to have other parentstransport their children Monthly,

will check the recall list maintained by the National

Highway Traffic Safety Administration for carseats that cannot be used

4) For children who travel in wheelchairs, thefacility will provide 4-point tie-downs in aforward-facing direction and a three-pointrestraint system for the occupant separatefrom the wheelchair restraint The tie-downsystem will be placed through the wheelchair

in the exact location specified by the facturer Only wheelchairs that are labeled assuitable for use in transportation will be used

manu-in the vehicle

5) Compliance with the above policies will bedetermined by spot checks and interviews per-formed by the program director

E Route Planning and Trip Safety:

map out all routes in advance, provide thisinformation to drivers, parents, legalguardians and accompanying caregivers, andensure adequate insurance coverage

2) The location of rest rooms, sources of waterand telephones will be determined inadvance Children may only use a publicrest room if they are accompanied by a staffmember

3) All trip participants will wear identifyinginformation that, for children, gives the pro-gram’s name and phone number

4) A parent or legal guardian will sign aninformed consent form for trips for eachchild before each trip

5) A first-aid kit, emergency contact tion, and emergency transport authorizationinformation for the children in the group will

informa-be taken on all trips

6) Children will be counted every 15 minuteswhile on a field trip

7) Walking trips:

• The children will learn pedestrian safety

by caregiver role-modeling and verbalreinforcement Caregivers will teachchildren to cross only at the corner,when traffic signals indicate it is safe tocross, and only after looking left, rightand left again

• Caregivers will keep younger childrentogether through use of a travel rope (aknotted rope which is stretched betweentwo caregivers and which the children

Staff title/name

Staff title/name

hold onto while they walk), by having

an adult hold each child’s hand, or byanother means that keeps the child phys-ically connected to an adult at all times

A designated adult will supervise thechildren at the front and another adult atthe back of each group

8) Motor vehicle trips:

• No child who is too small to use ashoulder-lap belt restraint and airbagsystem (as specified by the manufacturer

of the vehicle) will ride in the front seat

• If the vehicle is a school bus, beforeevery trip in the bus, staff will instructchildren and all adults using the busabout the 10 foot danger zone aroundthe vehicle where the driver cannot see

• Caregivers will interact with childrenwho are awake while traveling by tellingstories, singing songs, playing games, ortalking about what the children see

• Staff will explain rules of the road andprovide a positive example by obeyingthese rules; children will be asked topoint out and identify traffic warningsigns

• No child will be transported for morethan an hour, one way, on a daily basis

responsible for assuring all children areaccounted for before the vehicle leavesthe facility, when the children disembark

at the destination, when the childrenreenter the vehicle at the trip location,and again when the children disembarkfrom the vehicle upon return to the facil-ity Staff will conduct a ‘sweep’ of thevehicle each time the vehicle is parked

to be sure that no child is left in thevehicle

• The same child:staff ratios required atthe facility will be maintained duringtransportation The driver will not becounted as staff in the ratio for childrenunder six years of age

• Each child will be assigned to an adultfor every part of the trip

• Children will never be left alone in avehicle or unsupervised by an adult

• For children who have special needs fortransportation, the facility will use aplan based on a functional assessment ofthe child’s needs related to transporta-tion that is filled out by the child’sphysician This plan will address spe-cial equipment, staffing and care in thevehicle during transport

XII Sanitation and Hygiene

A Handwashing:

1) Signs will be posted at each sink with thetimes when handwashing is required and thesteps to follow

2) All staff, volunteers, and children will washtheir hands at the following times

(as applicable):

a) upon arrival for the day, when movingfrom one child care group to another orcoming in from outdoors

b) before and after:

• eating, handling food, or feeding achild

• giving medication

• playing in water that is used by morethan one person

c) after:

• diapering and toileting

• handling bodily fluids (mucus, blood,vomit) and wiping noses, mouths, andsores

• cleaning or handling garbage

• handling pets or other animals

c) Dry hands with paper towel or approveddrying device Drying devices will not be

Staff title/name

used unless there is a faucet that does notrequire the user to touch the faucet afterthe hands are washed.

d) Use a towel to turn off the faucet and, ifinside a toilet room with a closed door,use the towel to open the door Discardthe towel in an appropriate receptacle

e) Apply hand lotion, if needed

If a child is too heavy to hold for handwashing

at the sink, and cannot be brought to the sink forhandwashing, use disposable wipes or a damppaper towel moistened with a drop of liquid soap

to clean the child’s hands Then wipe the child’shands with a paper towel wet with clear water

Dry the child’s hands with a fresh paper towel

Note: this method is less satisfactory than washing

at the sink where the soil can be rinsed off in ning water

run-B Diapering:

1) Diapering will be done only in a designateddiapering area Food handling will not bepermitted in diapering areas

2) Surfaces in diapering areas will be keptclean, waterproof, and free of cracks, tears,and crevices

3) All containers of lotions and cleaning itemsare to be labeled with each child’s name andinstructions and stored off the diapering sur-face and out of reach of children

4) All staff and volunteers will follow the lowing diapering procedures:

fol-a) Collect all supplies, but keep everythingoff the diapering surface except the itemsyou will completely use up during the dia-pering process: Prepare a sheet of non-absorbent paper that will cover the diaperchanging surface from the child’s chest tothe child’s feet Bring a fresh diaper, asmany wipes as needed for this diaperchange, non-porous gloves (e.g latex orvinyl, if used), a plastic bag for any soiledclothes, and a dab of any diapering cream

if the baby uses it Take the supplies out

of the containers and put the containersaway where they will not be touched dur-ing the diaper changing process

b) Avoid contact with soiled items, andalways keep a hand on the baby

Anything that comes in contact with stool

or urine is a source of germs These willhave to be cleaned and sanitized aftereach diaper change where potential con-tact with soiled items occurred Carry thebaby to the changing table, keeping soiledclothing from touching the caregiver’sclothing Bag soiled clothes and, later,securely tie the plastic bag to send theclothes home

c) Unfasten the diaper, but leave the soileddiaper under the child Hold the child’sfeet to raise the child out of the soiled dia-per and use disposable wipes to clean thediaper area Remove stool and urine fromfront to back and use a fresh wipe eachtime Put the soiled wipes into the soileddiaper Note and report any skin prob-lems such as redness

d) Remove the soiled diaper, clean soiledsurfaces, and then remove gloves

1) Fold the diaper over and secure it withthe tabs Put it into a covered, lined,foot pedal-operated step can Ifreusable diapers are being used, put thediaper into the plastic-lined step can forthose diapers or in a separate plasticbag to be sent home for laundering

Do not rinse or handle the contents ofthe diaper

2) Check for spills under the baby Ifthere is visible soil, remove any largeamount with a wipe, then fold the dis-posable paper over on itself from theend under the child’s feet so that aclean paper surface is now under thechild

3) Remove the gloves if gloves are beingused and put them directly into the stepcan

4) Use a disposable wipe to wipe the giver’s hands

care-e) Put on a clean diaper–slide the diaperunder the baby, adjust it, apply any skincream if the child uses it, and fasten thediaper

f) Clean the baby’s hands, using soap andwater at a sink if you can If the child istoo heavy to hold for handwashing andcannot stand at the sink, use disposable

wipes or soap and water with disposablepaper towels to clean the child’s hands.

Dress the baby before removing him fromthe diapering surface Take the child back

to the child care area

g) Clean and disinfect the diapering area

1) Dispose of the table liner into the stepcan

2) Clean any visible soil from the ing table

chang-3) Disinfect the table by spraying it so theentire surface is wet with bleach solu-tion (1 tablespoon of household bleach

to 1 quart of water; mixed fresh daily)

Leave the bleach on the surface for

2 minutes The surface can then bewiped dry or left to air dry

h) Wash hands thoroughly as directed in XIIA.3 above

C Toileting:

Toilets will be kept visibly clean Toiletsshould be separate from the children’s activityarea Children less than 5 years of age and olderchildren who require assistance will be accompa-nied to the toilet by an adult

Toilets will be adapted for independent use bythe child A non-slip plastic step, and a toilet seatadapter with a non-porous surface which is easy towash and sanitize may be used Daily,

will clean and sanitize the toilets, step stools, toilet seatadapters and other surfaces used by children fortoileting and when visibly soiled

Potties (potty chairs, training chairs) will not bepermitted because of the risk of spreading infec-tious diarrhea The only exception will be forindividually assigned potties that will be used andstored only in the toilet room After each use,

will empty the potty into the toilet, clean, and disinfect

it The utility sink that is designated for cleaningand sanitizing potties is in .This utility sink will be used for no other purpose

will assure that toilet paper and holders, paper towels,soap dispensers, and disposable non-porous glovesare available within easy reach of all users

will monitor toileting areas on a weekly basis to ensure

that proper handwashing and cleaning proceduresare followed

Anyone who cleans toilets or potties will wearnonporous gloves Staff who are involved withtoileting or cleaning of toilets will adhere to hand-washing routines before leaving the toilet roomand again before food handling

D Facility Cleaning Routines:

The facility will be maintained in a clean andsanitary condition When a spill occurs, the areawill be made inaccessible to children and

will be notified about the need for clean-up When sur-faces are soiled by body fluids or other potentiallyinfectious material, they will be disinfected afterthey are cleaned with soap and water to remove allorganic material Surfaces will be disinfectedusing a (non-toxic) solution of 1/4cup of house-hold bleach to one gallon of tap water (or 1 table-spoon of household bleach to 1 quart of water)

To disinfect, the surface will be sprayed untilglossy The bleach solution will be left on for atleast 2 minutes before it is wiped off with a cleanpaper towel, or it may be allowed to air dry.The facility will provide training for staff whoare responsible for cleaning Such training willinclude cleaning techniques, proper use of protec-tive barriers such as gloves, proper handling anddisposal of contaminated materials, and informa-tion required by the United States OccupationalSafety and Health Administration about the use ofany chemical agents

Routine cleaning of the facility will be vised by

super-according to the schedule and procedures inAppendix R

Caution will be used when shampooing rugs inareas used at any time for children to crawl.Facility cleaning requiring potentially hazardouschemicals will be scheduled to minimize exposure

of the children

E Pets:

will be responsible for checking that the appropriate careinstructions for pets are followed

Pets will meet with the following guidelines:1) Any pet or animal present at the facility,indoors or outdoors, must be in good health,

show no evidence of carrying any disease,and be a friendly companion for the chil-dren Dogs, cats, and other furry animals, ifallowed, will be immunized for any diseasewhich can be transmitted to humans and will

be maintained on a flea, tick, and worm trol program The following animals will not

con-be permitted in child care:

• ferrets

• turtles or other reptiles that can carrysalmonella

• birds of the parrot family

• any wild or dangerous animals 2) Pets will be kept clean and housed in cleanliving quarters Children will not be allowedaccess to the pet’s food or excrement

Animal tanks and cages will be secured insuch a manner that prevents children fromclimbing on the structure and prevents thestructure from tipping over

3) All pets will be enclosed in cages or

separat-ed by some other means from the childrenexcept when children are handling themunder adult supervision Children will notmouth pets or put their hands in their mouthsafter touching the pet or areas used bythe pet Pets will not be allowed in areaswhere food is prepared, stored or eaten

4) Children, caregivers, and staff will followproper handwashing procedures afterhandling animals

5) In the event of an animal bite or scratch,procedures for first aid and notification ofparents or legal guardians contained in thesepolicies will be followed

F Plants:

will be responsible for checking that all plants receive theappropriate care instructions and meet the follow-ing guidelines:

1) A list of poisonous plants, their appearance,location, and commonly produced reactions

is available from local poison control ters These plants will not be permitted inthe facility environment

cen-2) No plants are permitted that are toxic, ate a lot of pollen, or that drop small flowers

gener-or leaves

3) Plants will be regularly dusted Childrenwill not be allowed to put plants in theirmouths

4) Children, caregivers, and staff will followproper handwashing procedures afterhandling plants

5) In the event of contact with a poisonousplant, the regional poison control center will

be consulted for instructions, emergency cedures will be followed, and the child’s par-ent or legal guardian will be notified as soon

pro-as possible

G Toys:

will be responsible for checking that all toys receive theappropriate care and meet the following guide-lines:

1) will check toys accessible to children under 4

years of age using a small object tester orruler Objects are prohibited that haveremovable parts, or a diameter of less than

11/4inch and a length of less than 21/4inches,

or are small enough to fit completely in achild’s mouth No latex balloons, plasticbags, and styrofoam objects can be accessi-ble to children under 4 years of age

2) Children in diapers will have only washabletoys Each group should have its own toysand not share toys with other groups

3) All toys that are mouthed during the course

of the day will be set aside in an inaccessiblecontainer before another child plays with thetoy Mouthed toys will be thoroughlywashed with soap and water, and disinfected

Toys may be washed and disinfected byhand or by washing in a dishwasher Towash and disinfect hard plastic toys: soakand scrub the toy in warm, soapy water Use

a brush to get the crevices clean Rinse inclean water, then immerse the toy in a solu-tion of bleach water as when washing dishes

by hand (See XIII B.13 below)

4) Cloth toys for children who are stillmouthing toys will be limited to use by onlyone child and cleaned in a washing machineand dried in a clothes dryer every week, ormore often if heavily soiled

Staff title/name

Staff title/name

Staff title/name

5) Toys used by children who do not put theseobjects in their mouths will be cleaned atleast weekly and when obviously soiled.

Soap or detergent and water followed byclear water rinsing and air drying will beused No disinfecting is required

6) Water tables where more than one childplays in the same water will not be usedunless the container and toys are disinfectedbefore each use of the table, the children allwash their hands before they use the table,and staff supervise the water play closely to

be sure no child drinks the water or has anycontact between body fluids (from thechild’s nose, mouth, eye) and the water inthe water table An alternative to these pre-cautions is to give each child a personalbasin of water for play and supervise to besure children confine their play to their ownbasin

7) Toys that develop sharp edges, are coated withlead paint, have breakable glass, have screwsthat have unthreaded, or that present risks ofinjury from common use will be repaired ordiscarded

H Exposure to Blood and Other Potentially Infectious Materials:

1) Staff will follow the standard precautionsfor child care recommended by the Centersfor Disease Control and Prevention inhandling any fluid that might contain blood

or other body fluids Standard precautionsrequire treating all blood, fluids that maycontain blood or blood products, and otherbodily fluids as potentially infectious Theinstructions for implementing standardprecautions are:

• Spills of body fluids, feces, nasal and eyedischarges, saliva, urine and vomit should

• Clean and disinfect any surfaces, such ascountertops and floors, on to which bodyfluids have been spilled

• Discard fluid contaminated material in aplastic bag that has been securely sealed

• Mops used to clean up body fluids should

be cleaned, rinsed with a disinfecting tion, wrung as dry as possible, and hung todry completely

solu-• Be sure to wash your hands after cleaningany spill

2) is responsible for: developing the Blood-borne

Pathogens Exposure Plan (required by theUnited States Occupational Safety andHealth Administration (OSHA) for any facili-

ty with employees), ensuring all staff bers are trained in ways to protect themselves,and ensuring that the facility follows the rec-ommendations for immunization againsthepatitis b for those whose job includes therisk of exposure to blood The facility’sBloodborne Pathogens Exposure Plan willconform to the requirements reflected in themodel plan provided by OSHA

mem-XIII Food Handling and Feeding Policy

A Drinking Water:

Safe drinking water will be accessible to dren who can serve themselves and offeredbetween meals to all children, while indoors andoutdoors The drinking water source will beapproved by the local health department Staffwill contact the local health department to be suretheir source of water is free of lead, parasites, bac-teria and other contaminants Drinking water will

chil-be dispensed by personal water bottle, in drinkingfountains, or by single-use paper cups

Drinking water will be offered to children whoare over 2 years of age after each snack or meal

Younger children will be offered water by givers during the day, such as between feedings

care-Caregivers will offer water to children morefrequently when the temperature is above

Staff title/name

bacteria or viruses that can be carried infood, will be responsible for food handling.

12) Those who prepare food will not changediapers and vice-versa Where more thanone caregiver works in a facility, handwash-ing routines followed by those who preparefood will be monitored by

at least once a week In family child care homes,where there is only one caregiver who musthandle food and perform toileting anddiaper changing, the caregiver will washhands carefully after contact with stool andurine and before handling food

13) Handwashing sink(s) will be separate fromfood-preparation sink(s)

14) Refrigerators will be maintained at a perature below 40 degrees F, and freezerswill be maintained below 0 degrees F

tem-15) All ground meat will be cooked to reach

160 degrees F; poultry breasts will reach

170 degrees F; dark meat poultry will reach 180 degrees F and pork will reach

160 degrees F All other foods will be fullycooked to reach at least 140 degrees F

16) Hot foods will be kept at or above

140 degrees F after they are fully cooked,and cold foods will be kept at or below

40 degrees F These temperatures will bemaintained until the foods are served

will checkfood temperatures using a food thermome-ter Freezers will maintain a temperature of

0 degrees F Refrigerators and freezers willhave thermometers which

will check weekly to be sure the ate temperature is being maintained (SeeAppendix T for Refrigerator or FreezerTemperature Log.)

appropri-17) All food stored in the refrigerator exceptfresh, whole fruits and vegetables will becovered, wrapped, or protected from contamination

18) Inside a refrigerator, cooked or ready-to-eatfoods will be stored above raw foods thatrequire cooking

19) Food preparation, storage and service areasand equipment will be kept clean, sanitary,and will conform with national guidelines

(See Caring for Our Children,

http://nrc.uchsc.edu)

10) Foods that do not require refrigeratedstorage will be kept at least 6 inches abovethe floor in clean, dry, well-ventilatedstorerooms or other approved areas

Storage will facilitate easy cleaning

11) Containers will be of a type that protectfood from rodents and insects Dry, bulkfoods (cereals) which are not in their origi-nal, unopened containers will be stored offthe floor in clean metal, glass, or food-grade plastic containers with tight-fittingcovers These containers will be labeledand dated

12) Medications requiring refrigeration will bestored as specified in VI MedicationPolicy

13) Cutting boards will be made of nonporousmaterial and will be scrubbed with hotwater and detergent and disinfected withbleach/water solution made of 1 tablespoon

of household bleach to one quart of waterbetween use for different foods Boardswith crevices and cuts will not be used

14) A dishwasher will be used to wash dishesand food service utensils whenever possi-ble If dishes and utensils are washed byhand, the following procedure will be followed:

• Use a three compartment sink or threebasins for the separate tasks of washing,rinsing, and disinfecting No compart-ment that is used for this purpose willever be used for handwashing or diaperchanging activities Use a dish rack with

a drain board for drying Where ble, cloth that can be laundered will beused instead of sponges If a sponge isused during dish washing, it must becleaned and disinfected between uses bybeing squeezed out in a bleach solutionaccording to the instructions on thebleach container

possi-• In the first compartment, wash dishes andutensils in hot tap water with a dishwashing detergent

• In the second compartment, rinse thedishes and utensils thoroughly with hottap water

Staff title/name

Staff title/name

Staff title/name

• In the third compartment, immerse thedishes and utensils for at least one minute

in a solution of bleach water that contains

11/2tablespoons of bleach for each gallon of hot tap water that is at least

75 degrees F

• Place the dishes in a rack to air dry Donot use a dish towel to dry dishes or uten-sils

15) Bottles, bottle caps, and nipples will not

be reused without first being cleaned anddisinfected

16) Washable napkins and bibs will be dered after each use; tablecloths will bekept clean

laun-17) Children who can feed themselves will sit

in a chair that puts the table at a levelbetween their waist and their mid-chest andallows their feet to rest on the floor or on afirm surface while they eat

18) Food that has been served and not eatenfrom individual plates, containers andfamily-style serving bowls will bediscarded

19) Containers which hold organic material(food, soiled tissues) shall be covered with

a tight-fitting lid These containers will beclosed after each use except when childrenare participating in clean up Garbage/trashwill be removed from the facility daily

20) Cleaning agents will be stored separatelyfrom food When cleaning agents or toxicmaterials are stored in the same room withfood, these supplies will be kept in a clearlylabeled, locked storage cabinet that is notused for food

C Food Brought from Home:

will inform parents or legal guardians of the foodservice plan of the facility and suggest ways tocoordinate with this plan (See Appendix S forMeal Pattern Requirements) The facility willsupplement a child’s home-provided meal if thenutritional content appears to be inadequate Theparent or legal guardian will be informed by staff

if food brought from home is being supplemented

on a regular basis Caregivers will check for foodallergies before providing any supplemental food

In this facility, food may be brought from homeunder the following conditions: (for special occa-sions, for lunch, for snack) Meals may be provid-

ed by the family upon written agreement betweenthe parent or legal guardian and staff

1) Perishable food brought from home to beshared with other children must be store-bought and in its original package Bakedgoods may be made at home if they are fullycooked, do not require refrigeration andwere made with freshly purchased ingredi-ents There must be enough for all thechildren

2) Lunch and snack foods brought from homewill meet the guidelines of the Child andAdult Care Food Program for the types offoods and portion sizes They will beprepared and transported in a sanitary fash-ion, including maintenance of safe foodtemperatures for perishable items

will check the arrival temperature and storage require-ments of food brought from home Foodthat is not at a safe temperature when itarrives will be discarded Perishable foodsthat require refrigeration will be kept below

40 degrees F and perishable hot foods will

be kept above 140 degrees until served.Food brought from home will be labeledwith the child’s name, the date, the type offood, and any need for temperature control.3) Children will not be allowed to share foodprovided by the child’s family unless thefood is intended for sharing with all of thechildren

4) Leftover food will be discarded The onlyfood that may be returned to the family isfood that does not require refrigeration orholding at a hot temperature, that came tothe facility in a commercially-wrapped pack-age, and that was never opened

D Food Prepared at or for the Facility:

1) Menu Planning and Portion Control:

is responsible for menu planning and portions Menu plans andfood service routines will be reviewed

with a registered dietician

or person with comparable nutrition and food vice expertise (Check with children’s hospitals,other pediatric health care facilities, or the health

ser-Staff title/name

Staff title/name

frequency

Staff title/name

department for qualified nutritionists) (SeeAppendix S for Meal Pattern Requirements).

2) Food Purchasing/Ordering:

is responsible for assuring that all purchased food meets the fol-lowing requirements:

• Suppliers of food and beverage meet local,state, and federal codes

• Purchased meats and poultry have beeninspected and passed by federal or stateinspectors

• All milk products are pasteurized

3) Food PreparationFood will be prepared following the policieslisted under B Food Safety/Dishes, Utensils andSurfaces, above In addition:

• Dry milk and milk products may be stituted in the facility for cooking purposesonly, provided they are prepared, refriger-ated, and stored in a sanitary manner,labeled with a date of preparation, andused or discarded within 24 hours of thedate of preparation

recon-• Home-canned food, food from dented,rusted, bulging, or leaking cans, or foodfrom cans without labels will not be used

• Fruits and vegetables will be washed oughly with water before use

thor-• Frozen foods will be defrosted in therefrigerator, under cold running water, aspart of the cooking process, or by usingthe defrost setting of a microwave oven,and never by leaving them at room tem-perature or in standing water, as in a pan

or a bowl

• Meat, fish, poultry, milk, and egg productswill be refrigerated until immediatelybefore use

• Hot foods will be steamed for no longerthan 30 minutes before covering andrefrigerating

E Infant/Toddler Feeding:

will obtain and review a written description of each child’sfeeding history before the child enters the pro-gram Consultants, including nurses, nutritionists,speech therapists, occupational therapists, and

physical therapists may assist in the formation ofindividual feeding plans (Check with children’shospitals, other pediatric health care facilities, orthe health department for consultants) Otherwise,the following procedures will be used:

11) A caregiver trained in first-aid for chokingwill be present whenever infants or toddlersare being fed No more than three infantswill be fed by one caregiver During feed-ing, the child’s primary caregiver will sitnear the child, make eye contact and com-municate with the child

12) Food will be cut up into 1/4- 1/2 inch piecesfor finger feeding by children who are sixmonths of age and older Utensils will beavailable to children who can use them

13) Round, firm foods that might lodge in thethroat of a child under 4 years of age arenot permitted These foods include hotdogs, whole grapes, peanuts, popcorn,thickly spread peanut butter, and hardcandy

14) When high chairs are used, caregivers willstrap the child in securely and not rely sole-

ly upon the tray for restraint

15) Caregivers will check that a child’s handsare out of the way when attaching ordetaching the tray from the chair

16) Infants will not be allowed to stand in thehigh chair; older children will not be per-mitted to hang onto the high chair

17) Trays, arms, and seats of high chairs will becleaned and disinfected before and aftereach use They will be stored out of thepath of doors or walkways

18) For bottle feeding, infants will either beheld or fed sitting up Bottle propping,feeding in cribs, beds or while using othersleep equipment, and carrying of bottles byyoung children will not be permitted

19) Infants will be fed “on demand” to theextent possible, but at least every four hoursand usually not more than hourly

10) Infant meals and supplements (snacks) vided by the facility will contain at a mini-mum the food components specified innational guidelines (See Appendix S)

pro-Food will be appropriate for a child’s tional requirements and developmentalstage specified in written instructions

nutri-Staff title/name

Staff title/name

obtained from the child’s parent, legalguardian or health care provider.

11) The introduction of solid foods will beaccomplished routinely between 4 and

6 months of age, as indicated by an ual child’s nutritional and developmentalneeds after consultation with the parent orlegal guardian Modification of basic foodpatterns will be provided in writing by thechild’s health care provider

individ-12) After six months of age, children will beencouraged to self-feed to the extent thatthey have the necessary skills They will beoffered a choice of foods from a limitednumber of appropriate options Caregiverswill prepare food for self-feeding beforepresenting it to the child Children will beencouraged, but not forced to eat a variety

of foods

13) Breastfeeding: Breastfeeding will be ported by providing a place for nursingmothers to feed their babies and by coordi-nating feeding routines in child care withthe mother’s schedule Mothers whodesire privacy for breastfeeding may use

sup-.Expressed breast milk may be brought fromhome if frozen or kept cold during transit

Fresh breastmilk must be used within 48hours Previously frozen, thawed breast-milk must be used within 24 hours Bottleswill be labeled with the child’s name andthe date the milk was expressed Frozenbreast milk will be dated and may be kept inthe freezer located in _

for up to 3 months (a freezer that maintains

a temperature of 0 degrees F) Frozenbreast milk will be thawed under runningcold water or in the refrigerator Precau-tions appropriate to the handling of a bodyfluid will be followed This includes goodhandwashing Gloves are not requiredwhile feeding expressed breast milk, butbreast milk should otherwise be treated as abody fluid Caregivers who have open cuts

or sores on their hands should practiceuniversal precautions In the event thatbreast milk is accidentally fed to an infantwhose mother did not provide the breastmilk fed to the child, the procedure outlined

in Standard 3.027 of Caring for Our Children will be implemented to address

the potential exposure of the infant to avirus-containing fluid

14) Formula will be brought to the facility in afactory-sealed container The formula will

be in a ready-to-feed strength or preparedfrom powder or concentrate at the childcare site Formula will be diluted accord-ing to the instructions provided by the man-ufacturer or from the child’s health

provider, using water from a sourceapproved by the local health department.Formula brought from home will be labeledwith the child’s name

15) Only cleaned and disinfected bottles andnipples will be used All filled bottles ofbreast milk or iron-fortified formula will berefrigerated until immediately prior to feed-ing, and will not be prepared and storedmore than 24 hours before feeding occurs.Once open, liquid formula containers will

be emptied into a glass or plastic container,the formula refrigerated and discarded after

48 hours Any contents remaining in afeeding bottle after a feeding will be dis-carded

16) Bottled breast milk or formula to bewarmed will be placed in a pan of warmwater at a temperature not to exceed 120degrees F for five minutes, gently mixed,and temperature-tested before feeding.Bottled breast milk or formula will never

be warmed in a microwave oven

17) Only whole, pasteurized milk will beserved to children younger than 24 months

of age who are not on formula or breastmilk Only formula or breast milk will beserved to infants under 12 months of age Skim milk, reconstituted nonfat dry milk,and 1-2% milk will not be served to chil-dren younger than 24 months of age, except

at the written direction of a parent or legalguardian and the child’s health careprovider

18) Commercially packaged baby food will beserved from a bowl or cup and not directlyfrom the commercial container unless theentire container will be used for one feed-ing Solids will be fed by spoon only, not

by bottle Uneaten food in dishes will bediscarded

location in the facility

location

F Preschool/School-age Feeding:

1) Children will help with setting the table,serving food and cleaning the table Wherepossible, family style service will be used

to allow children to learn how to servethemselves

2) Children will eat only when seated todecrease the possibility of choking

3) Children will eat in social groups with acaregiver to guide and encourage, but notforce appropriate conversation and eatingbehavior If a child refuses to eat some type

of food, staff will offer the food again a littlelater or prepared differently the next time

4) Food will not be offered as a reward ordenied as punishment

5) Adults will not eat or drink anything thechildren are not allowed to have while theadults are in view of the children

G Feeding of Children with Nutritional Special Needs:

Children with special needs related to theirability to eat or a nutritional need will have anindividual management plan that includes a writ-ten description of each child’s feeding history,including prohibited foods, and substitute foodswhere applicable, as supplied by the parent, legalguardian and the child’s health care provider onadmission to the program

XIV Sleeping

A Area for Sleeping/Napping:

Play, dining, and napping may be carried on inthe same room (exclusive of bathrooms, kitchens,hallways, and closets), provided that:

1) The room is large enough to accommodateeach activity in separated and isolated areas

2) Programming is such that usage of the roomfor one purpose does not interfere with otheruses (i.e., children playing loudly with toyswhile other children are trying to nap)

B Handling of Sleeping Equipment:

that each crib, cot, sleeping bag, bed, mat, orpad is labeled with the name of the one childwho uses it Before sleep equipment can beused for a different child, all surfaces of theequipment will be cleaned and disinfected

Sleeping equipment will provide a firm face for sleeping and will meet the safetystandards of the U.S Consumer ProductSafety Commission Bunk beds will not beaccessible to children under 7 years of age

sur-Sleeping surfaces are firm Waterbeds andsoft bedding materials such as sheepskin,quilts, comforters, pillows and granularmaterials (plastic foam beads or pellets) used

in bean bags are not accessible to infants

2) Infants will be put to sleep on their backswithout loose bedding or soft objects

Children who can turn themselves over will

be allowed to assume a sleeping position that

is comfortable for them

that cribs, cots, sleeping bags, beds, mats, orpads are placed at least three feet away fromwhere any other child sleeps and that sleepsurfaces are sanitary

4) Bedding materials will be stored in such away so that there is no contact between thesleeping surfaces of one child with the sleep-ing surfaces of another child or with surfacesthat were in contact with the floor

Staff title/name

Staff title/name

C Bed Linen:

1) Children will be issued clean bed linenweekly and will have individually assignedspaces for sleeping Children will not sharebed linen Clean linen will be provided by

2) Seasonably appropriate covering will beprovided

3) Bed linen provided for cots, cribs, orplaypens will be tight-fitting

4) Bed linen will not include fabrics or als of animal origin other than wool (i.e.,feathers, fur, animal hair, etc.)

materi-XV Smoking, Prohibited

Substances, and Guns

The indoor and outdoor environment, and cles used by the program are designated as non-smoking areas The use of tobacco in any form,alcohol, or illegal drugs is prohibited on the facili-

vehi-ty premises Signs to this effect will be kept

post-ed around the facility

Possession of illegal substances or unauthorizedpotentially toxic substances is prohibited

All child care providers and staff will maintainsobriety while providing child care Caregivers,staff, or other adults who are inebriated, intoxicated,

or otherwise under the influence of mind-altering orpolluting substances will be required to leave thepremises immediately

No guns or other lethal weapons will be in acenter In a home facility, any gun will beunloaded and ammunition and guns will be storedseparate from one another, each under lock andkey, in an area inaccessible to children Parents orlegal guardians will be informed if guns or ammu-nition are kept in the facility

XIV Staff Policies

The following requirements apply to staff whohave any contact with the children or with any-thing with which the children come into contact

These policies supplement any other personnelpolicies

A Pre-employment Requirements:

1) All staff (volunteer and paid) who have anycontact with the children or with anythingwith which the children come into contact,

will have an initial, job-related health ment performed within the 4 month periodthat begins three months before the employ-ment date and ends one month after theemployment date (Sample Child Care StaffHealth Assessment form in Appendix U).The staff health assessment will be signed by

assess-a licensed physiciassess-an, physiciassess-an’s assess-assistassess-ant, orCRNP, and will include:

• A health history

• A physical examination

• Vision and hearing screening

• Once, before beginning work in a childcare setting, all adults must have TBscreening by the Mantoux method (intra-dermal, intermediate strength PPD injec-tion with needle and syringe) to check forinfection with TB, unless there is docu-mentation that there has been a positivetest result in the past of active TB that hasbeen successfully treated Repeated TBtesting will not be required unless symp-toms of possible TB or exposure to some-one who has a high risk of TB occurs Allpersons over 12 years of age in a familychild care home who are present while thechildren are in care should receive initial

TB tests even if they are not providingcare Anyone with a positive result fromthe Mantoux test should be evaluated by aphysician, who will check for TB Personswith active TB should not return to a childcare setting until the local health depart-ment determines they are no longer conta-gious Anyone with symptoms of active

TB such as a cough that “won’t go away,”coughing up blood, weight loss, nightsweats, or tiredness should not attend,work, or volunteer at a child care facilityuntil a physician has completed an evalua-tion for TB

• A review of immunization status formeasles, mumps, rubella, diphtheria,tetanus, and polio An assessment of theneed for vaccines against varicella,influenza, pneumococcus, and hepatitis Aand B, and risk from exposure to commonchildhood infections for which vaccinesare not available, such as parvovirus andcytomegalovirus The Occupational Safetyand Health Administration requires that

the child’s family or the facility

employers of individuals who may beexpected to incur occupational exposure toblood or other potentially infectious mate-rials (e.g providing first aid) must offerimmunization against hepatitis b to suchindividuals either pre-exposure or immedi-ately upon exposure.

• A review of occupational health concerns,including risk during pregnancy, if appro-priate

2) An assessment will be performed that siders orthopedic, psychological, neurologi-cal, or sensory limitations or communicablediseases that may impair the adult’s ability toperform the essential functions of the jobwith accommodation or pose a significantlikelihood of danger to the health and safety

con-of the caregiver or others The major pational health hazards in child care areinfectious diseases, stress, noise, injuriesfrom back strain and biting, skin injury fromfrequent handwashing, and environmentalexposures to art materials, indoor cleaningand disinfecting materials All staff (volun-teer and paid) are required to read and sign astatement of health risks related to working

occu-in child care

3) A list of potentially hazardous materials sent in the facility and Material Safety DataSheets are available at This information will be reviewed andupdated by

pre-annually

4) All staff (volunteer and paid) will providetwo written references from persons who arenot family members who can vouch that theprospective staff member is reliable and able

to work well with children

5) A check of public records for history of viction of a crime against children (ChildAbuse Registry) will be completed prior toany caregiver’s contact with children Allpotential employees, substitutes, and volun-teers will be required to attest to any previ-ous convictions, in particular, whether theyhave ever been convicted of any crimeagainst children or other violent crime Avolunteer’s or employee’s failure to fully dis-close previous convictions will be viewed asautomatic grounds for dismissal

con-6) All caregivers will sign an agreement toabide by the policies of the program

Breaks may be taken only if child:staff ratios forsupervision of the children can be maintainedduring the break period

D Ongoing Health Requirements:

1) On a daily basis, the administrator of thefacility shall visually and verbally assess thestaff (paid and volunteer) for signs of illhealth Staff may have their work limited

or modified and be required by

to have a health assessment if the health tus of the staff member, as it affects the abili-

sta-ty of the person to continue to do the workrequired, is uncertain Staff will report totheir supervisor promptly and have a releasefrom a health care provider to return to workfor any of the following conditions:

• a condition that may significantly affectthe person’s ability to do the job (e.g.,pregnancy, specific injuries, infectious dis-eases), or if the condition is likely to pose

location

Identify coverage

Amount of annual leave and define holidays

Identify days/year of sick leave

Describe plan

List circumstances, such as training, for which substitutes are provided

Describe workers’ compensation, parental leave, reduced child care fees, life insurance, educational and any other benefits for which employees are eligible

Identify days/year of leave

specify number of minutes specify number of consecutive hours worked specify any other type of break

Staff title/name

Staff title/name

Staff title/name

a significant risk of harm to the health andsafety of the person or others.

• a serious or prolonged illness

• when promotion or reassignment toanother role could be affected by health

• plan to return from a job-related injury

• liability issues (e.g back injury, heartattack, stress, or mental illness)

2) All staff (volunteer and paid) will supply andannually update or verify the followinginformation in writing:

• emergency contacts (next of kin)

• name, address, birth date, training,experience, and educational background

3) No food or drink other than the food served

by the program may be eaten in front of thechildren Food brought to the program bystaff will be stored in

and eaten only during break periods whenthe staff are away from the children

4) Staff illness will be reported to

as soon

as the condition is known during the day

Although disclosure cannot be required, staffwho are infected with the human immunode-ficiency virus or who are hepatitis B carriersmay care for children provided they do nothave open lesions that cannot be adequatelycovered or conditions that allow contact withtheir blood, and provided that they can com-petently perform their duties

5) Staff will be excluded for illness in dance with the exclusion guidelines listed in

accor-Preparing for Illness.

• routines and transitions

• acceptable methods of discipline

han-• back-to-sleep positioning for infants

• teaching health promotion to children andfamilies

• medication administration

• recognizing symptoms of illness and when

to exclude ill children

• emergency procedures

• child abuse prevention, recognition, andreporting

• injury prevention and hazard recognition

• compliance with the regulations of theUnited States Occupational Safety andHealth Administration and the facility’sBloodborne Pathogen Exposure ControlPlan

• the names and ages of children whose carewill involve the staff person and thedevelopmental and special needs of thesechildren

Within 90 days of employment and every threeyears thereafter each staff member will successful-

ly complete training in a pediatric first aid coursethat includes the following items: ability todemonstrate rescue breathing and management of

a blocked airway, as well as the conditions listed

in Standard 1.027 in Caring for Our Children.

At all times when children with special needsare in care and whenever children are swimming

or wading, at least one staff member who is rently certified to provide Infant/Child CPR will

cur-be immediately available

Ongoing training will be required for all paidand volunteer staff Staff will not be expected totake responsibility for any aspect of care for whichthey have not been oriented or trained Minimumtraining requirements for staff involved in indepen-dent direct care of children will include 30 hours inthe first year of work (16 hours of the 30 hours inchild development and 14 hours in child health,safety, and staff health) Each year after the firstyear, staff will be required to have at least 24 hours

Staff title/name

location

of continuing education based on individual petency needs (16 hours in child development and

com-8 hours in child health, safety, and staff health)

In addition, staff will be required to receivetraining in _

F Performance Evaluation:

Staff are required to comply with the policiesand procedures of the program A review of awritten self-evaluation and job performance will

be conducted annually by When a staff member does not meet the minimumcompetency, the staff member will be placed onprobation and assistance will be provided to helpthe staff meet the requirements for up to

Competency will be measured

by compliance with the policies and procedurescontained in the following program documents:

1) These health policies2)

XVII Design and

Maintenance of the Physical Plant and Its Contents

The child care facility will meet or exceed eral, state, and local guidelines for physical plant

fed-contents and maintenance (See Caring for Our Children, National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs, Second Edition.)

Cleaning of the facility will be performedaccording to guidelines written and monitored by

(See Appendix R Cleaning Guidelines)

All potentially toxic materials such as cides, toxic cleaning materials, aerosol cans, andpoisons will be used according to manufacturer’sinstructions and under the supervision of

pesti- These materials are to be stored in

and be inaccessible to children

In no instance will these materials be used sothat children are exposed to any hazard Examplesinclude: no spraying of pesticides while childrenare present or onto surfaces touched by children;

using caution when painting or renovating to imize the children’s exposure to paint fumes andlead

min-XVIII Review and Revision

of Policies, Plans, and Procedures

will make policies, plans, and procedures available to families,caregivers, staff, and consultants on an annual basisand whenever the policies are changed Copies ofstanding policies will always be available for family

or staff review during the facility’s hours of tion When a child is enrolled in the facility, par-ents or legal guardians will sign that they have read,have understood, and have agreed to abide by thecontent of the policies When new staff members(paid or volunteer) are assigned to work in thefacility, they will sign that they have read, haveunderstood, and here agreed to abide by the content

opera-of the policies

For Administrators and Consultants:

For Staff and Parents

I agree to report these conditions to my supervisorand to obtain any necessary medical treatment if I

am affected by any of these conditions

Understood, and Agreed to By

list areas and amount of training required

National Association for the Education of

Young Children Healthy Young Children:

A Manual for Programs Ed Susan S Aronson.

National Association for the Education of YoungChildren 4th edition Washington, D.C., 2002

APPENDICES

A Application for Child Care Services

B Child Health Assessment

C Child Care Emergency Information

D Special Care Plan and Authorization forRelease of Information

E Consent for Child Care Program Activities

F Child Care Agreement

G Family/Caregiver Information Exchange andInstructions for Daily Health Check

M Medication Consent and Log

N First Aid Kit Inventory

O Injury Report Form

P Evacuation Drill Log

Q Health and Safety Checklist

R Cleaning Guidelines

S Meal Pattern Requirements

T Refrigerator or Freezer Temperature Log

U Child Care Staff Health Assessment