Introduction xvii (pdf)

Acknowledgments iix (pdf)

Guiding Principles xix(pdf)

Advice to the User xxi

New and Significant Changes in Caring for Our Children (CFOC) Standards Since the
2nd Edition xxiv

Chapter 1: Staffing 1

1.1 Child:Staff Ratio, Group Size, and Minimum Age 3

1.1.1 Child:Staff Ratio and Group Size 3

1.1.1.1 Ratios for Small Family Child Care Homes 3

1.1.1.2 Ratios for Large Family Child Care Homes and Centers 4

1.1.1.3 Ratios for Facilities Serving Children with Special Health Care Needs and Disabilities 6

1.1.1.4 Ratios and Supervision During Transportation 6

1.1.1.5 Ratios and Supervision for Swimming, Wading, and Water Play 7

1.1.2 Minimum Age 7

1.1.2.1 Minimum Age to Enter Child Care 7

1.2 Recruitment and Background Screening 9

1.2.0.1 Staff Recruitment 9

1.2.0.2 Background Screening 10

1.3 Pre-service Qualifications 10

1.3.1 Director’s Qualifications 10

1.3.1.1 General Qualifications of Directors 10

1.3.1.2 Mixed Director/Teacher Role 12

1.3.2 Caregiver’s/Teacher’s and Other Staff Qualifications 12

1.3.2.1 Differentiated Roles 12

1.3.2.2 Qualifications of Lead Teachers and Teachers 12

1.3.2.3 Qualifications for Assistant Teachers, Teacher Aides, and Volunteers 13

1.3.2.4 Additional Qualifications for Caregivers/Teachers Serving Children Three to Thirty-Five Months of Age 14

1.3.2.5 Additional Qualifications for Caregivers/Teachers Serving Children Three to Five Years of Age 15

1.3.2.6 Additional Qualifications for Caregivers/Teachers Serving School-Age Children of Age 15

1.3.2.7 Qualifications and Responsibilities for Health Advocates 16

1.3.3 Family Child Care Home Caregiver/Teacher Qualifications 18

1.3.3.1: General Qualifications of Family Child Care Caregivers/Teachers to Operate a Family Child Care Home 18

1.3.3.2 Support Networks for Family Child Care 19

1.4 Professional Development/Training 19

1.4.1 Pre-service Training 19

1.4.1.1 Professional Development/Training 19

1.4.2 Orientation Training 21

1.4.2.1 Initial Orientation of All Staff 21

1.4.2.2 Orientation for Care of Children with Special Health Care Needs 22

1.4.2.3 Orientation Topics 23

1.4.3 First Aid and CPR Training 24

1.4.3.1 First Aid and CPR Training for Staff 24

1.4.3.2 Topics Covered in First Aid Training 25

1.4.3.3 CPR Training for Swimming and Water Play 26

1.4.4 Continuing Education/Professional Development 26

1.4.4.1 Continuing Education for Directors and Caregivers/Teachers in Centers and Large Family Child Care Homes 26

1.4.4.2 Continuing Education for Small Family Child Care Home Caregivers/Teachers 28

1.4.5 Specialized Training/Education 29

1.4.5.1 Training of Staff Who Handle Food 29

1.4.5.2 Child Abuse and Neglect Education 30

1.4.5.3 Training on Occupational Risk Related to Handling Body Fluids 30

1.4.5.4 Education of Center Staff 31

1.4.6 Educational Leave/Compensation 31

1.4.6.1 Training Time and Professional Development Leave 31

1.4.6.2 Payment for Continuing Education 31

1.5 Substitutes 32

1.5.0.1 Employment of Substitutes 32

1.5.0.2 Orientation of Substitutes 32

1.6 Consultants 33

1.6.0.1 Child Care Health Consultants 33

1.6.0.2 Frequency of Child Care Health Consultation Visits 36

1.6.0.3 Early Childhood Mental Health Consultants 36

1.6.0.4 Early Childhood Education Consultants 38

1.6.0.5 Specialized Consultation for Facilities Serving Children with Disabilities 39

1.7 Staff Health 39

1.7.0.1 Pre-Employment and Ongoing Adult Health Appraisals, Including Immunization 39

1.7.0.2 Daily Staff Health Check 40

1.7.0.3 Health Limitations of Staff 41

1.7.0.4 Occupational Hazards 41

1.7.0.5 Stress 41

1.8 Human Resource Management 43

1.8.1 Benefits 43

1.8.1.1 Basic Benefits 43

1.8.2 Evaluation 43

1.8.2.1 Staff Familiarity with Facility Policies, Plans and Procedures 43

1.8.2.2 Annual Staff Competency Evaluation 44

1.8.2.3 Staff Improvement Plan 44

1.8.2.4 Observation of Staff 44

1.8.2.5 Handling Complaints About Caregivers/Teachers 44

Chapter 2: Program Activities for Healthy Development 47

2.1 Program of Developmental Activities 49

2.1.1 General Program Activities 49

2.1.1.1 Written Daily Activity Plan and Statement of Principles 49

2.1.1.2 Health, Nutrition, Physical Activity, and Safety Awareness 50

2.1.1.3 Coordinated Child Care Health Program Model 50

2.1.1.4 Monitoring Children's Development/Obtaining Consent for Screening 51

2.1.1.5 Helping Families Cope with Separation 53

2.1.1.6 Transitioning within Programs and Indoor and Outdoor Learning/Play Environments 54

2.1.1.7 Communication in Native Language Other Than English 55

2.1.1.8 Diversity in Enrollment and Curriculum 55

2.1.1.9 Verbal Interaction 56

2.1.2 Program Activities for Infants and Toddlers from Three Months to Less Than Thirty-Six Months 57

2.1.2.1 Personal Caregiver/Teacher Relationships for Infants and Toddlers 57

2.1.2.2 Interactions with Infants and Toddlers 57

2.1.2.3 Space and Activity to Support Learning of Infants and Toddlers 58

2.1.2.4 Separation of Infants and Toddlers from Older Children 59

2.1.2.5 Toilet Learning/Training 59

2.1.3 Program Activities for Three- to Five-Year-Olds 61

2.1.3.1 Personal Caregiver/Teacher Relationships for Three- to Five-Year-Olds 61

2.1.3.2 Opportunities for Learning for Three- to Five-Year-Olds 61

2.1.3.3 Selection of Equipment for Three- to Five-Year-Olds 61

2.1.3.4 Expressive Activities for Three- to Five-Year-Olds 62

2.1.3.5 Fostering Cooperation of Three- to Five-Year-Olds 62

2.1.3.6 Fostering Language Development of Three- to Five-Year-Olds 62

2.1.3.7: Body Mastery for Three- to Five-Year-Olds 62

2.1.4 Program Activities for School-Age Children 63

2.1.4.1 Supervised School-Age Activities 63

2.1.4.2 Space for School-Age Activity 63

2.1.4.3 Developing Relationships for School-Age Children 64

2.1.4.4 Planning Activities for School-Age Children 64

2.1.4.5 Community Outreach for School-Age Children 64

2.1.4.6 Communication Between Child Care and School 64

2.2 Supervision and Discipline 64

2.2.0.1 Methods of Supervision of Children 64

2.2.0.2 Limiting Infant/Toddler Time in Crib, High Chair, Car Seat, Etc. 66

2.2.0.3 Limiting Screen Time – Media, Computer Time. 66

2.2.0.4 Supervision Near Bodies of Water 68

2.2.0.5 Behavior Around a Pool 69

2.2.0.6 Discipline Measures 70

2.2.0.7 Handling Physical Aggression, Biting, and Hitting 72

2.2.0.8 Preventing Expulsions, Suspensions, and Other Limitations in Services 73

2.2.0.9 Prohibited Caregiver/Teacher Behaviors 75

2.2.0.10 Using Physical Restraint 76

2.3 Parent/Guardian Relationships 77

2.3.1 General 77

2.3.1.1 Mutual Responsibility of Parents/Guardians and Staff 77

2.3.1.2 Parent/Guardian Visits78

2.3.2 Regular Communication 78

2.3.2.1 Parent/Guardian Conferences 78

2.3.2.2 Seeking Parent/Guardian Input 79

2.3.2.3 Support Services for Parents/Guardians 80

2.3.2.4 Parent/Guardian Complaint Procedures 80

2.3.3 Health Information Sharing 80

2.3.3.1 Parents'/Guardians' Provision of Information on Their Child's Health and Behavior 80

2.3.3.2 Communication from Specialists 81

2.4 Health Education 81

2.4.1 Health Education for Children 81

2.4.1.1 Health and Safety Education Topics for Children 81

2.4.1.2 Staff Modeling of Healthy and Safe Behavior and Health and Safety Education Activities 82

Gender and Body Awareness 83

2.4.2 Health Education for Staff 83

2.4.2.1 Health and Safety Education Topics for Staff 83

2.4.3 Health Education for Parents/Guardians 84

2.4.3.1 Opportunities for Communication and Modeling of Health and Safety Education for Parents/Guardians 84

2.4.3.2 Parent/Guardian Education Plan 84

Chapter 3: Health Promotion and Protection 87

3.1 Health Promotion in Child Care 89

3.1.1 Daily Health Check 89

3.1.1.1 Conduct of Daily Health Check 89

3.1.1.2 Documentation of the Daily Health Check 89

3.1.2 Routine Health Supervision 89

3.1.2.1 Routine Health Supervision and Growth Monitoring 89

3.1.3 Physical Activity and Limiting Screen Time 90

3.1.3.1 Active Opportunities for Physical Activity 90

3.1.3.2 Playing Outdoors 93

3.1.3.3 Protection from Air Pollution While Children Are Outside 94

3.1.3.4 Caregivers'/Teachers' Encouragement of Physical Activity 95

3.1.4 Safe Sleep 96

3.1.4.1 Safe Sleep Practices and SIDS/Suffocation Risk Reduction 96

3.1.4.2 Swaddling 99

3.1.4.3 Pacifier Use 99

3.1.4.4 Scheduled Rest Periods and Sleep Arrangements 100

3.1.4.5 Unscheduled Access to Rest Areas 101

3.1.5 Oral Health 101

3.1.5.1 Routine Oral Hygiene Activities 101

3.1.5.2 Toothbrushes and Toothpaste 102

3.1.5.3 Oral Health Education 103

3.2 Hygiene 104

3.2.1 Diapering and Changing Soiled Clothing 104

3.2.1.1 Type of Diapers Worn 104

3.2.1.2 Handling Cloth Diapers 105

3.2.1.3 Checking For the Need to Change Diapers 105

3.2.1.4 Diaper Changing Procedure 106

3.2.1.5 Procedure for Changing Children's Soiled Underwear/Pull-Ups and Clothing 108

3.2.2 Hand Hygiene 110

3.2.2.1 Situations that Require Hand Hygiene 110

3.2.2.2 Handwashing Procedure 111

3.2.2.3 Assisting Children with Hand Hygiene 112

3.2.2.4 Training and Monitoring for Hand Hygiene 112

3.2.2.5 Hand Sanitizers 113

3.2.3 Exposure to Body Fluids 114

3.2.3.1 Procedure for Nasal Secretions and Use of Nasal Bulb Syringes 114

3.2.3.2 Cough and Sneeze Etiquette 114

3.2.3.3 Cuts and Scrapes 114

3.2.3.4 Prevention of Exposure to Blood and Body Fluids 114

3.3 Cleaning, Sanitizing, and Disinfecting 116

3.3.0.1 Routine Cleaning, Sanitizing, and Disinfecting 116

3.3.0.2 Cleaning and Sanitizing Toys 117

3.3.0.3 Cleaning and Sanitizing Objects Intended for the Mouth 118

3.3.0.4 Cleaning Individual Bedding 118

3.3.0.5 Cleaning Crib Surfaces 118

3.4 Health Protection in Child Care 118

3.4.1 Tobacco and Drug Use 118

3.4.1.1 Use of Tobacco, Alcohol, and Illegal Drugs 118

3.4.2 Animals 119

3.4.2.1 Animals that Might Have Contact with Children and Adults 119

3.4.2.2 Prohibited Animals 121

3.4.2.3 Care for Animals 121

3.4.3 Emergency Procedures 122

3.4.3.1 Emergency Procedures 122

3.4.3.2 Use of Fire Extinguishers 123

3.4.3.3 Response to Fire and Burns 123

3.4.4 Child Abuse and Neglect 123

3.4.4.1 Recognizing and Reporting Suspected Child Abuse, Neglect, and Exploitation 123

3.4.4.2 Immunity for Reporters of Child Abuse and Neglect 124

3.4.4.3 Preventing and Identifying Shaken Baby Syndrome/Abusive Head Trauma 125

3.4.4.4 Care for Children Who Have Been Abused/Neglected 125

3.4.4.5 Facility Layout to Reduce Risk of Child Abuse and Neglect 125

3.4.5 Sun Safety and Insect Repellent 126

3.4.5.1 Sun Safety Including Sunscreen 126

3.4.5.2 Insect Repellent and Protection from Vector-Borne Diseases 127

3.4.6 Strangulation 129

3.4.6.1 Strangulation Hazards 129

3.5 Care Plans and Adaptations 129

3.5.0.1 Care Plan for Children with Special Health Care Needs 129

3.5.0.2 Caring for Children Who Require Medical Procedures 130

3.6 Management of Illness 131

3.6.1 Inclusion/Exclusion Due to Illness 131

3.6.1.1 Inclusion/Exclusion/Dismissal of Children 131

3.6.1.2 Staff Exclusion for Illness 135

3.6.1.3 Thermometers for Taking Human Temperatures 135

3.6.1.4 Infectious Disease Outbreak Control 136

3.6.1.5 Sharing of Personal Articles Prohibited 136

3.6.2 Caring for Children Who Are Ill 137

3.6.2.1 Exclusion and Alternative Care for Children Who Are Ill 137

3.6.2.2 Space Requirements for Care of Children Who Are Ill 137

3.6.2.3 Qualifications of Directors of Facilities That Care for Children Who Are Ill 138

3.6.2.4 Program Requirements for Facilities That Care for Children Who Are Ill 138

3.6.2.5 Caregiver/Teacher Qualifications for Facilities That Care for Children Who Are Ill 138

3.6.2.6 Child-Staff Ratios for Facilities That Care for Children Who Are Ill 139

3.6.2.7 Child Care Health Consultants for Facilities That Care for Children Who Are Ill 139

3.6.2.8 Licensing of Facilities That Care for Children Who Are Ill 140

3.6.2.9 Information Required for Children Who Are Ill 140

3.6.2.10 Inclusion and Exclusion of Children from Facilities That Serve Children Who Are Ill 141

3.6.3 Medications 141

3.6.3.1 Medication Administration 141

3.6.3.2 Labeling, Storage, and Disposal of Medications 143

3.6.3.3 Training of Caregivers/Teachers to Administer Medication 143

3.6.4 Reporting Illness and Death 144

3.6.4.1 Procedure for Parent/Guardian Notification About Exposure of Children to Infectious Disease 144

3.6.4.2 Infectious Diseases That Require Parent/Guardian Notification 145

3.6.4.3 Notification of the Facility About Infectious Disease or Other Problems by Parents 145

3.6.4.4 List of Excludable and Reportable Conditions for Parents/Guardians 145

3.6.4.5 Death 146

Chapter 4: Nutrition and Food Service 149

4.1 Introduction 151

4.2 General Requirements 152

4.2.0.1 Written Nutrition Plan 152

4.2.0.2 Assessment and Planning of Nutrition for Individual Children 153

4.2.0.3 Use of USDA - CACFP Guidelines 153

4.2.0.4 Categories of Foods 155

4.2.0.5 Meal and Snack Patterns 156

4.2.0.6 Availability of Drinking Water 157

4.2.0.7 100% Fruit Juice 157

4.2.0.8 Feeding Plans and Dietary Modifications 158

4.2.0.9 Written Menus and Introduction of New Foods 159

4.2.0.10 Care for Children with Food Allergies 160

4.2.0.11 Ingestion of Substances that Do Not Provide Nutrition 161

4.2.0.12 Vegetarian/Vegan Diets 162

4.3 Requirements for Special Groups or Ages of Children 162

4.3.1 Nutrition for Infants 162

4.3.1.1 General Plan for Feeding Infants 162

4.3.1.2 Feeding Infants on Cue by a Consistent Caregiver/Teacher 164

4.3.1.3 Preparing, Feeding, and Storing Human Milk 165

4.3.1.4 Feeding Human Milk to Another Mother's Child 167

4.3.1.5 Preparing, Feeding, and Storing Infant Formula 167

4.3.1.6 Use of Soy-Based Formula and Soy Milk 169

4.3.1.7 Feeding Cow's Milk 169

4.3.1.8 Techniques for Bottle Feeding 170

4.3.1.9 Warming Bottles and Infant Foods 171

4.3.1.10 Cleaning and Sanitizing Equipment Used for Bottle Feeding 172

4.3.1.11 Introduction of Age-Appropriate Solid Foods to Infants 172

4.3.1.12 Feeding Age-Appropriate Solid Foods to Infants 173

4.3.2 Nutrition for Toddlers and Preschoolers 174

4.3.2.1 Meal and Snack Patterns for Toddlers and Preschoolers 174

4.3.2.2 Serving Size for Toddlers and Preschoolers 174

4.3.2.3 Encouraging Self-Feeding by Older Infants and Toddlers 175

4.3.3 Nutrition for School-Age Children 175

4.3.3.1 Meal and Snack Patterns for School-Age Children 175

4.4 Staffing 176

4.4.0.1 Food Service Staff by Type of Facility and Food Service 176

4.4.0.2 Use of Nutritionist/Registered Dietitian 176

4.5 Meal Service, Seating, and Supervision 177

4.5.0.1 Developmentally Appropriate Seating and Utensils for Meals 177

4.5.0.2 Tableware and Feeding Utensils 178

4.5.0.3 Activities that Are Incompatible with Eating 178

4.5.0.4 Socialization During Meals 179

4.5.0.5 Numbers of Children Fed Simultaneously by One Adult 180

4.5.0.6 Adult Supervision of Children Who Are Learning to Feed Themselves 180

4.5.0.7 Participation of Older Children and Staff in Mealtime Activities 180

4.5.0.8 Experience with Familiar and New Foods 181

4.5.0.9 Hot Liquids and Foods 181

4.5.0.10 Foods that Are Choking Hazards 181

4.5.0.11 Prohibited Uses of Food 182

4.6 Food Brought From Home 182

4.6.0.1 Selection and Preparation of Food Brought From Home 182

4.6.0.2 Nutritional Quality of Food Brought From Home 183

4.7 Nutrition Learning Experiences for Children and Nutrition Education for Parents/Guardians 183

4.7.0.1 Nutrition Learning Experiences for Children 183

4.7.0.2 Nutrition Education for Parents/Guardians 185

4.8 Kitchen and Equipment 185

4.8.0.1 Food Preparation Area 185

4.8.0.2 Design of Food Service Equipment 186

4.8.0.3 Maintenance of Food Service Surfaces and Equipment 186

4.8.0.4 Food Preparation Sinks 187

4.8.0.5 Handwashing Sink Separate from Food Zones 187

4.8.0.6 Maintaining Safe Food Temperatures 187

4.8.0.7 Ventilation Over Cooking Surfaces 187

4.8.0.8 Microwave Ovens 188

4.9 Food Safety 188

4.9.0.1 Compliance with U.S. Food and Drug Administration Food Sanitation Standards, State and Local Rules 188

4.9.0.2 Staff Restricted from Food Preparation and Handling 188

4.9.0.3 Precautions for a Safe Food Supply 189

4.9.0.4 Leftovers 191

4.9.0.5 Preparation for and Storage of Food in the Refrigerator 191

4.9.0.6 Storage of Foods Not Requiring Refrigeration 192

4.9.0.7 Storage of Dry Bulk Foods 192

4.9.0.8 Supply of Food and Water for Disasters 192

4.9.0.9 Cleaning Food Areas and Equipment 193

4.9.0.10 Cutting Boards 193

4.9.0.11 Dishwashing in Centers 193

4.9.0.12 Dishwashing in Small and Large Family Child Care Homes 194

4.9.0.13 Method for Washing Dishes by Hand 194

4.10 Meals from Outside Vendors or Central Kitchens 195

4.10.0.1 Approved Off-Site Food Services 195

4.10.0.2 Food Safety During Transport 195

4.10.0.3 Holding of Food Prepared At Off-Site Food Service Facilities 195

Chapter 5: Facilities, Supplies, Equipment, and Environmental Health 197

5.1 Overall Requirements 199

5.1.1 General Location, Layout, and Construction of the Facility 199

5.1.1.1 Location of Center 199

5.1.1.2 Inspection of Buildings 199

5.1.1.3 Compliance with Fire Prevention Code 199

5.1.1.4 Accessibility of Facility 199

5.1.1.5 Environmental Audit of Site Location 200

5.1.1.6 Structurally Sound Facility 201

5.1.1.7 Use of Basements and Below Grade Areas 201

5.1.1.8 Buildings of Wood Frame Construction 201

5.1.1.9 Unrelated Business in a Child Care Area 201

5.1.1.10 Office Space 202

5.1.1.11 Separation of Operations from Child Care Areas 202

5.1.1.12 Multiple Use of Rooms 202

5.1.2 Space per Child 203

5.1.2.1 Space Required per Child 203

5.1.2.2 Floor Space Beneath Low Ceiling Heights 204

5.1.2.3 Areas for School-Age Children 204

5.1.3 Openings 204

5.1.3.1 Weather-Tightness and Water-Tightness of Openings 204

5.1.3.2 Possibility of Exit from Windows 204

5.1.3.3 Screens for Ventilation Openings 205

5.1.3.4 Safety Guards for Glass Windows/Doors 205

5.1.3.5 Finger-Pinch Protection Devices 205

5.1.3.6 Directional Swing of Indoor Doors 206

5.1.4 Exits 206

5.1.4.1 Alternate Exits and Emergency Shelter 206

5.1.4.2 Evacuation of Children with Special Health Care Needs and Children with Disabilities 206

5.1.4.3 Path of Egress 207

5.1.4.4 Locks 207

5.1.4.5 Closet Door Latches 208

5.1.4.6 Labeled Emergency Exits 208

5.1.4.7 Access to Exits 208

5.1.5 Steps and Stairs 208

5.1.5.1 Balusters 208

5.1.5.2 Handrails 208

5.1.5.3 Landings 208

5.1.5.4 Guards at Stairway Access Openings 208

5.1.6 Exterior Areas 209

5.1.6.1 Designated Walkways, Bike Routes, and Drop-Off and Pick-Up Points 209

5.1.6.2 Construction and Maintenance of Walkways 209

5.1.6.3 Drainage of Paved Surfaces 210

5.1.6.4 Walking Surfaces 210

5.1.6.5 Areas Used by Children for Wheeled Vehicles 210

5.1.6.6 Guardrails and Protective Barriers 210

5.1.6.7 Location of Satellite Dishes 211

5.2 Quality of the Outdoor and Indoor Environment 211

5.2.1 Ventilation, Heating, Cooling, and Hot Water 211

5.2.1.1 Fresh Air 211

5.2.1.2 Indoor Temperature 212

5.2.1.3 Heating and Ventilation Equipment Inspection and Maintenance 212

5.2.1.4 Ventilation When Using Art Materials 213

5.2.1.5 Ventilation of Recently Carpeted or Paneled Areas 213

5.2.1.6 Ventilation to Control Odors 213

5.2.1.7 Electric Fans 214

5.2.1.8 Maintenance of Air Filters 214

5.2.1.9 Type and Placement of Room Thermometers 214

5.2.1.10 Gas, Oil, or Kerosene Heaters, Generators, Portable Gas Stoves, and Charcoal and Gas Grills 214

5.2.1.11 Portable Electric Space Heaters 215

5.2.1.12 Fireplaces, Fireplace Inserts, and Wood/Corn Pellet Stoves 215

5.2.1.13 Barriers/Guards for Heating Equipment and Unitss 216

5.2.1.14 Water Heating Devices and Temperatures Allowed 216

5.2.1.15 Maintenance of Humidifiers and Dehumidifiers 216

5.2.2 Lighting 217

5.2.2.1 Levels of Illumination 217

5.2.2.2 Light Fixtures Including Halogen Lamps 217

5.2.2.3 High Intensity Discharge Lamps, Multi-Vapor, and Mercury Lamps 218

5.2.2.4 Emergency Lighting 218

5.2.3 Noise 218

5.2.3.1 Noise Levels 218

5.2.4 Electrical Fixtures and Outlets 219

5.2.4.1 Electrical Service 219

5.2.4.2 Safety Covers and Shock Protection Devices for Electrical Outlets 219

5.2.4.3 Ground-Fault Circuit-Interrupter for Outlets Near Water 220

5.2.4.4 Location of Electrical Devices Near Water 220

5.2.4.5 Extension Cords 220

5.2.4.6 Electrical Cords 220

5.2.5 Fire Warning Systems 221

5.2.5.1 Smoke Detection Systems and Smoke Alarms 221

5.2.5.2 Portable Fire Extinguishers 221

5.2.6 Water Supply and Plumbing 221

5.2.6.1 Water Supply 221

5.2.6.2 Testing of Drinking Water Not From Public System 222

5.2.6.3 Testing for Lead and Copper Levels in Drinking Water 222

5.2.6.4 Water Test Results 223

5.2.6.5 Emergency Safe Drinking Water and Bottled Water 223

5.2.6.6 Water Handling and Treatment Equipment 223

5.2.6.7 Cross-Connections 224

5.2.6.8 Installation of Pipes and Plumbing Fixtures 224

5.2.6.9 Handwashing Sink Using Portable Water Supply 224

5.2.6.10 Drinking Fountains 224

5.2.7 Sewage and Garbage 225

5.2.7.1 On-Site Sewage Systems 225

5.2.7.2 Removal of Garbage 225

5.2.7.3 Containment of Garbage 225

5.2.7.4 Containment of Soiled Diapers 226

5.2.7.5 Labeling, Cleaning, and Disposal of Waste and Diaper Containers226

5.2.7.6 Storage and Disposal of Infectious and Toxic Wastes226

5.2.8 Integrated Pest Management 226

5.2.8.1 Integrated Pest Management 226

5.2.8.2 Insect Breeding Hazard 227

5.2.9 Prevention and Management of Toxic Substances 228

5.2.9.1 Use and Storage of Toxic Substances 228

5.2.9.2 Use of a Poison Center 229

5.2.9.3 Informing Staff Regarding Presence of Toxic Substances 229

5.2.9.4 Radon Concentrations 230

5.2.9.5 Carbon Monoxide Detectors 230

5.2.9.6 Preventing Exposure to Asbestos or Other Friable Materials 231

5.2.9.7 Proper Use of Art and Craft Materials 231

5.2.9.8 Use of Play Dough and Other Manipulative Art or Sensory Materials 232

5.2.9.9 Plastic Containers and Toys 232

5.2.9.10 Prohibition of Poisonous Plants 234

5.2.9.11 Chemicals Used to Control Odors 234

5.2.9.12 Treatment of CCA Pressure-Treated Wood 234

5.2.9.13 Testing for Lead 235

5.2.9.14 Shoes in Infant Play Areas 236

5.2.9.15 Construction and Remodeling During Hours of Operation 237

5.3 General Furnishings and Equipment 237

5.3.1 General Furnishings and Equipment Requirements 237

5.3.1.1 Safety of Equipment, Materials, and Furnishings 237

5.3.1.2 Product Recall Monitoring 238

5.3.1.3 Size of Furniture 238

5.3.1.4 Surfaces of Equipment, Furniture, Toys, and Play Materials 239

5.3.1.5 Placement of Equipment and Furnishings 240

5.3.1.6 Floors, Walls, and Ceilings 240

5.3.1.7 Facility Arrangements to Minimize Back Injuries 241

5.3.1.8 High Chair Requirements 241

5.3.1.9 Carriage, Stroller, Gate, Enclosure, and Play Yard Requirements 242

5.3.1.10 Restrictive Infant Equipment Requirements 242

5.3.1.11 Exercise Equipment 243

5.3.1.12 Availability and Use of a Telephone or Wireless Communication Device 243

5.3.2 Additional Equipment Requirements for Facilities Serving Children with Special Health Care Needs 244

5.3.2.2 Special Adaptive Equipment 244

5.3.2.3 Storage for Adaptive Equipment 244

5.3.2.4 Orthotic and Prosthetic Devices 244

5.4 Space and Equipment in Designated Areas 245

5.4.1 Toilet and Handwashing Areas 245

5.4.1.1 General Requirements for Toilet and Handwashing Areas 245

5.4.1.2 Location of Toilets and Privacy Issues 245

5.4.1.3 Ability to Open Toilet Room Doors 245

5.4.1.4 Preventing Entry to Toilet Rooms by Infants and Toddlers 245

5.4.1.5 Chemical Toilets 245

5.4.1.6 Ratios of Toilets, Urinals, and Hand Sinks to Children 246

5.4.1.7 Toilet Learning/Training Equipment 246

5.4.1.8 Cleaning and Disinfecting Toileting Equipment 247

5.4.1.9 Waste Receptacles in the Child Care Facility and in Child Care Facility Toilet Room(s) 247

5.4.1.10 Handwashing Sinks 247

5.4.1.11 Prohibited Uses of Handwashing Sinks 248

5.4.1.12 Mop Sinks 248

5.4.2 Diaper Changing Areas 248

5.4.2.1 Diaper Changing Tables 248

5.4.2.2 Handwashing Sinks for Diaper Changing Areas in Centers 248

5.4.2.3 Handwashing Sinks for Diaper Changing Areas in Homes 249

5.4.2.4 Use, Location, and Setup of Diaper Changing Areas 249

5.4.2.5 Changing Table Requirements 249

5.4.2.6 Maintenance of Changing Tables 250

5.4.3 Bathtubs and Showers 250

5.4.3.1 Ratio and Location of Bathtubs and Showers 250

5.4.3.2 Safety of Bathtubs and Showers 251

5.4.4 Laundry Area 251

5.4.4.1 Laundry Service and Equipment 251

5.4.4.2 Location of Laundry Equipment and Water Temperature for Laundering 251

5.4.5 Sleep and Rest Areas 251

5.4.5.1 Sleeping Equipment and Supplies 251

5.4.5.2 Cribs 253

5.4.5.3 Stackable Cribs 254

5.4.5.4 Futons 255

5.4.5.5 Bunk Beds 255

5.4.6 Space for Children Who Are Ill, Injured, or Need Special Therapies 255

5.4.6.1 Space for Children Who Are Ill 255

5.4.6.2 Space for Therapy Services 255

5.5 Storage Areas 256

5.5.0.1 Storage and Labeling of Personal Articles 256

5.5.0.2 Coat Hooks/Cubicles 256

5.5.0.3 Storage of Play and Teaching Equipment and Supplies 256

5.5.0.4 Storage for Soiled and Clean Linens 256

5.5.0.5 Storage of Flammable Materials 256

5.5.0.6 Inaccessibility to Matches, Candles, and Lighters 257

5.5.0.7 Storage of Plastic Bags 257

5.5.0.8 Firearms 257

5.6 Supplies 257

5.6.0.1 First Aid and Emergency Supplies 257

5.6.0.2 Single Service Cups 258

5.6.0.3 Supplies for Bathrooms and Handwashing Sinks 258

5.6.0.4 Microfiber Cloths, Rags, and Disposable Towels and Mops Used for Cleaning 258

5.7 Maintenance 259

5.7.0.1 Maintenance of Exterior Surfaces 259

5.7.0.2 Removal of Hazards From Outdoor Areas 259

5.7.0.3 Removal of Hazards From Outdoor Areas 259

5.7.0.4 Inaccessibility of Hazardous Equipment 259

5.7.0.5 Cleaning Schedule for Exterior Areas 259

5.7.0.6 Storage Area Maintenance and Ventilation 259

5.7.0.7 Structure Maintenance 261

5.7.0.8 Electrical Fixtures and Outlets Maintenance 261

5.7.0.9 Plumbing and Gas Maintenance 261

5.7.0.10 Cleaning of Humidifiers and Related Equipment 261

Chapter 6: Play Areas/Playgrounds and Transportation 263

6.1 Play Area/Playground Size and Location 265

6.1.0.1 Size and Location of Outdoor Play Area 265

6.1.0.2 Size and Requirements of Indoor Play Area 265

6.1.0.3 Rooftops as Play Areas 266

6.1.0.4 Elevated Play Areas 266

6.1.0.5 Visibility of Outdoor Play Area 267

6.1.0.6 Location of Play Areas Near Bodies of Water 267

6.1.0.7 Shading of Play Area 267

6.1.0.8 Enclosures for Outdoor Play Areas 268

6.2 Play Area/Playground Equipment 269

6.2.1 General Requirements 269

6.2.1.1 Play Equipment Requirements 269

6.2.1.2 Play Equipment and Surfaces Meet ADA Requirements 270

6.2.1.3 Design of Play Equipment 270

6.2.1.4 Installation of Play Equipment 270

6.2.1.5 Play Equipment Connecting and Linking Devices 270

6.2.1.6 Size and Anchoring of Crawl Spaces 271

6.2.1.7 Enclosure of Moving Parts on Play Equipment 271

6.2.1.8 Material Defects and Edges on Play Equipment 271

6.2.1.9 Entrapment Hazards of Play Equipment 272

6.2.2 Use Zones and Clearance Requirements 272

6.2.2.1 Use Zone for Fixed Play Equipment 272

6.2.2.2 Arrangement of Play Equipment 272

6.2.2.3 Location of Moving Play Equipment 272

6.2.2.4 Clearance Requirements of Playground Areas 273

6.2.2.5 Clearance Space for Swingss 273

6.2.3 Play Area and Playground Surfacing 273

6.2.3.1 Prohibited Surfaces for Placing Climbing Equipment 273

6.2.4 Specific Play Equipment 274

6.2.4.1 Sandboxes 274

6.2.4.2 Water Play Tables 275

6.2.4.3 Sensory Table Materials 275

6.2.4.4 Trampolines 276

6.2.4.5 Ball Pits 276

6.2.5 Inspection of Play Areas/Playgrounds and Equipment 277

6.2.5.1 Inspection of Indoor and Outdoor Play Areas and Equipment 277

6.2.5.2 Inspection of Play Area Surfacing 277

6.3 Water Play Areas (Pools, Etc.) 278

6.3.1 Access to and Safety Around Bodies of Water 278

6.3.1.1 Enclosure of Bodies of Water 278

6.3.1.2 Accessibility to Above-Ground Pools 279

6.3.1.3 Sensors or Remote Monitors 279

6.3.1.4 Safety Covers for Swimming Pools 279

6.3.1.5 Deck Surface 279

6.3.1.6 Pool Drain Covers 280

6.3.1.7 Pool Safety Rules 280

6.3.1.8 Supervision of Pool Pump 280

6.3.2 Pool Equipment 281

6.3.2.1 Lifesaving Equipment 281

6.3.2.2 Lifeline in Pool 281

6.3.2.3 Pool Equipment and Chemical Storage Rooms 281

6.3.3 Pool Maintenance 281

6.3.3.1 Pool Performance Requirements 281

6.3.3.2 Construction, Maintenance, and Inspection of Pools 281

6.3.3.3 Electrical Safety for Pool Areas 282

6.3.3.4 Pool Water Temperature 282

6.3.4 Water Quality of Pools 282

6.3.4.1 Pool Water Quality 282

6.3.4.2 Chlorine Pucks 283

6.3.5 Other Water Play Areas 283

6.3.5.1 Hot Tubs, Spas, and Saunas 283

6.3.5.2 Water in Containers 283

6.3.5.3 Portable Wading Pools 283

6.4 Toys 283

6.4.1 Pool Toys 283

6.4.1.1 Selected Toys 283

6.4.1.2 Inaccessibility of Toys or Objects to Children Under Three Years of Age 284

6.4.1.3 Crib Toys 285

6.4.1.4 Projectile Toys 285

6.4.1.5 Balloons 285

6.4.2 Riding Toys and Helmets 286

6.4.2.1 Riding Toys with Wheels and Wheeled Equipment 286

6.4.2.2 Helmets 286

6.4.2.3 Bike Routes 287

6.5 Transportation 287

6.5.1 Transportation Staff 287

6.5.1.1 Competence and Training of Transportation Staff 287

6.5.1.2 Qualifications for Drivers 288

6.5.2 Transportation Safety 289

6.5.2.1 Drop-Off and Pick-Up 289

6.5.2.2 Child Passenger Safety 289

6.5.2.3 Child Behavior During Transportation 291

6.5.2.4 Interior Temperature of Vehicles 291

6.5.2.5 Distractions While Driving 291

6.5.2.6 Route to Emergency Medical Services 291

6.5.3 Vehicles 293

6.5.3.1 Passenger Vans 293

Chapter 7: Infectious Diseases 295

7.1 How Infections Spread 297

7.2 Immunizations 297

7.2.0.1 Immunization Documentation 297

7.2.0.2 Unimmunized Children 298

7.2.0.3 Immunization of Caregivers/Teachers 299

7.3 Respiratory Tract Infections 300

7.3.1 Group A Streptococcal (GAS) Infections 300

7.3.1.1 Exclusion for Group A Streptococcal (GAS) Infections 300

7.3.1.2 Informing Caregivers/Teachers of Group A Streptococcal (GAS) Infection 301

7.3.2 Haemophilus Influenzae Type B (HIB) 301

7.3.2.1 Immunization for Haemophilus Influenzae Type B (HIB) 301

7.2.3.2 Informing Parents/Guardians of Haemophilus Influenzae Type B (HIB) Exposure 302

7.3.2.3 Informing Public Health Authorities of Invasive Haemophilus Influenzae Type B Cases 302

7.3.3 Influenza 303

7.3.3.1 Influenza Immunizations for Children and Caregivers/Teachers 303

7.3.3.2 Influenza Control 303

7.3.3.3 Influenza Prevention Education 303

7.3.4 Mumps 304

7.3.4.1 Mumps 304

7.3.5 Neisseria Meningitidis (Meningococcus) 305

7.3.5.1 Recommended Control Measures for Invasive Meningococcal Infection in Child Care 305

7.3.5.2 Informing Public Health Authorities of Meningococcal Infections 305

7.3.6 Parvovirus B19 306

7.3.6.1 Attendance of Children with Erythema Infectiosum (EI) (Parvovirus B19) 306

7.3.7 Pertussis 306

7.3.7.1 Informing Public Health Authorities of Pertussis Cases 306

7.3.7.2 Prophylactic Treatment for Pertussis 306

7.3.7.3 Exclusion for Pertussis 307

7.3.8 Respiratory Syncytial Virus (RSV) 307

7.3.8.1 Attendance of Children with Respiratory Syncytial Virus (RSV) Respiratory Tract Infection 307

7.3.9 Streptococcus Pneumoniae 308

7.3.9.1 Immunization with Streptococcus Pneumoniae Conjugate Vaccine (PCV13) 308

7.3.9.2 Informing Public Health Authorities of Invasive Streptococcus Pneumoniae 309

7.3.10 Tuberculosis 309

7.3.10.1 Measures for Detection, Control, and Reporting of Tuberculosis 309

7.3.10.2 Attendance of Children with Latent Tuberculosis Infection or Active Tuberculosis Disease 310

7.3.11 Unspecified Respiratory Tract Infection 311

7.3.11.1 Attendance of Children with Unspecified Respiratory Tract Infection 311

7.4 Enteric (Diarrheal) Infections and Hepatitis A Virus (HAV) 311

7.4.0.1 Control of Enteric (Diarrheal) and Hepatitis A Virus (HAV) Infections 311

7.4.0.2 Staff Education and Policies on Enteric (Diarrheal) and Hepatitis A Virus (HAV) Infections 313

7.4.0.3 Disease Surveillance of Enteric (Diarrheal) and Hepatitis A Virus (HAV) Infections 314

7.4.0.4 Maintenance of Records on Incidents of Diarrhea 314

7.5 Skin and Mucous Membrane Infections 315

7.5.1 Conjunctivitis 315

7.5.1.1 Conjunctivitis 315

7.5.2 Enteroviruses 316

7.5.2.1 Enterovirus Infections 316

7.5.3 Human Papillomaviruses (Warts) 316

7.5.3.1 Human Papillomaviruses (HPV) (Warts) 316

7.5.4 Impetigo 317

7.5.4.1 Impetigo 317

7.5.5 Lymphadenitis 317

7.5.5.1 Lymphadenitis 317

7.5.6 Measles 318

7.5.6.1 Immunization for Measles 318

7.5.7 Molluscum Contagiosum 318

7.5.7.1 Molluscum Contagiosum 318

7.5.8 Pediculosis Capitis (Head Lice) 319

7.5.8.1 Attendance of Children with Head Lice 319

7.5.9 Tinea Capitis and Tinea Cruris (Ringworm) 319

7.5.9.1 Attendance of Children with Ringworm 319

7.5.10 Staphylococcus Aureus Skin Infections Including MRSA 320

7.5.10.1 Staphylococcus Aureus Skin Infections Including MRSA 320

7.5.11 Scabies 321

7.5.11.1 Attendance of Children with Scabies 321

7.5.12 Thrush 321

7.5.12.1 Thrush (Candidiasis) 321

7.6 Bloodborne Infections 321

7.6.1 Hepatitis B Virus (HBV) 321

7.6.1.1 Disease Recognition and Control of Hepatitis B Virus (HBV) Infection 321

7.6.1.2 Observation and Follow-Up of a Child Who is a Hepatitis B Virus (HBV) Carrier 322

7.6.1.3 Staff Education on Prevention of Bloodborne Diseases 322

7.6.1.4 Informing Public Health Authorities of Hepatitis B Virus (HBV) Cases 322

7.6.1.5 Handling Injuries to a Hepatitis B Virus (HBV) Carrier 322

7.6.2 Hepatitis C Virus (HCV) 324

7.6.2.1 Infection Control Measures with Hepatitis C Virus (HCV) 324

7.6.3 Human Immunodeficiency Virus (HIV) 324

7.6.3.1 Attendance of Children with HIV) 324

7.6.3.2 Protecting HIV-Infected Children and Adults in Child Care 324

7.6.3.3 Staff Education About Preventing Transmission of HIV Infection 324

7.6.3.4 Staff Education About Preventing Transmission of HIV Infection 324

7.7 Herpes Viruses 326

7.7.1 Cytomegalovirus (CMV) 326

7.7.1.1 Staff Education and Policies on Cytomegalovirus (CMV) 326

7.7.1.2 Testing of Children with Cytomegalovirus (CMV) 327

7.7.2 Herpes Simplex 327

7.7.2.1 Disease Recognition and Control of Herpes Simplex Virus 327

7.7.3 Herpes Virus 6 and 7 (Roseola) 327

7.7.3.1 Roseola 327

7.7.4 Varicella-Zoster (Chickenpox) Virus 328

7.7.4.1 Staff and Parent/Guardian Notification About Varicella-Zoster (Chickenpox) Virus 328

7.7.4.2 Exclusion of Children with Varicella-Zoster (Chickenpox) Virus 328

7.8 Interaction with State or Local Health Departments 329

7.9 Note to Reader on Judicious Use of Antibiotics 329

Chapter 8: Children with Special Health Care Needs and Disabilities 331

8.1 Guiding Principles for This Chapter and Introduction 333

8.2 Inclusion of Children with Special Needs in the Child Care Setting 335

8.2.0.1 Inclusion in All Activities 335

8.2.0.2 Planning for Inclusion 335

8.3 Process Prior to Enrolling at a Facility 336

8.3.0.1 Initial Assessment of the Child to Determine His or Her Special Needs 336

8.4 Developing a Service Plan for a Child with a Disability or a Child with Special Health
Care Needs 337

8.4.0.1 Determining the Type and Frequency of Services 337

8.4.0.2 Formulation of an Action Plan 337

8.4.0.3 Determination of Eligibility for Special Services 337

8.4.0.4 Designation and Role of Staff Person Responsible for Coordinating Care in the Child Care Facility 338

8.4.0.5 Development of Measurable Objectives 338

8.4.0.6 Contracts and Reimbursement 340

8.5 Coordination and Documentation 340

8.5.0.1 Coordinating and Documenting Services 340

8.5.0.2 Written Reports on IFSPs/IEPs to Caregivers/Teachers 341

8.6 Periodic Reevaluation 341

8.6.0.1 Periodic Reevaluation 341

8.6.0.2 Statement of Program Needs and Plans 341

8.7 Assessment of Facilities for Children with Special Needs 341

8.7.0.1 Facility Self-Assessment 341

8.7.0.2 Technical Assistance in Developing Plan 341

8.7.0.3 Review of Plan for Serving Children with Disabilities or Children with Special Health Care Needs 341

8.8 Additional Standards for Providers Caring for Children with Special Health Care Needs 342

Chapter 9: Administration 345

9.1 Governance 347

9.1.0.1 Governing Body of the Facility 347

9.1.0.2 Written Delegation of Administrative Authority 347

9.2 Policies 348

9.2.1 Overview 348

9.2.1.1 Content of Policies 348

9.2.1.2 Review and Communication of Written Policies 349

9.2.1.3 Enrollment Information to Parents/Guardians and Caregivers/Teachers 349

9.2.1.4 Exchange of Information Upon Enrollment 350

9.2.1.5 Nondiscriminatory Policy 350

9.2.1.6 Written Discipline Policies 351

9.2.2 Transitions 351

9.2.2.1 Planning for Child's Transition to New Services 351

9.2.2.2 Format for the Transition Plan 352

9.2.2.3 Exchange of Information at Transitions 352

9.2.3 Health Policies 353

9.2.3.1 Policies and Practices that Promote Physical Activity 353

9.2.3.2 Content and Development of the Plan for Care of Children and Staff Who Are Ill 354

9.2.3.3 Written Policy for Reporting Notifiable Diseases to the Health Department 355

9.2.3.4 Written Policy for Obtaining Preventive Health Service Information 355

9.2.3.5 Documentation of Exemptions and Exclusion of Children Who Lack Immunizations 356

9.2.3.6 Identification of Child's Medical Home and Parental Consent for Information Exchange 356

9.2.3.7 Information Sharing on Therapies and Treatments Needed 357

9.2.3.8 Information Sharing on Family Health 358

9.2.3.9 Written Policy on Use of Medications 358

9.2.3.10 Sanitation Policies and Procedures 360

9.2.3.11 Food and Nutrition Service Policies and Plans 361

9.2.3.12 Infant Feeding Policy 361

9.2.3.13 Plans for Evening and Nighttime Child Care 362

9.2.3.14 Oral Health Policy 362

9.2.3.15 Policies Prohibiting Smoking, Tobacco, Alcohol, Illegal Drugs, and Toxic Substances 363

9.2.3.16 Policy Prohibiting Firearms 363

9.2.3.17 Child Care Health Consultant's Review of Health Policies 363

9.2.4 Emergency/Security Policies and Plans 364

9.2.4.1 Written Plan and Training for Handling Urgent Medical Care or Threatening Incidents 364

9.2.4.2 Review of Written Plan for Urgent Care 365

9.2.4.3 Disaster Planning, Training, and Communication 366

9.2.4.4 Written Plan for Seasonal and Pandemic Influenza 368

9.2.4.5 Emergency and Evacuation Drills/Exercises Policy 370

9.2.4.6 Use of Daily Roster During Evacuation Drills 371

9.2.4.7 Sign-In/Sign-Out System 371

9.2.4.8 Authorized Persons to Pick Up Child 371

9.2.4.9 Policy on Actions to Be Followed When No Authorized Person Arrives to Pick Up a Child 372

9.2.4.10 Documentation of Drop-Off, Pick-Up, Daily Attendance of Child, and Parent/Provider Communication 372

9.2.5 Transportation Policies 373

9.2.5.1 Transportation Policy for Centers and Large Family Homes 373

9.2.5.2 Transportation Policy for Small Family Child Care Homes 373

9.2.6 Play Area Policies 374

9.2.6.1 Policy on Use and Maintenance of Play Areas 374

9.2.6.2 Reports of Annual Audits/Monthly Maintenance Checks of Play Areas and Equipment 375

9.2.6.3 Records of Proper Installation and Maintenance of Facility Equipment 375

9.3 Human Resource Management 375

9.3.0.1 Written Human Resource Management Policies for Centers and Large Family Child Care Homes 375

9.3.0.2 Written Human Resource Management Policies for Small Family Child Care Homes 376

9.4 Records 377

9.4.1 Facility Records/Reports 377

9.4.1.1 Facility Insurance Coverage 377

9.4.1.2 Maintenance of Records 378

9.4.1.3 Written Policy on Confidentiality of Records 378

9.4.1.4 Access to Facility Records 379

9.4.1.5 Availability of Records to Licensing Agency 380

9.4.1.6 Availability of Documents to Parents/Guardians 380

9.4.1.7 Requirements for Compliance of Contract Services 381

9.4.1.8 Records of Illness 381

9.4.1.9 Records of Injury 382

9.4.1.10 Documentation of Parent/Guardian Notification of Injury, Illness, or Death in Program 383

9.4.1.11 Review and Accessibility of Injury and Illness Reports 383

9.4.1.12 Record of Valid License, Certificate, or Registration of Facility 384

9.4.1.13 Maintenance and Display of Inspection Reports 384

9.4.1.14 Written Plan/Record to Resolve Deficiencies 384

9.4.1.15 Availability of Reports on Inspections of Fire Protection Devices 385

9.4.1.16 Evacuation and Shelter-In-Place Drill Record 385

9.4.1.17 Documentation of Child Care Health Consultation/Training Visits 385

9.4.1.18 Records of Nutrition Service 386

9.4.1.19 Community Resource Information 386

9.4.2 Child Records 386

9.4.2.1 Contents of Child's Records 386

9.4.2.2 Pre-Admission Enrollment Information for Each Child 387

9.4.2.3 Contents of Admission Agreement Between Child Care Program and Parent/Guardian 388

9.4.2.4 Contents of Child's Primary Care Provider's Assessment 389

9.4.2.5 Health History 390

9.4.2.6 Contents of Medication Record 391

9.4.2.7 Contents of Facility Health Log for Each Child 391

9.4.2.8 Release of Child's Records 392

9.4.3 Staff Records 392

9.4.3.1 Maintenance and Content of Staff and Volunteer Records 392

9.4.3.2 Maintenance of Attendance Records for Staff Who Care for Children 393

9.4.3.3 Training Record 393

Chapter 10: Licensing and Community Action 395

10.1 Introduction 397

10.2 Regulatory Policy 397

10.2.0.1 Regulation of All Out-of-Home Child Care 397

10.2.0.2 Adequacy of Staff and Funding for Regulatory Enforcement 397

10.2.0.3 State Statute Support of Regulatory Enforcement 397

10.3 Licensing Agency 398

10.3.1 The Regulation Setting Process 398

10.3.1.1 Operation Permits 398

10.3.1.2 Rational Basis of Regulations 398

10.3.1.3 Community Participation in Development of Licensing Rules 398

10.3.2 Advisory Groups 399

10.3.2.1 Child Care Licensing Advisory Board 399

10.3.2.2 State Early Childhood Advisory Council 399

10.3.2.3 Collaborative Development of Child Care Requirements and Guidelines for Children Who Are Ill 400

10.3.2.4 Public-Private Collaboration on Care of Children Who Are Ill 400

10.3.3 Licensing Role with Staff Credentials, Child Abuse Prevention, and ADA Compliance 400

10.3.3.1 Credentialing of Individual Child Care Providers 400

10.3.3.2 Background Screening 401

10.3.3.3 Licensing Agency Role in Communicating the Importance of Reporting Suspected Child Abuse 402

10.3.3.4 Licensing Agency Provision of Child Abuse Prevention Materials 402

10.3.3.5 Licensing Agency Role in Communicating the Importance of Compliance with Americans with Disabilities Act 402

10.3.4 Technical Assistance from the Licensing Agency 402

10.3.4.1 Sources of Technical Assistance to Support Quality of Child Care 402

10.3.4.2 Licensing Agency Provision of Written Agreements for Parents/Guardians and Caregivers/Teachers 403

10.3.4.3 Support for Consultants to Provide Technical Assistance to Facilities 403

10.3.4.4 Development of List of Providers of Services to Facilities 405

10.3.4.5 Resources for Parents/Guardians of Children with Special Health Care Needs 405

10.3.4.6 Compensation for Participation in Multidisciplinary Assessments for Children with Special Health Care or Education Needs 405

10.3.4.7 Technical Assistance to Facilities to Address Diversity in the Community 406

10.3.5 Licensing Staff Training 406

10.3.5.1 Education, Experience and Training of Licensing Inspectors 406

10.3.5.2 Performance Monitoring of Licensing Inspectors 406

10.3.5.3 Training of Licensing Agency Personnel about Child Abuse 407

10.4 Facility Licensing 407

10.4.1 Initial Considerations for Licensing 407

10.4.1.1 Uniform Categories and Definitions 407

10.4.1.2 Quality Rating and Improvement Systems 408

10.4.1.3 Licensing Agency Procedures Prior to Issuing a License 408

10.4.1.4 Alternative Means of Compliance 408

10.4.2 Facility Inspections and Monitoring 409

10.4.2.1 Frequency of Inspections for Child Care Centers, Large Family Child Care Homes, and Small Family Child Care Homes 409

10.4.2.2 Statutory Authorization of On-Site Inspections 409

10.4.2.3 Monitoring Strategies 409

10.4.2.4 Agency Collaboration to Safeguard Children in Child Care 410

10.4.3 Procedures for Complaints, Reporting, and Data Collecting 410

10.4.3.1 Procedure for Receiving Complaints 410

10.4.3.2 Whistle-Blower Protection under State Law 410

10.4.3.3 Collection of Data on Illness or Harm to Children in Facilities 411

10.5 Health Department Responsibilities and Role 411

10.5.0.1 State and Local Health Department Role 411

10.5.0.2 Written Plans for the Health Department Role 413

10.5.0.3 Requirements for Facilities to Report to Health Department 413

10.5.0.4 Use of Fact Sheets on Common Illnesses Associated with Child Care 414

10.6 Caregiver/Teacher Support 414

10.6.1 Caregiver/Teacher Training 414

10.6.1.1 Regulatory Agency Provision of Caregiver/Teacher and Consumer Training and Support Services 414

10.6.1.2 Provision of Training to Facilities by Health Agencies 415

10.6.2 Caregiver/Teacher Networking and Collaboration 416

10.6.2.1 Development of Child Care Provider Organizations and Networks 416

10.6.2.2 Fostering Collaboration to Establish Programs for School-Age Children 416

10.7 Public Policy Issues and Resource Development 416

10.7.0.1 Development of Resource and Referral Agencies 416

10.7.0.2 Coordination of Public and Private Resources to Ensure Families' Access to Quality Child Care 417

Appendices (PDF)

Appendix A: Signs and Symptoms Chart 421

Appendix B: Major Occupational Health Hazards 426

Appendix C: Nutrition Specialist, Registered Dietitian, Licensed Nutritionist, Consultant, and Food Service Staff Qualifications 427

Appendix D: Gloving 428

Appendix E: Child Care Staff Health Assessment 429

Appendix F: Enrollment/Attendance/Symptom Record 430

Appendix G: Recommended Childhood Immunization Schedule 431

Appendix H: Recommended Adult Immunization Schedule 434

Appendix I: Recommendations for Preventive Pediatric Health Care 439

Appendix J: Selecting an Appropriate Sanitizer or Disinfectant 440

Appendix K: Routine Schedule for Cleaning, Sanitizing, and Disinfecting 442

Appendix L: Cleaning Up Body Fluids 444

Appendix M: Clues to Child Abuse and Neglect 445

Appendix N: Protective Factors Regarding Child Abuse and Neglect 449

Appendix O: Care Plan for Children with Special Health Care Needs 451

Appendix P: Situations that Require Medical Attention Right Away 458

Appendix Q: Getting Started with MyPlate 459

Appendix R: Choose MyPlate: 10 Tips to a Great Plate 460

Appendix S: Physical Activity: How Much Is Needed? 461

Appendix T: Foster Care 462

Appendix U: Recommended Safe Minimum Internal Cooking Temperatures 464

Appendix V: Food Storage Chart 465

Appendix W: Sample Food Service Cleaning Schedule 467

Appendix X: Adaptive Equipment for Children with Special Health Care Needs 468

Appendix Y: Non-Poisonous and Poisonous Plants 470

Appendix Z: Depth Required for Shock-Absorbing Surfacing Materials for Use Under
Play Equipment 472

Appendix AA: Medication Administration Packet 474

Appendix BB: Emergency Information Form for Children with Special Health Care Needs 479

Appendix CC: Incident Report Form 481

Appendix DD: Injury Report Form for Indoor and Outdoor Injuries 482

Appendix EE: America’s Playgrounds Safety Report Card 484

Appendix FF: Child Health Assessment 487

Appendix GG: Licensing and Public Regulation of Early Childhood Programs 488

Appendix HH: Use Zones and Clearance Dimensions for Single-and Multi-Axis Swings 496

Appendix II: Bicycle Helmets: Quick-Fit Check 499

Appendix JJ: Our Child Care Center Supports Breastfeeding 501

Appendix KK: Authorization for Emergency Medical/Dental Care 502

Appendix LL: Conversion Table CFOC 2nd Edition to 3rd Edition 503

Appendix MM: Conversion Table CFOC 3rd Edition to 2nd Edition 523

Acronyms/Abbreviations 541

Glossary 544

Index 559