Caring for Our Children (CFOC)

Chapter 9: Administration

9.1 Governance

9.1.0

9.1.0.1: Governing Body of the Facility


The facility should have an identifiable governing body or person with the responsibility for and authority over the operation of the center or program. The governing body should appoint one person at the facility, or two in the case of co-directors, who is responsible for day-to-day management. The director for facilities licensed for more than thirty children should have no other assigned duties (1). Centers with fewer than thirty children may employ a director who teaches as well.

Responsibilities of the person in charge of the operation of the facility should include, but should not be limited to, the following:

  1. Ensuring stable and continuing compliance with all applicable rules, regulations, and facility policies and procedures while also assuring a safe and healthy environment;
  2. Developing and implementing policies that promote the achievement of quality child care;
  3. Ensuring that all written policies are updated and used, as described in this chapter;
  4. Assuring the reliability and integrity of staff by hiring; firing/dismissals; assigning roles, duties, and responsibilities; supervising; and evaluating personnel;
  5. Providing orientation of all new parents/guardians, employees, and volunteers to the physical structure, policies, and procedures of the facility;
  6. Notifying all staff, volunteers, and parents/guardians of any changes in the facility’s policies and procedures;
  7. Providing for continuous supervision of visitors and all non-facility personnel;
  8. When problems are identified, planning for corrective action, and assigning and verifying that a specific person corrects the problem by a specified date;
  9. Arranging or providing repair, maintenance, or other services at the facility;
  10. Providing or arranging for in-service training and supplemental education for staff and volunteers, based on the needs of the facility and qualifications and skills of staff and volunteers;
  11. Recommending an annual budget and managing the finances of the facility;
  12. Maintaining required records for staff, volunteers, and children at the facility;
  13. Providing for parent/guardian involvement, including parent education;
  14. Reporting to the governing or advisory board on a regular basis as to the status of the facility’s operation;
  15. Providing oversight of research studies conducted at the facility and joint supervision of students using the facility for clinical practice.
RATIONALE
Management principles of quality improvement in any human service require identification of goals and leadership to ensure that all those involved (those with authority and experience, and those affected) participate in working toward those goals. Problem-solving approaches that are effective in other settings also work in early childhood programs. This standard describes accepted personnel management practices. For any organization to function effectively, lines of responsibility must be clearly delineated with an individual who is designated to have ultimate responsibility (1).
COMMENTS
Management should ensure policy is carried out by providing staff and parents/guardians with written handbooks, training, supervision with frequent feedback, and monitoring with checklists. A comprehensive site observation checklist is available in the print version of Model Child Care Health Policies, available online at http://www
.ecels-healthychildcarepa.org/content/MHP4thEd Total.pdf. Copies of this publication can be purchased from the National Association for the Education of Young Children (NAEYC) at http://www.naeyc.org or from the American Academy of Pediatrics (AAP) at http://www.aap.org. It is also available on the Healthy Child Care Pennsylvania Website for download at http://www.ecels-healthychildcarepa.org.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home
REFERENCES
  1. National Association for the Education of Young Children (NAEYC). 2004. Standard 10.A.04: NAEYC accreditation criteria for leadership and management standard. Washington, DC: NAEYC.

9.1.0.2: Written Delegation of Administrative Authority


There should be written delegation of administrative authority, designating the person in charge of the facility and the person(s) in charge of individual children, for all hours of operation.
RATIONALE
Caregivers/teachers are responsible for the protection of the children in their care at all times. In group care, each child must be assigned to an adult to ensure individual children are supervised and individual needs are addressed. Children should not be placed in the care of unauthorized family members or other individuals (1-8).
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home
REFERENCES
  1. Zero to Three. 2007. The infant-toddler set-aside of the Child Care and Development Block Grant: Improving quality child care for infants and toddlers. Washington, DC: Zero to Three. http://main.zerotothree.org/site/DocServer/Jan_07_Child_Care_Fact_Sheet.pdf.
  2. National Institute of Child Health and Human Development (NICHD). 2006. The NICHD study of early child care and youth development: Findings for children up to age 4 1/2 years. Rockville, MD: NICHD. http://www.nichd.nih.gov/publications/pubs/upload/seccyd_051206.pdf.
  3. Goldstein, A., K. Hamm, R. Schumacher. Supporting growth and development of babies in child care: What does the research say? Washington, DC: Center for Law and Social Policy (CLASP); Zero to Three. http://main.zerotothree.org/site/DocServer/ChildCareResearchBrief.pdf.
  4. De Schipper, E. J., J. M. Riksen-Walraven, S. A. E. Geurts. 2006. Effects of child-caregiver ratio on the interactions between caregivers and children in child-care centers: An experimental study. Child Devel 77:861-74.
  5. National Fire Protection Association (NFPA). 2009. NFPA 101: Life safety code. 2009 ed. Quincy, MA: NFPA.
  6. Fiene, R. 2002. 13 indicators of quality child care: Research update. Washington, DC: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. http://aspe.hhs.gov/basic-report/13-indicators-quality-child-care.
  7. Zigler, E., W. S. Gilliam, S. M. Jones. 2006. A vision for universal preschool education, 107-29. New York: Cambridge University Press.
  8. Stebbins, H. 2007. State policies to improve the odds for the healthy development and school readiness of infants and toddlers. Washington, DC: Zero to Three. http://main.zerotothree
    .org/site/DocServer/NCCP_article_for_BM_final.pdf.

9.2 Policies

9.2.1 Overview

9.2.1.1: Content of Policies


The facility should have policies to specify how the caregiver/teacher addresses the developmental functioning and individual or special health care needs of children of different ages and abilities who can be served by the facility, as well as other services and procedures. These policies should include, but not be limited to, the following:

  1. Admissions criteria, enrollment procedures, and daily sign-in/sign-out policies, including authorized individuals for pick-up and allowing parent/guardian access whenever their child is in care;
  2. Inclusion of children with special health care needs;
  3. Nondiscrimination;
  4. Payment of fees, deposits, and refunds;
  5. Termination of enrollment and parent/guardian notification of termination;
  6. Supervision;
  7. Staffing, including caregivers/teachers, the use of volunteers, helpers, or substitute caregivers/teachers, and deployment of staff for different activities;
  8. A written comprehensive and coordinated planned program based on a statement of principles;
  9. Discipline;
  10. Methods and schedules for conferences or other methods of communication between parents/guardians and staff;
  11. Care of children and staff who are ill;
  12. Temporary exclusion for children and staff who are ill and alternative care for children who are ill;
  13. Health assessments and immunizations;
  14. Handling urgent medical care or threatening incidents;
  15. Medication administration;
  16. Use of child care health consultants and education and mental health consultants;
  17. Plan for health promotion and prevention (e.g., tracking routine child health care, health consultation, health education for children/staff/families, oral health, sun safety, safety surveillance, preventing obesity, etc.);
  18. Disasters, emergency plan and drills, evacuation plan, and alternative shelter arrangements;
  19. Security;
  20. Confidentiality of records;
  21. Transportation and field trips;
  22. Physical activity (both outdoors and when children are kept indoors), play areas, screen time, and outdoor play policy;
  23. Sleeping, safe sleep policy, areas used for sleeping/napping, sleep equipment, and bed linen;
  24. Sanitation and hygiene;
  25. Presence and care of any animals on the premises;
  26. Food and nutrition including food handling, human milk, feeding and food brought from home, as well as a daily schedule of meals and snacks;
  27. Evening and night care plan;
  28. Smoking, tobacco use, alcohol, prohibited substances, and firearms;
  29. Human resource management;
  30. Staff health;
  31. Maintenance of the facility and equipment;
  32. Preventing and reporting child abuse and neglect;
  33. Use of pesticides and other potentially toxic substances in or around the facility;
  34. Review and revision of policies, plans, and procedures.

The facility should have specific strategies for implementing each policy. For centers, all of these items should be written. Facility policies should vary according to the ages and abilities of the children enrolled to accommodate individual or special health care needs. Program planning should precede, not follow the enrollment and care of children at different developmental levels and abilities and with different health care needs. Policies, plans, and procedures should generally be reviewed annually or when any changes are made. A child care health consultant can be very helpful in developing and implementing model policies.

RATIONALE
Neither plans nor policies affect quality unless the program has devised a way to implement the plan or policy. Children develop special health care needs and have developmental differences recognized while they are enrolled in child care (2). Effort should be made to facilitate accommodation as quickly as possible to minimize delay or interruption of care (1). For examples of policies see Model Child Care Health Policies at http://www.ecels-healthy
childcarepa.org/content/MHP4thEd Total.pdf and the California Childcare Health Program at http://www
.ucsfchildcarehealth.org. Nutrition and physical activity policies for child care developed by the NAP SACC Program, Center for Health Promotion and Disease Prevention, University of North Carolina are available at http://www
.center-trt.org.
COMMENTS
Reader’s note: Chapter 9 includes many standards containing additional information on specific policies noted above.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
REFERENCES
  1. Aronson, S. S., ed. 2002. Model child care health policies. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics.
  2. Child Care Law Center. 2009. Questions and answers about the Americans with Disabilities Act: A quick reference for child care providers. Updated Version. http://www.childcarelaw.org/docs/
    ADA Q and A 2009 Final 3 09.pdf.

9.2.1.2: Review and Communication of Written Policies


All written policies should be reviewed and updated at least annually. The facility should provide copies of policies, which include pertinent plans and procedures, to all staff and parents/guardians at least annually, and two weeks before new policies or changes to existing policies go into effect. When a child enters a facility, when new policies are written, and when changes to existing policies have been made, parents/guardians should sign a statement that they have received a copy of the policy and read and/or understand the content of the policy.

Parents/guardians who are not able to read should have the policies presented orally to them. Parents/guardians who are not able to understand the policies because of a language barrier should have the policies presented to them in a language with which they are familiar (1).

RATIONALE
State of the art information changes. A yearly review encourages child care administrators to keep information and policies current. Current information on health and safety practices that is shared and developed cooperatively among caregivers/teachers and parents/guardians invites more participation and compliance with health and safety practices.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
REFERENCES
  1. Gonzalez-Mena, J. 2007. 50 early childhood strategies for working and communicating with diverse families. Upper Saddle River, NJ: Pearson Merrill Prentice Hall.

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


At enrollment, and before assumption of supervision of children by caregivers/teachers at the facility, the facility should provide parents/guardians and caregivers/teachers with a statement of services, policies, and procedures, including, but not limited, to the following:

  1. The licensed capacity, child:staff ratios, ages and number of children in care. If names of children and parents/guardians are made available, parental/guardian permission for any release to others should be obtained;
  2. Services offered to children including a written daily activity plan, sleep positioning policies and arrangements, napping routines, guidance and discipline policies, diaper changing and toilet learning/training methods, child handwashing, medication administration policies, oral health, physical activity, health education, and willingness for special health or therapy services delivered at the program (special requirements for a child should be clearly defined in writing before enrollment);
  3. Hours and days of operation;
  4. Admissions criteria, enrollment procedures, and daily sign-in/sign-out policies, including authorized individuals for pick-up and allowing parent/guardian access whenever their child is in care;
  5. Payment of fees, deposits, and refunds;
  6. Methods and schedules for conferences or other methods of communication between parents/guardians and staff.

Policies on:

  1. Staffing, including caregivers/teachers, the use of volunteers, helpers, or substitute caregivers/teachers, and deployment of staff for different activities;
  2. Inclusion of children with special health care needs;
  3. Nondiscrimination;
  4. Termination and parent/guardian notification of termination;
  5. Supervision;
  6. Discipline;
  7. Care of children and caregivers/teachers who are ill;
  8. Temporary exclusion and alternative care for children who are ill;
  9. Health assessments and immunizations;
  10. Handling urgent medical care or threatening incidents;
  11. Medication administration;
  12. Use of child care health consultants, education and mental health consultants;
  13. Plan for health promotion and prevention (tracking routine child health care, health consultation, health education for children/staff/families, oral health, sun safety, safety surveillance, etc.);
  14. Disasters, emergency plan and drills, evacuation plan, and alternative shelter arrangements;
  15. Security;
  16. Confidentiality of records;
  17. Transportation and field trips;
  18. Physical activity (both outdoors and when children are kept indoors), play areas, screen time, and outdoor play policy;
  19. Sleeping, safe sleep policy, areas used for sleeping/napping, sleep equipment, and bed linen;
  20. Sanitation and hygiene;
  21. Presence and care of any animals on the premises;
  22. Food and nutrition including food handling, human milk, feeding and food brought from home, as well as a daily schedule of meals and snacks;
  23. Evening and night care plan;
  24. Smoking, tobacco use, alcohol, prohibited substances, and firearms;
  25. Preventing and reporting child abuse and neglect;
  26. Use of pesticides and other potentially toxic substances in or around the facility.

Parents/guardians and caregivers/teachers should sign that they have reviewed and accepted this statement of services, policies, and procedures. Policies, plans and procedures should generally be reviewed annually or when any changes are made.

RATIONALE
Model Child Care Health Policies, available at http://www.ecels-healthychildcarepa.org/content/MHP4thEd Total.pdf, has text to comply with many of the topics covered in this standard. Each policy has a place for the facility to fill in blanks to customize the policies for a specific site. The text of the policies can be edited to match individual program operations. Starting with a template such as the one in Model Child Care Health Policies can be helpful.
COMMENTS
For large and small family child care homes, a written statement of services, policies, and procedures is strongly recommended and should be added to the “Parent Handbook.” Conflict over policies can lead to termination of services and inconsistency in the child’s care arrangements. If the statement is provided orally, parents/guardians should sign a statement attesting to their acceptance of the statement of services, policies and procedures presented to them. Model Child Care Health Policies can be adapted to these smaller settings.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.2.1.1 Content of Policies
9.2.3.2 Content and Development of the Plan for Care of Children and Staff Who Are Ill
9.2.3.9 Written Policy on Use of Medications
9.2.3.11 Food and Nutrition Service Policies and Plans
9.2.3.12 Infant Feeding Policy
9.2.3.13 Plans for Evening and Nighttime Child Care
9.2.3.15 Policies Prohibiting Smoking, Tobacco, Alcohol, Illegal Drugs, and Toxic Substances
9.2.3.16 Policy Prohibiting Firearms
9.2.4.1 Written Plan and Training for Handling Urgent Medical Care or Threatening Incidents
9.2.4.2 Review of Written Plan for Urgent Care and Threatening Incidents
9.2.4.3 Disaster Planning, Training, and Communication
9.2.4.4 Written Plan for Seasonal and Pandemic Influenza
9.2.4.5 Emergency and Evacuation Drills/Exercises Policy
9.2.4.6 Use of Daily Roster During Evacuation Drills
9.2.4.7 Sign-In/Sign-Out System
9.2.4.8 Authorized Persons to Pick Up Child
9.2.4.9 Policy on Actions to Be Followed When No Authorized Person Arrives to Pick Up a Child
9.2.4.10 Documentation of Drop-Off, Pick-Up, Daily Attendance of Child, and Parent/Provider Communication
9.4.1.3 Written Policy on Confidentiality of Records
9.4.2.3 Contents of Admission Agreement Between Child Care Program and Parent/Guardian

9.2.1.4: Exchange of Information Upon Enrollment


Arrangements for enrollment of children should be made in person by the parents/guardians. The facility should advise the parents/guardians of their responsibility to provide information to the facility regarding their children and inform them of the facility’s confidentiality guidelines.
RATIONALE
Parents/guardians should be fully informed about the facility’s services before delegating responsibility for care of the child. The facility and parents/guardians should exchange information necessary for the safety and health of the child.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

9.2.1.5: Nondiscriminatory Policy


The facility’s written admission policy should be nondiscriminatory in regard to race, culture, sex, religion, national origin, ancestry, sexual preference, or disability. A copy of the policy and definitions of eligibility should be available for review on demand.
RATIONALE
Nondiscriminatory policies advocate for quality child care services for all children regardless of the child’s citizenship, residency status, financial resources, and language differences (1).
COMMENTS
Facilities should be able to accommodate all children except those whose needs require extreme modifications beyond the capability of the facility’s resources. Facilities should not have blanket policies against admitting children with disabilities. Instead, a facility should make an individual assessment of a child’s needs and the facility’s ability to meet those needs. Federal laws (e.g., Americans with Disabilities Act) do not permit discrimination based on disability. Inclusion of children with special health care needs and disabilities in all child care and early childhood educational programs is strongly encouraged.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
REFERENCES
  1. U.S. Department of Justice, Civil Rights Division, Disability Rights Section. 1997. Commonly asked questions about child care centers and the Americans with Disabilities Act. http://www.ada.gov/childq%26a.htm.

9.2.1.6: Written Discipline Policies


Each facility should have a written discipline policy reflective of the positive methods of guidance appropriate to the ages of the children enrolled outlined in Standard 2.2.0.6 and prohibited caregiver behaviors as outlined in Standard 2.2.0.9.

The facility should have policies for dealing with biting, hitting, and other undesired behavior by children and written protocol reflective guidance outlined in Standard 2.2.0.7.

Policies should explicitly prohibit corporal punishment, psychological abuse, humiliation, abusive language, binding or tying to restrict movement, restriction of access to large motor physical activities, and the withdrawal or forcing of food and other basic needs.

All caregivers/teachers should sign an agreement to implement the facility’s discipline policies. A policy explicitly stating the consequence for staff who do not follow the discipline policies should be reviewed and signed by each staff member prior to hiring.

RATIONALE
Caregivers/teachers are more likely to avoid abusive practices if they are well-informed about effective, non-abusive methods for managing children’s behaviors. Positive methods of discipline create a constructive and supportive social group and reduce incidents of aggression.

Corporal punishment may be physical abuse or may become abusive very easily. Research links corporal punishment with negative effects such as later criminal behavior and impairment of learning (1-3). Primary factors supporting the prohibition of certain methods of punishment include current child development theory and practice, legal aspects (namely that a caregiver/teacher is not acting in place of parents/guardians with regard to the child), and increasing liability suits. According to the NARA 2008 Child Care Licensing Study, forty-eight states prohibit corporal punishment in centers; forty-three of forty-four states that license small family child care homes prohibit corporal punishment and only one state does not prohibit corporal punishment in large family child care homes (4).

COMMENTS
Parents/guardians should be encouraged to utilize similar positive discipline methods at home in order to encourage these practices and to provide a more consistent discipline approach for the child.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
REFERENCES
  1. Paintal, S. 1999. Banning corporal punishment of children: A position paper. Child Educ 76:36-39.
  2. American Academy of Pediatrics, Committee on School Health. 2006. Policy statement: Corporal punishment in the schools. Pediatrics 106:343.
  3. Education Commission of the States. 1999. Collection of clearinghouse notes, 1998-1999. Denver, CO: ECS.

9.2.2 Transitions

9.2.2.1: Planning for Child’s Transition to New Services


If a parent/guardian requests assistance with the transition process from the facility to a public school or another program, the designated care or service coordinator at the facility should review the child’s records, including needs, learning style, supports, progress, and recommendations. The designated care or service coordinator should obtain written informed consent from the parent/guardian prior to sharing information at a transition meeting, in a written summary, or in some other verbal or written format.

The process for the child’s departure should also involve sharing and the exchange of progress reports with other care providers for the child and the parents/guardians of the child within the realm of confidentiality guidelines.

Any special health care need of the child and successful strategies that have been employed while at child care should be shared. For children who are receiving services under Part C of IDEA 2004, a transition plan is required, usually at least ninety days prior to the time that the child will leave the facility or program.

In the case of a child who may be eligible for preschool services, with approval of the family of the child, a conference should be convened among the lead agency, the family, and the local educational agency not less than ninety days (and at the discretion of all such parties, not more than nine months) before the child is eligible for the preschool services, to discuss any such services that the child may receive. In the case of a child who may not be eligible for such preschool services, with the approval of the family, reasonable efforts should be made to convene a conference among the lead agency, the family, and providers of other appropriate services, to discuss the appropriate services that the child may receive; to review the child’s program options; for the period from the child’s third birthday through the remainder of the school year; and to establish a transition plan, including as appropriate, steps to exit from the program. A plan also requires description of efforts to promote collaboration among Early Head Start programs under section 645A of the Head Start Act, early education and child care programs.

The facility should determine in what form and for how long archival records of transitioned children should be maintained by the facility.

RATIONALE
All children and their families will experience one or more program transitions during early childhood. One of the most common transitions is from preschool to kindergarten. Families in transition benefit when support and advocacy are available from a facility representative who is aware of their needs and of the community’s resources (1). This process is essential in planning the child’s departure or transition to another program. Information regarding successful behavior strategies, motivational strategies, and similar information may be helpful to staff in the setting to which the child is transitioning.
COMMENTS
Some families are capable of advocating effectively for themselves and their children; others require help negotiating the system outside of the facility. An interdisciplinary process is encouraged. Though coordinating and evaluating health and therapeutic services for children with special health care needs is primarily the responsibility of the school district or regional center, staff from the child care facility (one of many service providers) should participate, as staff members have had a unique opportunity to observe the child. In small and large family child care homes where an interdisciplinary team is not present, the caregivers/teachers should participate in the planning and preparation along with other care or treatment providers, with parent/guardian written consent.

It is important for all providers of care to coordinate their activities and referrals; otherwise the family may not be well informed. If records are shared electronically, providers should ensure that the records are encrypted for security and confidentiality.

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.2.2.2 Format for the Transition Plan
9.4.1.3 Written Policy on Confidentiality of Records
9.4.1.4 Access to Facility Records
9.4.1.5 Availability of Records to Licensing Agency
9.4.1.6 Availability of Documents to Parents/Guardians
REFERENCES
  1. Harbin, G., B. Rous, N. Peeler, J. Schuster, K. McCormick. 2007. Research brief: Desired family outcomes of the early childhood transition process. http://community.fpg.unc.edu/connect/

9.2.2.2: Format for the Transition Plan


Each service agency or primary care provider should have a format and timeline for the process of developing a transition plan for children with special health care needs to be followed when each child leaves the facility. The plan should include the following components:

  1. Review and final preparation of the child’s records;
  2. A child and family needs assessment;
  3. Identification of potential child care, educational, or programmatic arrangements;
  4. Summary of any special health care needs and successful strategies that were employed in child care.
RATIONALE
Many factors contribute to the success or failure of a transition. These concerns can be monitored effectively when a written plan is developed and followed to ensure that all steps in a transition are included and are undertaken in a timely, responsive manner (1).
COMMENTS
Though the child care provider can and should offer support in this process, child care is a free-market system where the parent/guardian is the consumer and decision-maker.

It is best if the process of planning begins at least nine months prior to the child turning three and an anticipated transition, since finding the proper facility for a child can be a complex and time consuming process in some communities. Each state is required to develop transition guidelines that implement the federal guidelines in respect to timelines, procedural due process expectations, and the required representation at the various meetings. Each agency can adapt the format to its own needs. However, consistent formats for planning and information exchange, requiring written parental/guardian consent, would be useful to both caregivers/teachers and families in both localities when children with special health care needs are involved. The use of outside consultants for small and large family child care homes is especially important in meeting this type of standard.

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.2.2.1 Planning for Child’s Transition to New Services
REFERENCES
  1. Harbin, G., B. Rous, N. Peeler, J. Schuster, K. McCormick. 2007. Research brief: Desired family outcomes of the early childhood transition process. http://community.fpg.unc.edu/connect/Desired-Family-Outcomes-of-the-Early-Childhood-Transition-Process-1.pdf.

9.2.2.3: Exchange of Information at Transitions


A written communication policy should be in place to describe needed communication between parents/guardians and caregivers/teachers during transitions that occur at times when children are being dropped off or picked up and other interactions with parents/guardians. When several staff shifts are involved, information about the child should be exchanged between caregivers/teachers assigned to each shift.
RATIONALE
Personal contact on a daily basis between the child care staff and parents/guardians is essential to ensure the transfer of information required to provide for the child’s needs. Information about the child’s experiences and health during the interval when an adult other than the parent/guardian is in charge should be provided to parents/guardians because they may need such information to understand the child’s later behavior.
COMMENTS
A sample of issues that should be communicated and exchanged include change in routine at home/program, change in child’s health status, recent problems sleeping/eating, or change in family routines or family health.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

9.2.3 Health Policies

9.2.3.1: Policies and Practices that Promote Physical Activity

Content in the Standard was modified on 08/25/2016 and 05/30/2018.


The facility should have written policies for the promotion of indoor and outdoor physical activity and the removal of potential barriers to physical activity participation. Policies should cover the following areas:

     a. Benefits: benefits of physical activity and outdoor play.

     b. Duration: Children will spend 60 to 120 minutes each day outdoors depending on their age, weather permitting. Policies will describe what will be done to ensure physical activity

         and provisions for gross motor activities indoors on days with more extreme conditions (ie, very wet, very hot, or very cold).

     c. Type: Structured (caregiver/teacher-initiated) versus unstructured activity.

     d. Setting: provision of covered areas for shade and shelter on playgrounds, if feasible (1).

     e. Clothing: Clothing should protect children from sun exposure and permit easy movement (not too loose and not too tight) that enables full participation in active play; footwear

         should provide support for running and climbing. Hats and sunglasses should be worn to protect children from sun exposure. 

Examples of appropriate clothing/footwear include:

     a. Gym shoes or sturdy gym shoe equivalent.

     b. Clothes for the weather, including heavy coat, hat, and mittens in the winter/snow; raincoat and boots for the rain; and layered clothes for climates in which the temperature can

         vary dramatically on a daily basis. Lightweight, breathable clothing, without any hood and neck strings, should be worn when temperatures are hot to protect children from sun

         exposure. 

Examples of inappropriate clothing/footwear include:

     a. Footwear that can come off while running or that provides insufficient support for climbing (2)

     b. Clothing that can catch on playground equipment (eg, those with drawstrings or loops)

If children wear “dress clothes” or special outfits that cannot be easily laundered, caregivers/teachers should talk with the children’s parents/guardians about the program’s goals in providing physical activity during the program day and encourage them to provide a set of clothes that can be used during physical activities.

Facilities should discuss the importance of this policy with parents/guardians on enrollment and periodically thereafter.

RATIONALE

If appropriately dressed, children can safely play outdoors in most weather conditions. Children can learn math, science, and language concepts through games involving movement (3,4).

Having a policy on outdoor physical activity that will take place on days when there are adverse weather conditions informs all caregivers/teachers and families about the facility’s expectations. The policy can make clear that outdoor activity may require special clothing in colder weather or arrangements for cooling off when it is warm. By having such a policy, the facility encourages caregivers/teachers and families to anticipate and prepare for outdoor activity when cold, hot, or wet weather prevails.

The inappropriate dress of a child is often a barrier in reaching recommended amounts of physical activity in child care centers. Sometimes, children cannot participate in physical activity because of their inappropriate clothes. Caregivers/teachers can be helpful by having extra clean clothing on hand (5). Children can play in the rain and snow and in low temperatures when wearing clothing that keeps them dry and warm. When it is very warm, children can play outdoors, if they play in shady areas, and wear sunscreen, sun-protective clothing, and insect repellent, if necessary (6). Caregivers/teachers should have water available for children to mist, sprinkle, and drink while in warmer weather.

COMMENTS

For assistance in creating and writing physical activity policies, Nemours provides several resources and best practice advice on program implementation. Information is available at https://www.nemours.org/service/health/growuphealthy/activity/educators.html.

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.2.6.1 Policy on Use and Maintenance of Play Areas
Appendix S: Physical Activity: How Much Is Needed?
REFERENCES
  1. Weinberger N, Butler, AG, Schumacher P. Looking inside and out: perceptions of physical activity in childcare spaces. Early Child Development and Care. 2014;184(2):194-210

  2. Tandon PS, Walters KM, Igoe BM, Payne EC, Johnson DB. Physical activity practices, policies and environments in Washington state child care settings: results of a statewide survey. Matern Child Health J. 2017;21(3):571–582

  3. Bento G, Dias G. The importance of outdoor play for young children’s healthy development. Porto Biomed J. 2017;2(5):157–160. http://dx.doi.org/10.1016/j.pbj.2017.03.003. Accessed January 11, 2018

  4. Jayasuriya A, Williams M, Edwards T, Tandon P. Parents’ perceptions of preschool activities: exploring outdoor play. Early Educ Dev. 2016;27(7):1004–1017

  5. Henderson KE, Grode GM, O’Connell ML, Schwartz MB. Environmental factors associated with physical activity in childcare centers. Int J Behav Nutr Phys Act. 2015;12:43

  6. American Academy of Pediatrics. Choosing an insect repellent for your child. HealthyChildren.org Web site. https://www.healthychildren.org/English/safety-prevention/at-play/Pages/Insect-Repellents.aspx. Updated March 1, 2017. Accessed January 11, 2018

NOTES

Content in the Standard was modified on 08/25/2016 and 05/30/2018.

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


All child care facilities should have written policies for the management and care of children and staff who are ill. The facility’s plan for the care of children and staff who are ill should be developed in consultation with the facility’s child care health consultant and other health care professionals to address current understanding of the technical issues of contagion and other health risks. This plan should include:

  1. Policies and procedures for urgent and emergency care;
  2. Admission, inclusion/exclusion, and re-entry policies;
  3. A description of illnesses common to children in child care, their management, and precautions to address the needs and behavior of the child who is ill, as well as to protect the health of other children and staff;
  4. A procedure to obtain and maintain updated individual care plans for children and staff with special health care needs;
  5. A procedure for documenting the name of person affected, date and time of illness, a description of symptoms, the response of the caregiver/teacher or other staff to these symptoms, who was notified (such as a parent/guardian, primary care provider, nurse, physician, or health department), and the response;
  6. Medication policy;
  7. Seasonal and pandemic influenza policy; and
  8. Staff illness-guidelines for exclusion and re-entry.

In group care, the facility should address the well-being of all those affected by illness: the child, the staff, parents/guardians of the child, other children in the facility and their parents/guardians, and the community. The priority of the policy should be to meet the needs of the child who is ill and the other children in the facility. The policy should address the circumstances under which separation of the affected individual (child or staff person) from the group is required; the circumstances under which the staff, parents/guardians, or other designated persons need to be informed; and the procedures to be followed in these cases.

The policy should take into consideration:

  1. The physical facility;
  2. The number and the qualifications of the facility’s personnel;
  3. The fact that children do become ill frequently and at unpredictable times;
  4. The fact that adults may be on staff with known health problems or may develop health problems while at work;
  5. The fact that working parents/guardians often are not given leave for their children’s illnesses; and
  6. The amount of care the child who is ill requires if the child remains in the program, whether staff can devote the time for caring for a child who is ill in the classroom without leaving other children unattended, and whether the child is able to participate in any of the classroom activities (1).
RATIONALE
Infectious diseases are a major concern of parents/guardians and staff. Since children, especially those in group settings, can be a reservoir for many infectious agents, and since caregivers/teachers and other staff come into close and frequent contact with children, they are at risk for developing a wide variety of infectious diseases (1). Following the infection control standards will help protect both children and staff from infectious disease. Recording the occurrence of illness in a facility and the response to the illness characterizes and defines the frequency of the illness, suggests whether an outbreak has occurred, may suggest an effective intervention, and provides documentation for administrative purposes.
COMMENTS
Facilities may comply by adopting a model policy and using reference materials as authoritative resources. The current edition of Managing Infectious Diseases in Child Care and Schools, a publication of the American Academy of Pediatrics (AAP), is a reference for policies and their implementation. This publication includes detailed handouts that can be used to inform parents/guardians and outline guidelines and rationale for exclusion, return to care, and notification of public health authorities.

Other helpful references include the current edition of Model Child Care Health Policies (2), or the current edition of the Red Book (3). Caregivers/teachers can check for other materials provided by the licensing agency, resource and referral agency, or health department. Curriculum for Managing Infectious Diseases, an online training module for caregivers/teachers is available from the AAP at http://www.healthychildcare.org/ParticipantsManualID.html.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.2.3.9 Written Policy on Use of Medications
9.2.4.3 Disaster Planning, Training, and Communication
9.2.4.4 Written Plan for Seasonal and Pandemic Influenza
9.4.2.1 Contents of Child’s Records
Appendix A: Signs and Symptoms Chart
Appendix F: Enrollment/Attendance/Symptom Record
Appendix AA: Medication Administration Packet
REFERENCES
  1. Aronson, S. S., T. R. Shope, eds. 2017. Managing infectious diseases in child care and schools: A quick reference guide, 4th Edition. Elk Grove Village, IL: American Academy of Pediatrics.
  2. Pennsylvania chapter of the American Academy of Pediatrics. Model Child Care Health Polices. Aronson SS, ed. 5th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2014.
  3. American Academy of Pediatrics. School Health In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. 31st Edition. Itasca, IL:  American Academy of Pediatrics; 2018: 138-146


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


The facility should have a written policy that complies with the state’s reporting requirements for children who are ill. All notifiable diseases should be reported to the health department. The facility should have the telephone number of the responsible health authority to whom confirmed or suspected cases of these diseases, or outbreaks of other infectious diseases, should be reported, and should designate a staff member as responsible for reporting the disease.
RATIONALE
Reporting to the health department provides the department with knowledge of illnesses within the community and ability to offer preventive measures to children and families exposed to the outbreak of a disease. In some states, caregivers/teachers may not be a mandatory reporter. In those states, caregivers/teachers are encouraged to report any infectious disease to the responsible health authority.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

9.2.3.4: Written Policy for Obtaining Preventive Health Service Information


Each facility should develop and follow a written policy for obtaining necessary medical information including immunizations (see Appendix G: Recommended Childhood Immunization Schedule) and periodic preventive health assessments (see Appendix I: Recommendations for Preventive Pediatric Health Care) as recommended by the American Academy of Pediatrics (AAP) in Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents (1-3). Facility staff should encourage parents/guardians to schedule these preventive health services in a timely fashion.

Documentation of an age-appropriate health assessment that includes current immunizations and health screenings should be filed in the child’s record at the facility. Immunization records should be provided at the time of enrollment. The health assessment should be provided within two weeks of admission or indication that an appointment has been made with the health care provider. Updates of the health record should be maintained according to the American Academy of Pediatrics’ (AAP’s) periodicity schedule, Appendix I: Recommendations for Preventive Pediatric Health Care. Health record information should be reviewed by the staff of the facility and information sharing between the staff, the parents/guardians, and the child’s health care professional should be encouraged and facilitated in order to provide better care for the child in the child care setting.

Centers should have written procedures for the verification of compliance with recommended immunizations and periodic health assessments of children. Centers should maintain confidential records of immunizations, periodic health assessments, including Body Mass Index (BMI) for children age two and older, and any special health considerations.

RATIONALE
Health assessments are important to ensure prevention, early detection of remediable problems, and planning for adaptations needed so that all children can reach their potential. When age-appropriate health assessments and use of health insurance benefits are promoted by caregivers/teachers, children enrolled in child care will have increased access to immunizations and other preventive services (4). With the expansion of eligibility for medical assistance and the federal subsidy of state child health insurance plans (SCHIP), the numbers of children who lack insurance for routine preventive health care should lessen.

Requiring facilities to maintain a current health record encourages and supports discussion of a child’s health needs between parents/guardians, caregivers/teachers, and the child’s primary care provider. It also encourages parents/guardians to seek preventive and primary care services in a timely fashion for their child.

The facility should have accurate, current information regarding the medical status and treatment of each child so it will be able to determine and adjust its capability to provide needed services. This documentation should consist of more than a statement from the child’s primary care provider that the child is up-to-date. Because of the administrative burden posed by requests to fill out forms, unless the specifics of services rendered are requested, the information may not reflect the child’s actual receipt of services according to the nationally recommended schedule. Instead, it may only represent that the child has a current health record in the primary care provider’s office. Until tracking systems become more widespread and effective in health care settings, a joint effort by the education system, family and primary care provider is required to ensure that children receive the preventive health services that ensure they are healthy and ready to learn.

COMMENTS
Assistance for caregivers/teachers and low income parents/guardians can be obtained through the Medicaid Early Periodic Screening and Diagnostic Treatment (EPSDT) program (Title XIX) and the state’s version of the federal Child Health Insurance Program (SCHIP) (5).

Most states require that caregivers/teachers document that the child’s health records are up-to-date to protect the child and other children whom the unimmunized child would expose to increased risk of vaccine-preventable disease. State regulations regarding immunization requirements for children may differ, but the child care facility should strive to comply with the national, annually published, “Recommended Childhood Immunization Schedule,” available at http://www.cispimmunize.org from the AAP, Centers for Disease Control and Prevention (CDC), and the American Academy of Family Physicians (AAFP).

A child’s entrance into the facility need not be delayed if an appointment for health supervision is scheduled. Often appointments for well-child care must be scheduled several weeks in advance. In such cases, the child care facility should obtain a health history report from the parents/guardians and documentation of an appointment for routine health supervision, as a minimum requirement for the child to attend the facility on a routine basis. The child should receive immunizations on admission or provide evidence of an immunization plan to prevent an increased exposure to vaccine-preventable diseases.

Local public health staff (such as the staff of immunization units, EPSDT programs) should provide assistance to caregivers/teachers in the form of record-keeping materials, educational materials, and on-site visits for education and help with surveillance activities. A copy of a form to use for documentation of routine health supervision services is available from Model Child Care Health Policies at http://www.ecelshealthychildcarepa.org/content/MHP4thEd Total.pdf.

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.4.1.3 Written Policy on Confidentiality of Records
Appendix I: Recommendations for Preventive Pediatric Health Care
Appendix FF: Child Health Assessment
REFERENCES
  1. American Academy of Pediatrics. 2008. Recommendations for preventive pediatric health care. http://practice.aap.org/content
    .aspx?aid=1599&nodeID=4000.
  2. Hagan, J. F., J. S. Shaw, P. M. Duncan, eds. 2008. Bright futures: Guidelines for health supervision of infants, children, and adolescents. 3rd ed. Elk Grove Village, IL: American Academy of Pediatrics.
  3. Haskins, R., J. Kotch. 1986. Day care and illness: Evidence, costs, and public policy. Pediatrics 77:951-82.
  4. U.S. Department of Health and Human Services, Centers for Medicare and Medicaid. Children’s health insurance program. http://www.cms.hhs.gov/home/chip.asp.
  5. American Academy of Pediatrics. Recomended childhood immunization schedules. http://www2.aap.org/immunization/izschedule.html.
     

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


For children who have been exempted from required, up-to-date immunizations, these exemptions should be documented in the child’s health record as a cross reference, (acceptable documentation includes a statement from the child’s primary provider, a legal exemption with notarization, waiver, or other state-specific required documentation signed by the parent/guardian). See Standard 7.2.0.2 for more information.

Within two weeks of enrollment the parent/guardian should provide documentation to the child care program regarding progress in obtaining immunizations. The parent/guardian should receive written notice of exclusion if noncompliance or lack of progress is evident. If more than one immunization is needed in a series, time should be allowed for the immunizations to be obtained at the appropriate intervals. Exemptions from the requirement related to compliance with the federal McKinney-Vento Homeless Assistance Act for children experiencing homelessness are documented and include a plan for obtaining available documents within a reasonable period of time.

RATIONALE
National surveys document that child care has a positive influence on protection from vaccine-preventable illness (1). Immunizations should be required for all children in child care and early education settings. Facilities must consider the consequences if they accept responsibility for exposing a child who cannot be fully immunized (because of immaturity) to an unimmunized child who may bring disease to the facility. Although up to two weeks after the child starts to participate in child care may be allowed for the acquisition of immunizations for which the child is eligible, parents/guardians should maintain their child’s immunization status according to the nationally recommended schedule to avoid potential exposure of other children in the facility to vaccine-preventable disease.
COMMENTS
An updated immunization schedule is published annually near the beginning of the calendar year in the AAP’s Pediatrics journal and in the CDC’s MMWR and should be consulted for current information. In addition to print versions of the recommended childhood immunization schedule, the “Recommended Immunization Schedules for Persons Aged 0 through 18 Years – United States” is posted on the Websites of the CDC at http://www.cdc.gov/vaccines/schedules/index.html and the AAP at https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/immunization/Pages/Immunization-Schedule.aspx.

When a child who has a medical exemption from immunization is included in child care, reasonable accommodation of that child requires planning to exclude such a child in the event of an outbreak. Caregivers/teachers should check the Website http://www.immunize.org/laws/ for specific state-mandated immunization requirements and exemptions.

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
REFERENCES
  1. Aronson, S. S. 1986. Maintaining health in child care settings. In Group care for young children, ed. N. Gunzenhauser, B. M. Caldwell. New Brunswick, NJ: Johnson and Johnson Baby Products Company.

9.2.3.6: Identification of Child’s Medical Home and Parental Consent for Information Exchange


As part of the enrollment of a child, the caregiver/teacher should ask the family to identify the child’s primary care provider, his or her medical home, and other specialty health care professionals. The parent/guardian should provide written consent to enable the caregiver/teacher to establish communication with those providers. The family should always be informed prior to the use of the permission unless it is an emergency. The providers with whom the facility should exchange information (with parental consent) should include:

  1. Sources of regular medical and dental care (such as the child’s primary care provider, dentist, and medical facility);
  2. Special clinics the child may attend, including sessions with medical specialists and registered dietitians;
  3. Special therapists for the child (e.g., occupational, physical, speech, and nutritional), along with written documentation of the services rendered provided by the special therapist;
  4. Counselors, therapists, or mental health service providers for parents/guardians (e.g., social workers, psychologists, or psychiatrists);
  5. Pharmacists for children who take prescription medication on a regular basis or have emergency medications for specific conditions.
RATIONALE
Primary care providers are involved not only in the medical care of the child but also involved in supporting the child’s emotional and developmental needs (1-3). A major barrier to productive working relationships between child care and health care professionals is inadequate communication (1,2).

Knowing who is treating the child and coordinating services with these sources of service is vital to the ability of the caregivers/teachers to offer appropriate care to the child. Every child should have a medical home and those with special health care needs may have additional specialists and therapists (4-7). The primary care provider and needed specialists will create the Care Plan which will be the blueprint for healthy and safe inclusion into child care for the child with special health care needs.

COMMENTS
A source of health care may be a community or specialty clinic, a public health department, specialist, or a private primary care provider. Families should also know the location of the hospital emergency room departments nearest to their home and child care facility.

The California Childcare Health Program has developed a form to help facilitate the exchange of information between the health professionals and the parents/guardians and caregivers/teachers at http://ucsfchildcarehealth.org/pdfs/forms/CForm_ExchangeofInfo.pdf. They also release an information form at http://ucsfchildcarehealth.org/pdfs/forms/CF_ReferralRel.pdf. For more information on the medical home concept, see the American Academy of Pediatrics’ (AAP) Medical Home Website at http://www.medicalhome
info.org.

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.4.1.3 Written Policy on Confidentiality of Records
9.4.1.4 Access to Facility Records
9.4.1.5 Availability of Records to Licensing Agency
9.4.1.6 Availability of Documents to Parents/Guardians
Appendix AA: Medication Administration Packet
Appendix FF: Child Health Assessment
Appendix O: Care Plan for Children with Special Health Care Needs
REFERENCES
  1. American Academy of Pediatrics (AAP). 2001. The pediatrician’s role in promoting health and safety in child care. Elk Grove Village, IL: AAP.
  2. Murph, J. R., S. D. Palmer, D. Glassy, eds. 2005. Health in child care: A manual for health professionals. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics.
  3. Hagan, J. F., J. S. Shaw, P. M. Duncan, eds. 2008. Bright futures: Guidelines for health supervision of infants, children, and adolescents. 3rd ed. Elk Grove Village, IL: American Academy of Pediatrics.
  4. Starfield, B., L. Shi. 2004. The medical home, access to care, and insurance: A review of evidence. Pediatrics 113:1493-98.
  5. Homer, C. J., K. Klatka, D. Romm, K. Kuhlthau, S. Bloom, P. Newacheck, J. Van Cleave, J. M. Perrin. 2008. A review of the evidence for the medical home for children with special health care needs. Pediatrics 122:e922–37.
  6. Inkelas, M., M. Regolado, N. Halfon. 2005. Stategies for integrating developmental services and promoting medical homes. Los Angeles: National Center for Infant and Early Childhood Health Policy.
  7. Nowak, A. J., P. S. Casamassimo. 2002. The dental home: A primary care concept. JADA 133:93-98.

9.2.3.7: Information Sharing on Therapies and Treatments Needed


The person at the child care facility who is responsible for planning care for the child with special therapies or treatments should obtain an individualized care plan, developed by the child’s primary care provider or specialist on allergies, medications, therapies, and treatments being provided to the child that are directly relevant to the health and safety of the child in the child care facility. The written consent of the child’s parents/guardians and, where appropriate, the child’s primary care provider should be obtained before this confidential information is sought from outside sources. Therapies and treatments need to meet the criteria for evidenced based practices.
RATIONALE
The facility must have accurate, current information regarding the health status and treatment of the child so it will be able to determine the facility’s capability to provide needed services or to obtain them elsewhere.

Medicines can be crucial to the health and wellness of children. They can also be very dangerous if the wrong type or wrong amount is given to the wrong person or at the wrong time.

Parents/guardians should always be notified in every instance when medication is used. Telephone instructions from a primary care provider are acceptable if the caregiver/teacher fully documents them and if the parent/guardian initiates the request for primary care provider or child care health consultant instruction. In the event medication for a child becomes necessary during the day or in the event of an emergency, administration instructions from a parent/guardian and the child’s primary care provider are required before a caregiver/teacher may administer medication.

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.4.1.3 Written Policy on Confidentiality of Records
9.4.1.4 Access to Facility Records
9.4.1.5 Availability of Records to Licensing Agency
9.4.1.6 Availability of Documents to Parents/Guardians
Appendix AA: Medication Administration Packet
Appendix O: Care Plan for Children with Special Health Care Needs

9.2.3.8: Information Sharing on Family Health


Families should be asked to share information about family health (such as chronic diseases) that might affect the child’s health. Families should be guaranteed that all information will be kept confidential.
RATIONALE
A family history of chronic disease helps caregivers/teachers understand family stress and experiences of the child within the family.
COMMENTS
Information on family health can be gathered by asking parents/guardians to tell the caregiver/teacher about any chronic health problems that the child’s parents/guardians, siblings, or household members have that might affect the child’s health. This information could also be obtained from the child’s primary care provider with permission from the parent/guardian.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

9.2.3.9: Written Policy on Use of Medications


The facility should have a written policy for the administration of any prescription or non-prescription (over-the-counter [OTC]) medication. The policy should address at least the following:

  1. The use of written parental/guardian consent forms for each prescription and OTC medication to be administered at the child care facility. The consent form should include:
    1. The child’s name;
    2. The name of the medication;
    3. The date(s) and times the medication is to be given;
    4. The dose or amount of medication to be given;
    5. How the medication is to be administered;
    6. The period of time the consent form is valid, which may not exceed the length of time the medication is prescribed for, the expiration date of the medication or one year, whichever is less.
  2. The use of the prescribing health professional’s authorization forms for each prescription and OTC medication to be administered at the child care facility.
  3. The circumstances under which the facility will agree to administer medication. This may include the administration of:
    1. Topical medications such as non-medicated diaper creams, insect repellants, and sun screens;
    2. OTC medicines for fever including acetaminophen and ibuprofen;
    3. Long-term medications that are administered daily for children with chronic health conditions that are managed with medications;
    4. Controlled substances, such as psychotropic medications;
    5. Emergency medications for children with health conditions that may become life-threatening such as asthma, diabetes, and severe allergies;
    6. One-time medications to prevent conditions such as febrile seizures.
  4. The circumstances under which the facility will not administer medication. This should include:
    1. No authorization from parent/guardian and/or prescribing health professional;
    2. Prohibition of administering OTC cough and cold medication;
    3. Not administering a new medication for the first time to a child while he or she is in child care;
    4. If the instructions are unclear or the supplies needed to measure doses or administer the medication are not available or not in good working condition;
    5. The medication has expired;
    6. If a staff person or his/her backup who has been trained to give that particular medication is not present (in the case of training for medications that require specific skills to administer properly, such as inhalers, injections, or feeding tubes/ports).
  5. The process of accepting medication from parents/guardians. This should include:
    1. Verifying the consent form;
    2. Verifying the medication matches what is on the consent form;
    3. Accepting authorization for prescription medications from the child’s prescribing health professional only if the medications are in their original container and have the child’s name, the name of the medication, the dose and directions for giving the medication, the expiration date of the medication, and a list of warnings and possible side effects;
    4. Accepting authorization for OTC medications from the child’s prescribing health professional only if the authorization indicates the purpose of the medication and time intervals of administration, and if the medications are in their original container and include the child’s name, the name of the medication, dose and directions for use, an expiration date for the medication, and a list of warnings and possible side effects;
    5. Verifying that a valid Care Plan accompanies all long-term medications (i.e., medications that are to be given routinely or available routinely for chronic conditions such as asthma, allergies, and seizures);
    6. Verifying any special storage requirements and any precautions to take while the child is on the prescription or OTC medication.
  6. The proper handling and storage of medications, including:
    1. Emergency medications – totally inaccessible to children but readily available to supervising caregivers/teachers trained to give them;
    2. Medications that require refrigeration;
    3. Controlled substances;
    4. Expired medications;
    5. A policy to insure confidentiality;
    6. Storing and preparing distribution in a quiet area completely out of access to children;
    7. Keeping all medication at all times totally inaccessible to children (e.g., locked storage);
    8. Whether to require even short-term medications be kept at the facility overnight.
  7. The procedures to follow when administering medications. These should include:
    1. Assigning administration only to an adequately trained, designated staff;
    2. Checking the written consent form;
    3. Adhering to the “six rights” of safe medication administration (child, medication, time/date, dose, route, and documentation) (1);
    4. Documenting and reporting any medication errors;
    5. Documenting and reporting and adverse effects of the medication;
    6. Documenting and reporting whether the child vomited or spit up the medication.
  8. The procedures to follow when returning medication to the family, including:
    1. An accurate account of controlled substances being administered and the amount being returned to the family;
    2. When disposing of unused medication, the remainder of a medication, including controlled substances.
  9. The disposal of medications that cannot be returned to the parent/guardian.

A medication administration record should be maintained on an ongoing basis by designated staff and should include the following:

  1. Specific, signed parental/guardian consent for the caregiver/teacher to administer medication including documentation of receiving controlled substances and verification of the amount received;
  2. Specific, signed authorization from the child’s prescribing health professional, prescribing the medication, including medical need, medication, dosage, and length of time to give medication.
  3. Information about the medication including warnings and possible side effects;
  4. Written documentation of administration of medication and any side effects;
  5. Medication errors log.

The facility should consult with the State Board of Nursing, other interested organizations and their child care health consultant about required training and documentation for medication administration. Based on the information, the facility should develop and implement a plan regarding medication administration training (9).

RATIONALE
Administering medication requires skill, knowledge and careful attention to detail. Parents/guardians and prescribing health professionals must give a caregiver/teacher written authorization to administer medication to the child (12). Caregivers/teachers must be diligent in their adherence to the medication administration policy and procedures to prevent any inadvertent medication errors, which may be harmful to the child (11). There is always a risk that a child may have a negative reaction to a medication, and children should be monitored for serious side effects that may require an emergency response. Because children twenty-four months of age and younger are in a period of rapid development and are more vulnerable to the possible side effects of medications, extra care should be given to the circumstances under which medications will be administered to this population. A child may have a negative reaction to a medication that was given at home or to one administered while attending child care. For these reasons caregivers/teachers need to be aware of each of the medications a child received at child care as well as at home. They should know the names of the medication(s), when each was given, who prescribed them, and what the known reactions or side effects may be in the event that a child has a negative reaction to the medicine (2,10).

OTC medicines are often assumed to be safe and not afforded the proper diligence. Even common drugs such as acetaminophen and ibuprofen can result in significant toxicity for infants and small children. Inaccurate dosing from the use of inaccurate measuring tools can result in illness or even death (2,3).

Cough and cold medications (CCM) are readily available OTC in the United States and are widely used to treat upper respiratory infection. These products are not safe for infants and young children and were withdrawn by the Consumer Healthcare Products Association for children less than two years of age in 2007 (4-6,8). The Food and Drug Administration (FDA) issued a public health advisory in 2008 stating these medications should not be used in children less than two years of age. The American Academy of Pediatrics (AAP) states that CCMs are not effective for children less than six years of age and their use can result in serious, adverse effects (7).

The medication record protects the person administering medication by documenting the process. The medication errors log can be reviewed and will point out what kind of intervention, if any, will be helpful in reducing the number of medication errors. Accounting for medications administered and thrown away is important for several reasons. It may assist a health professional in determining whether the child is actually getting the medicine, especially when the child is not getting better from treatment. Some medications are “controlled substances,” meaning that the medication is regulated by the federal government due to potential for abuse. Controlled substances include narcotic pain medicine, some behavior medications for ADHD, and some seizure medications. A prescribing health professional may need proper accounting for these types of medications to assure that requests for refills are because the medication was given to the patient and not used/abused by adults. Some medications, (i.e., antibiotics), can have a harmful affect on the environment if not disposed of properly.

For children with chronic health conditions or special health care needs, administering medications while the child is attending child care may be part of the child’s individualized family service plan (IFSP) or individualized education plan (IEP). Child care facilities must comply with the Americans with Disabilities Act.

COMMENTS
When a child care facility cannot return unused medication to the parent/guardian, the facility needs to dispose of the medication. An example of when medication cannot be returned is when a parent/guardian has removed the child from care and the facility cannot reach the parent/guardian to return the medication. Herbal and folk medicines and home remedies are not regulated and should not be given at child cares without a prescribing health professional’s order and complete pharmaceutical labeling. If they are given at home, the caregiver/teacher should be aware of their use and possible side effects.

A curriculum for child care providers on safe administration of medications in child care is available from the AAP at http://www.healthychildcare.org/HealthyFutures.html. A sample medication administration policy is located in Appendix AA: Medication Administration Packet.

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.4.2.6 Contents of Medication Record
Appendix AA: Medication Administration Packet
REFERENCES
  1. North Carolina Child Care Health & Safety Resource Center. 2007. Steps to administering medication. http://www.healthychild
    carenc.org/PDFs/steps_admin_medication.pdf.
  2. American Academy of Pediatrics. 2009. Healthy futures: Medication administration in early education and child care settings. http://www.healthychildcare.org/HealthyFutures.html.
  3. American Academy of Pediatrics, Council on School Health. 2009. Policy statement: Guidance for the administration of medication in school. Pediatrics 124:1244-51.
  4. American Academy of Pediatrics, Committee on Drugs. 2009. Policy statement: Acetaminophen toxicity in children. Pediatrics 123:1421-22.
  5. Vernacchio, L., J. Kelly, D. Kaufman, A. Mitchell. 2008. Cough and cold medication use by U.S. children, 1999-2006: Results from the Sloan Survey. Pediatrics 122:e323-29.
  6. Schaefer, M. K., N. Shehab, A. Cohen, D. S. Budnitz. 2008. Adverse events from cough and cold medicines in children. Pediatrics 121:783-87.
  7. Centers for Disease Control and Prevention. 2007. Infant deaths associated with cough and cold medications: Two states. MMWR 56:1-4.
  8. U.S. Food and Drug Administration. 2007. Nonperscription cough and cold medicine use in children. http://www.fda.gov/Safety/
    MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm152691.htm.
  9. Consumer Healthcare Products Association. Makers of OTC cough and cold medicines announce voluntary withdrawal of oral infant medicines. http://www.chpa-info.org/pressroom/10_11_07_OralInfantMedicines.aspx.
  10. Heschel, R. T., A. A. Crowley, S. S. Cohen. 2005. State policies regarding nursing delegation and medication administration in child care setttings: A case study. Policy, Politics, and Nurs Prac 6:86-98.
  11. Friedman, J. F., G. M. Lee, K. P. Kleinman, J. A. Finkelstein. 2004. Child care center policies and practices for management of ill children. Ambulatory Pediatrics 4:455-60.
  12. Sinkovits, H. S., M. W. Kelly, M. E. Ernst. 2003. Medication administration in day care centers for children. J Am Pharm Assoc 43:379-82.

9.2.3.10: Sanitation Policies and Procedures


The child care facility should have written sanitation policies and procedures for the following items:

  1. Maintaining equipment used for hand hygiene, toilet use, and toilet learning/training in a sanitary condition;
  2. Maintaining diaper changing areas and equipment in a sanitary condition;
  3. Maintaining toys in a sanitary condition;
  4. Managing animals in a safe and sanitary manner;
  5. Practicing proper handwashing and diapering procedures (the facility should display proper handwashing instruction signs conspicuously);
  6. Practicing proper personal hygiene of caregivers/teachers and children;
  7. Practicing environmental sanitation policies and procedures, such as sanitary disposal of soiled diapers;
  8. Maintaining sanitation for food preparation and food service.
RATIONALE
Many infectious diseases can be prevented through appropriate hygiene and sanitation practices. Bacterial cultures of environmental surfaces in facilities, which are used to gauge the adequacy of sanitation and hygiene practices, have demonstrated evidence of fecal contamination. Contamination of hands, toys, and other equipment in the room has appeared to play a role in the transmission of diseases in child care settings (1). Regular and thorough cleaning of toys, equipment, and rooms helps to prevent transmission of illness (1).

Animals can be a source of illness for people, and people may be a source of illness for animals (1).

The steps involved in effective handwashing (to reduce the amount of bacterial contamination) can be easily forgotten. Posted signs provide frequent reminders to staff and orientation for new staff. Education of caregivers/teachers regarding handwashing, cleaning, and other sanitation procedures can reduce the occurrence of illness in the group of children with whom they work (2).

Illnesses may be spread by way of:

  1. Human waste (such as urine and feces);
  2. Body fluids (such as saliva, nasal discharge, eye discharge, open skin sores, and blood);
  3. Direct skin-to-skin contact;
  4. Touching a contaminated object;
  5. The air (by droplets that result from sneezes and coughs).

Since many infected people carry communicable diseases without symptoms, and many are contagious before they experience a symptom, caregivers/teachers need to protect themselves and the children they serve by carrying out, on a routine basis, standard precautions and sanitation procedures that approach every potential illness-spreading condition in the same way.

Handling food in a safe and careful manner prevents the spread of bacteria, viruses, and fungi. Outbreaks of foodborne illness have occurred in many settings, including child care facilities.

COMMENTS
State health department rules and regulations may also guide the child care provider.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
Appendix K: Routine Schedule for Cleaning, Sanitizing, and Disinfecting
REFERENCES
  1. Chin, J., ed. 2000. Control of communicable diseases manual. Washington, DC: American Public Health Association.
  2. Kotch, J., P. Isbell, D. J. Weber, et al. 2007. Hand-washing and diapering equipment reduces disease among children in out-of-home child care centers. Pediatrics 120:e29-36.

9.2.3.11: Food and Nutrition Service Policies and Plans

Content in the STANDARD was modified on 05/21/2019.


Early care and education programs should have food handling, feeding, and written nutrition policies and plans under the direction of the administration that address the following items:

  1. Age-appropriate eating utensils and tableware
  2. Age-appropriate portion sizes to meet nutritional needs
  3. Emergency preparedness for water and nutrition services
  4. Food allergies and special dietary restrictions, including family/cultural food preferences
  5. Food brought from home, including food brought for celebrations
  6. Food budget
  7. Food safety, sanitation, preparation, and service
  8. Food procurement and storage
  9. Kitchen and meal service staffing
  10. Kitchen layout
  11. Menu and meal planning
  12. Nutrition education for children, staff, and parents/guardians
  13. Promotion of breastfeeding and provision of community resources to support mothers

A nutritionist/registered dietitian and a food service expert should provide input for and facilitate the development and implementation of a written nutrition plan for the early care and education program.1

RATIONALE

Children spend a significant amount of time in out-of-home care; this requires 1 or 2 meals to be served during the day.2 Having a plan that clearly assigns responsibility and that encompasses the pertinent nutrition elements will promote the optimal health of all children and staff in early care and education settings. Centers following safe steps in food handling, cooking, and storage safeguard against foodborne illness.3

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
Appendix JJ: Our Child Care Center Supports Breastfeeding
Appendix C: Nutrition Specialist, Registered Dietitian, Licensed Nutritionist, Consultant, and Food Service Staff Qualifications
REFERENCES
  1. School Nutrition Association. School nutrition professionals: roles & responsibilities. https://schoolnutrition.org/AboutSchoolMeals/SNPRolesResponsibilities. Accessed December 20, 2018

  2. Swindle T, Sigman-Grant M, Branen LJ, Fletcher J, Johnson SL. About feeding children: factor structure and internal reliability of a survey to assess mealtime strategies and beliefs of early childhood education teachers. Int J Behav Nutr Phys Act. 2018;15(1):85

  3. US Department of Agriculture, Food Safety and Inspection Service. Basics for handling food safely. https://www.fsis.usda.gov/wps/portal/fsis/topics/food-safety-education/get-answers/food-safety-fact-sheets/safe-food-handling/basics-for-handling-food-safely/ct_index. Modified March 24, 2015. Accessed December 20, 2018

NOTES

Content in the STANDARD was modified on 05/21/2019.

9.2.3.12: Infant Feeding Policy


A policy about infant feeding should be developed with the input and approval from the nutritionist/registered dietitian and should include the following:

  1. Storage and handling of expressed human milk;
  2. Determination of the kind and amount of commercially prepared formula to be prepared for infants as appropriate;
  3. Preparation, storage, and handling of infant formula;
  4. Proper handwashing of the caregiver/teacher and the children;
  5. Use and proper sanitizing of feeding chairs and of mechanical food preparation and feeding devices, including blenders, feeding bottles, and food warmers;
  6. Whether expressed human milk, formula, or infant food should be provided from home, and if so, how much food preparation and use of feeding devices, including blenders, feeding bottles, and food warmers, should be the responsibility of the caregiver/teacher;
  7. Holding infants during bottle-feeding or feeding them sitting up;
  8. Prohibiting bottle propping during feeding or prolonging feeding;
  9. Responding to infants’ need for food in a flexible fashion to allow cue feedings in a manner that is consistent with the developmental abilities of the child (policy acknowledges that feeding infants on cue rather than on a schedule may help prevent obesity) (1,2);
  10. Introduction and feeding of age-appropriate solid foods (complementary foods);
  11. Specification of the number of children who can be fed by one adult at one time;
  12. Handling of food intolerance or allergies (e.g., cow’s milk, peanuts, orange juice, eggs, wheat).

Individual written infant feeding plans regarding feeding needs and feeding schedule should be developed for each infant in consultation with the infant’s primary care provider and parents/guardians.

RATIONALE
Growth and development during infancy require that nourishing, wholesome, and developmentally appropriate food be provided, using safe approaches to feeding. Because individual needs must be accommodated and improper practices can have dire consequences for the child’s health and safety, the policy for infant feeding should be developed with professional nutritionists/registered dietitians. The infant feeding plans should be developed with each infant’s parents/guardians and, when appropriate, in collaboration with the child’s primary care provider.
TYPE OF FACILITY
Center, Early Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
Appendix JJ: Our Child Care Center Supports Breastfeeding
REFERENCES
  1. Birch, L., W. Dietz. 2008. Eating behaviors of young child: Prenatal and postnatal influences on healthy eating, 59-93. Elk Grove Village, IL: American Academy of Pediatrics.
  2. Taveras, E. M., S. L. Rifas-Shiman, K. S. Scanlon, L. M. Grummer-Strawn, B. Sherry, M. W. Gillman. 2006. To what extent is the protective effect of breastfeeding on future overweight explained by decreased maternal feeding restriction? Pediatrics 118:2341-48.

9.2.3.13: Plans for Evening and Nighttime Child Care


Facilities that provide evening and nighttime care should have plans for such care that include the supervision of sleeping children and the management and maintenance of sleep equipment including their sanitation and disinfection. Evacuation drills should occur during hours children are in care. Centers should have these plans in writing.
RATIONALE
Evening child care routines are similar to those required for daytime child care with the exception of sleep routines. Evening and nighttime child care requires special attention to sleep routines, safe sleep environment, supervision of sleeping children, and personal care routines, including bathing and tooth brushing. Nighttime child care must meet the nutritional needs of the children and address morning personal care routines such as toileting/diapering, hygiene, and dressing for the day. Children and staff must be familiar with evacuation procedures in case a natural or human generated disaster occurs during evening child care and nighttime child care hours.
COMMENTS
Sleeping time is a very sensitive time for infants and young children. Attention should be paid to individual needs, transitional objects, lighting preferences, and bedtime routines.
TYPE OF FACILITY
Center, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.2.4.3 Disaster Planning, Training, and Communication
9.2.4.4 Written Plan for Seasonal and Pandemic Influenza
9.2.4.5 Emergency and Evacuation Drills/Exercises Policy

9.2.3.14: Oral Health Policy


The program should have an oral health policy that includes the following:

  1. Information about fluoride content of water at the facility;
  2. Contact information for each child’s dentist;
  3. Resource list for children without a dentist;
  4. Implementation of daily tooth brushing or rinsing the mouth with water after eating;
  5. Use of sippy cups and bottles only at mealtimes during the day, not at naptimes;
  6. Prohibition of serving sweetened food products;
  7. Promotion of healthy foods per the USDA’s Child and Adult Care Food Program (CACFP);
  8. Early identification of tooth decay;
  9. Age-appropriate oral health educational activities;
  10. Plan for handling dental emergencies.
RATIONALE
Good oral hygiene is as important for a six-month-old child with one tooth as it is for a six-year-old with many teeth (1). Tooth brushing and activities at home may not suffice to develop the skill of proper tooth brushing or accomplish the necessary plaque removal, especially when children eat most of their meals and snacks during a full day in child care.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
REFERENCES
  1. American Academy of Pediatric Dentistry. 2009. Clinical guideline on periodicity of examination, preventive dental services, anticipatory guidance, and oral treatment for children. Pediatric Dentistry 30:112-18.

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

Content in the STANDARD was modified on 1/12/2017.

 


Facilities should have written policies addressing the use and possession of tobacco and electronic cigarette (e-cigarette) products, alcohol, illegal drugs, legal drugs (e.g. medicinal/recreational marijuana, prescribed narcotics, etc.) that have side effects that diminish the ability to properly supervise and care for children or safely drive program vehicles, and other potentially toxic substances. Policies should include that all of these substances are prohibited inside the facility, on facility grounds, and in any vehicles that transport children at all times. Policies should specify that smoking and vaping is prohibited at all times and in all areas (indoor and outdoor) of the program. This includes any vehicles that are used to transport children.

Policies must also specify that use and possession of all substances referred to above are prohibited during all times when caregivers/teachers are responsible for the supervision of children, including times when children are transported, when playing in outdoor play areas not attached to the facility, and during field trips and staff breaks.

Child care centers and large family child care homes should provide information to employees about available drug, alcohol, and tobacco counseling and rehabilitation, and any available employee assistance programs.

RATIONALE
The age, defenselessness, and lack of discretion of the child under care make this prohibition an absolute requirement. 

The hazards of second-hand and third-hand smoke exposure warrant the prohibition of smoking in proximity of child care areas at any time (1-10). Third-hand smoke refers to gases and particles clinging to smokers’ hair and clothing, cushions, carpeting and outdoor equipment after visible tobacco smoke has dissipated (9). The residue includes heavy metals, carcinogens, and even radioactive materials that young children can get on their hands and ingest, especially if they’re crawling or playing on the floor. Residual toxins from smoking at times when the children are not using the space can trigger asthma and allergies when the children do use the space (10). 

Safe child care necessitates sober caregivers/teachers. Alcohol and drug use, including the misuse of prescription, over-the-counter (OTC), or recreational drugs, prevent caregivers/teachers from providing appropriate care to infants and children by impairing motor coordination, judgment, and response time. Off-site use prior to or during work, of alcohol and illegal drugs is prohibited. OTC medications or prescription medications that have not been prescribed for the user or that could impair motor coordination, judgment, and response time is prohibited.

The use of alcoholic beverages and legal drugs in family child care homes when children are not in care is not prohibited, but these items should be stored safely at all times.

COMMENTS
The policies related to smoking and use of prohibited substances should be discussed with staff and parents/guardians. Educational material such as handouts could include information on the health risks and dangers of these prohibited substances and referrals to services for counseling or rehabilitation programs.

It is strongly recommended that, whenever possible, all caregivers/teachers should be non-tobacco and non-electronic cigarette (e-cigarette) users. Family child care homes should be kept smoke-free at all times to prevent exposure of the children who are cared for in these spaces.

In states that permit recreational and/or medicinal use of marijuana, special care is needed to store edible marijuana products securely and apart from other foods. State regulations typically required that these products be clearly labeled as containing an intoxicating substance and stored in the original packaging that is tamper-proof and child-proof. Any legal edible marijuana products in a family child care home should be helpy in a locked and child-resistant storage device. 

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
REFERENCES
  1. U.S. Environmental Protection Agency. Secondhand tobacco smoke and smoke-free homes. 2016. https://www.epa.gov/indoor-air-quality-iaq/secondhand-tobacco-smoke-and-smoke-free-homes.
  2. American Academy of Pediatrics. Healthychildren.org. 2015. The dangers of secondhand smoke. https://www.healthychildren.org/English/health-issues/conditions/tobacco/Pages/Dangers-of-Secondhand-Smoke.aspx
  3. U.S. Department of Health and Human Services. 2007. Children and secondhand smoke exposure. Excerpts from the health consequences of involuntary exposure to tobacco smoke: A report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
  4. Dreyfuss, J.H. Thirdhand smoke identified as potent, enduring carcinogen. CA Cancer J Clin. 2010;60(4):203-204. https://www.ncbi.nlm.nih.gov/pubmed/20530799.
  5. U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Secondhand Smoke What It Means to You. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006. http://www.surgeongeneral.gov/library/reports/secondhand-smoke-consumer.pdf
  6. Hang, B., Sarker, A.H., Havel, C., et al. Thirdhand smoke causes DNA damage in human cells. Mutagenesis. 2013;28(4):381-391. https://www.ncbi.nlm.nih.gov/pubmed/23462851
  7. Winickoff, J. P., J. Friebely, S. E. Tanski, C. Sherrod, G. E. Matt, M. F. Hovell, R. C. McMillen. 2009. Beliefs about the health effects of “thirdhand” smoke and home smoking bans. Pediatrics 123: e74-e79.
  8. Dale, L. 2014. What is thirdhand smoke, and why is it a concern? http://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/third-hand-smoke/faq-20057791.
  9. Centers for Disease Control and Prevention. 2016. Health effects of secondhand smoke. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/health_effects/
  10. Campaign for Tobacco-Free Kids. Secondhand smoke, kids and cars. 2016. http://www.tobaccofreekids.org/research/factsheets/pdf/0334.pdf.
  11. ADDITIONAL REFERENCES
     
    U.S. Fire Administration. Electronic cigarette fires and explosions. 2014. https://www.usfa.fema.gov/downloads/pdf/publications/electronic_cigarettes.pdf.
     
    Campbell. R. Electronic Cigarette Explosions and Fires: The 2015 Experience. 2016. http://www.nfpa.org/news-and-research/fire-statistics-and-reports/fire-statistics/fire-causes/electrical-and-consumer-electronics/electronic-cigarette-explosions-and-fires-the-2015-experience.
     
    National Institute on Drug Abuse. 2016. What is marijuana? https://www.drugabuse.gov/publications/drugfacts/marijuana.
     
    Rapoport, M.J., Lanctôt, K.L., Streiner, D.L., Bédard, M., Vingilis, E., Murray, B., Schaffer, A., Shulman, K.I., Herrmann, N. Benzodiazepine use and driving: A meta-analysis. J Clin Psychiatry. 2009;70(5):663-73. doi:10.4088/JCP.08m04325.
     
    Sansone, R.A., Sansome, L.A. Driving on Antidepressants: Cruising for a crash?. Psychiatry (Edgmont). 2009:6(9): 13–16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2766284/.
     
    Volkow, N.D., Baler, R.D., Compton, W.M., R.B. Weiss, S.R.B. Adverse health effects of marijuana use. N Engl J Med 2014:370:2219-2227. DOI: 10.1056/NEJMra1402309.
     
    Lenné MG, Dietze PM, Triggs TJ, Walmsley S, Murphy B, Redman JR. The effects of cannabis and alcohol on simulated arterial driving: Influences of driving experience and task demand. Accid Anal Prev. 2010;42(3):859-866. doi:10.1016/j.aap.2009.04.021.
     
    Hartman RL, Huestis MA. Cannabis effects on driving skills.Clin Chem. 2013;59(3):478-492. doi:10.1373/clinchem.2012.194381.
     
    Verster, J. C., D. S. Veldhuijzen, E. R. Volkerts. 2005. Is it safe to drive a car when treated with anxiolytics? Evidence from on the road driving studies during normal traffic. Current Psychiatry Reviews1:215-25.
     
    Centers for Disease Control and Prevention. 2009. Facts: Preventing residential fire injuries. http://www.cdc.gov/injury/pdfs/Fires2009CDCFactSheet-FINAL-a.pdf
     
    American Lung Association. E-cigarettes and Lung Health. 2016. http://www.lung.org/stop-smoking/smoking-facts/e-cigarettes-and-lung-health.html?referrer=https://www.google.com/.
     
    Children’s Hospital Colorado. 2016. Acute marijuana intoxication. https://www.childrenscolorado.org/conditions-and-advice/conditions-and-symptoms/conditions/acute-marijuana-intoxication/.
NOTES

Content in the STANDARD was modified on 1/12/2017.

 

9.2.3.16: Policy Prohibiting Firearms


Centers should have a written policy prohibiting firearms, ammunition, and ammunition supplies.

Large or small family homes should have a written policy that if firearms and other weapons are present, they should:

  1. Have child protective devices;
  2. Be unloaded or disarmed;
  3. Be kept under lock and key;
  4. Be inaccessible to children.

For large and small family homes the policy should include that ammunition and ammunition supplies should be:

  1. Placed in locked storage;
  2. Separate from firearms;
  3. Inaccessible to children.

Parents/guardians should be notified that firearms and other weapons are on the premises.

RATIONALE
The potential for injury to and death of young children due to firearms is apparent (1-3). These items should not be accessible to children in a facility (2,3).
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
REFERENCES
  1. American Academy of Pediatrics, Committee on Injury and Poison Prevention. 2004. Policy statement: Firearm-related injuries affecting the pediatric population. Pediatrics 114:1126.
  2. DiScala, C., R. Sege. 2004. Outcomes in children and young adults who are hospitalized for firearms-related injuries. Pediatrics 113:1306-12.
  3. Grossman, D. C., B. A. Mueller, C. Riedy, et al. 2005. Gun storage practices and risk of youth suicide and unintentional firearm injuries. JAMA 296:707-14.

9.2.3.17: Child Care Health Consultant’s Review of Health Policies


At least annually, after an incident or injury has occurred, or when changes are made in the health policies, the facility should obtain input and a review of the policies from a child care health consultant.
RATIONALE
Changes in health information may require changes in the health policies of a child care facility. These changes are best known to health professionals who stay in touch with sources of updated information and can suggest how the new information applies to the operation of the child care program (1,2). For example, when the information on the importance of back-positioning for putting infants down to sleep became available, it needed to be added to child care policies. Frequent changes in recommended immunization schedules offer another example of the need for review and modification of health policies.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
REFERENCES
  1. Alkon, A., J. Farrer, J. Bernzweig. 2004. Child care health consultants’ roles and responsibilities: Focus group findings. Pediatric Nursing 30:315-21.
  2. Dellert, J. C, D. Gasalberti, K. Sternas, P. Lucarelli, J. Hall. 2006. Outcomes of child care health consultation services for child care providers in New Jersey: A pilot study. Pediatric Nursing 32:530-37.

9.2.4 Emergency/Security Policies and Plans

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


The facility should have a written plan for reporting and managing what they assess to be an incident or unusual occurrence that is threatening to the health, safety, or welfare of the children, staff, or volunteers. The facility should also include procedures of staff training on this plan.

The management, documentation, and reporting of the following types of incidents, at a minimum, that occur at the child care facility should be addressed in the plan:

  1. Lost or missing child;
  2. Suspected maltreatment of a child (also see state’s mandates for reporting);
  3. Suspected sexual, physical, or emotional abuse of staff, volunteers, or family members occurring while they are on the premises of the child care facility;
  4. Injuries to children requiring medical or dental care;
  5. Illness or injuries requiring hospitalization or emergency treatment;
  6. Mental health emergencies;
  7. Health and safety emergencies involving parents/guardians and visitors to the program;
  8. Death of a child or staff member, including a death that was the result of serious illness or injury that occurred on the premises of the child care facility, even if the death occurred outside of child care hours;
  9. The presence of a threatening individual who attempts or succeeds in gaining entrance to the facility.

The following procedures, at a minimum, should be addressed in the plan for urgent care:

  1. Provision for a caregiver/teacher to accompany a child to a source of urgent care and remain with the child until the parent/guardian assumes responsibility for the child;
  2. Provision for the caregiver/teacher to provide the medical care personnel with an authorization form signed by the parent/guardian for emergency medical care and a written informed consent form signed by the parent/guardian allowing the facility to share the child’s health records with other service providers;
  3. Provision for a backup caregiver/teacher or substitute for large and small family child care homes to make the arrangement for urgent care feasible (child:staff ratios must be maintained at the facility during the emergency);
  4. Notification of parent/guardian(s);
  5. Pre-planning for the source of urgent medical and dental care (such as a hospital emergency room, medical or dental clinic, or other constantly staffed facility known to caregivers/teachers and acceptable to parents/guardians);
  6. Completion of a written incident/injury report and the program’s response;
  7. Assurance that the first aid kits are resupplied following each first aid incident, and that required contents are maintained in a serviceable condition, by a monthly review of the contents;
  8. Policy for scheduled reviews of staff members’ ability to perform first aid for averting the need for emergency medical services;
  9. Policy for staff supervision following an incident when a child is lost, missing, or seriously injured.
RATIONALE
Emergency situations are not conducive to calm and composed thinking. A written plan provides the opportunity to prepare and to prevent poor judgments made under the stress of an emergency.

Unannounced mock situations used as drills can help ease tension and build confidence in the staff’s ability to respond calmly in the event of a real incident. Discussion regarding performance and opportunities for improvement should follow the drill.

An organized, comprehensive approach to injury prevention and control is necessary to ensure that a safe environment is provided to children in child care. Such an approach requires written plans, policies, procedures, and record-keeping so that there is consistency over time and across staff and an understanding between parents/guardians and caregivers/teachers about concerns for, and attention to, the safety of children.

Routine restocking of first aid kits is necessary to ensure supplies are available at the time of an emergency. Staff should be trained in the use of standard precautions during the response to any situation in which exposure to bodily fluids could occur. Management within the first hour or so following a dental injury may save a tooth.

Intrusions by threatening individuals to child care facilities have occurred, some involved violence resulting in injury and death. These threats have come from strangers who gained access to the playground or an unsecured building, or impaired family members who had easy access to a secured building. Facilities must have a plan for what to do in such situations (1-3).

COMMENTS
The American Academy of Pediatrics’ policy statement, “Medical Emergencies Occurring at School” contains information including a comprehensive list of resources that is relevant to child care facilities. The Emergency Medical Services for Children National Resource Center (http://www.childrensnational.org/emsc/) has downloadable print information for emergency medical training, particularly the brochure entitled “Emergency Guidelines for School” at http://ems.ohio.gov/EMSC web site_11_04/pdf_doc files/EMSCGuide.pdf. This site also lists internet links to emergency plans for specific health needs such as diabetes, asthma, seizures, and allergic reactions. Resources for emergency response to non-medical incidents can be found at http://www.chtc.org/dl/handouts/20061114/20061114-2.pdf and http://dcf.vermont.gov/sites/dcf/files/pdf/cdd/care/EmergencyResponse.pdf.

It is recommended that parents/guardians inform caregivers/teachers their preferred sources for medical and dental care in case of emergency. Parents/guardians should be notified, if at all possible, before dental services are rendered, but emergency care should not be delayed because the child’s own dentist is not immediately available.

Facilities should develop and institute measures to control access of a threatening individual to the facility and the means of alerting others in the facility as well as summoning the police if such an event occurs.

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.2.4.2 Review of Written Plan for Urgent Care and Threatening Incidents
9.2.4.3 Disaster Planning, Training, and Communication
9.4.1.9 Records of Injury
9.4.1.10 Documentation of Parent/Guardian Notification of Injury, Illness, or Death in Program
9.4.1.11 Review and Accessibility of Injury and Illness Reports
9.4.2.1 Contents of Child’s Records
REFERENCES
  1. AFP. 2009. Belgian charged over daycare killings. Nine News, Jan 24. http://news.ninemsn.com.au/world/.
  2. Haggerty, R. 2010. Man kills self after firing shots at day care. Journal Sentinel, Feb 17. http://www.jsonline.com/news/crime/.
  3. Guerra, C. 2010. Child care providers get lessons in Lee County on being prepared. News-Press, Apr 19. http://beta.news
    -press.com.

9.2.4.2: Review of Written Plan for Urgent Care and Threatening Incidents

Content in the STANDARD was modified on 08/27/2020.


The early care and education program written plan(s) for urgent medical care and threatening incidents should be reviewed and updated annually or as needed. It should be reviewed with each employee on employment and yearly thereafter to ensure that policies and procedures are understood and followed in the event of such an occurrence. The plan(s) and associated procedures should be reviewed with a child care health consultant once a year, signed, and dated.

In the event that there is an urgent medical care or threatening incident, the facility should plan to review the process within 1 to 2 months after the incident to determine opportunities for improvement and any changes that need to be made to the plan for future incidents.

The care plan for a child with special health care needs should cover emergency care needs and be shared with and discussed between parents/guardians and caregivers/teachers prior to an emergency situation.1

RATIONALE

Emergency situations are not conducive to calm and composed thinking. Developing a written plan and reviewing it in preservice meetings with new employees, and annually thereafter, provides the opportunity to prepare and to provide guidance for good decision-making under the stress of an emergency. An organized, comprehensive approach to urgent care response and control based on current practice and evidence is necessary to ensure that a safe environment is provided to children in child care. Such an approach requires written plans, policies, procedures, and record keeping so that there is consistency over time and across staff. It also promotes understanding between parents/guardians and caregivers/teachers about concerns for, and attention to, the safety of children.

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.2.4.1 Written Plan and Training for Handling Urgent Medical Care or Threatening Incidents
9.2.4.3 Disaster Planning, Training, and Communication
Appendix KK: Authorization for Emergency Medical/Dental Care
Appendix CC: Incident Report Form
Appendix O: Care Plan for Children with Special Health Care Needs
Appendix P: Situations that Require Medical Attention Right Away
REFERENCES
  1. American Academy of Pediatrics. Managing Chronic Health Needs in Child Care and Schools: A Quick Reference Guide. Donoghue EA, Kraft CA, eds. 2nd ed. Itasca, IL: American Academy of Pediatrics; 2019

NOTES

Content in the STANDARD was modified on 08/27/2020.

9.2.4.3: Disaster Planning, Training, and Communication

Content in the STANDARD was modified on 02/27/2020.


Early care and education programs should develop written action plans to prepare for and respond to emergency or natural disaster situations. These written action plans should include preparation/response practices and procedures for hazards/disasters that could occur in any location, including acts of violence, biological or chemical terrorism, exposure to hazardous agents, facility damage, fire, missing child, power outage, and other situations that may require evacuation, relocation, lockdown, lockout, or shelter in place. All early care and education programs should have procedures in place to address natural disasters relevant to their location (eg, earthquakes, tornados, tsunamis, floods/flash floods, storms, volcanoes).

 

If a facility is unsure of what to do, the first point of contact in any situation should be the local public health authority.1 The local public health authority, in partnership with emergency personnel and other officials, will know how to engage the appropriate public health and other professionals for the situation.

 

Certain emergency/disaster situations may result in exceptions being made regarding state or local regulations (either in existing facilities or in temporary facilities). In these situations, facilities should make every effort to meet or exceed the temporary requirements.

 

Written Emergency/Disaster Action Plan

Facilities should develop and implement a written plan that describes the practices and procedures they will use to prepare for and respond to emergency or disaster situations. This emergency/disaster plan should include

  1. Information on disasters likely to occur in or near the facility, county, state, or region that require advance preparation and/or contingency planning
  2. Plans (and a timeline) to conduct regularly scheduled practice drills within the facility and in collaboration with community or other exercises
  3. Mechanisms for notifying and communicating with parents/guardians in various situations (eg, website postings; use of social media platforms; email notifications; recorded message on central telephone number, telephone calls, use of telephone tree, or cellular phone texts; posting of flyers at the facility and other community locations)
  4. Mechanisms for notifying and communicating with emergency management and public health officials (advance connections with these officials will be helpful to identify times when it would be important to notify others)
  5. Information on crisis management (decision-making and practices) related to sheltering in place; lockdown; relocating to another facility; evacuation procedures, including how nonmobile children and adults will be evacuated; safe transportation of children, including children with special health care needs; transporting necessary medical equipment; obtaining emergency medical care; and responding to an intruder or threatening individual
  6. Identification of primary and secondary meeting places and plans for reunification of parents/guardians with their children in the event of an evacuation
  7. Details on collaborative planning with other groups and representatives (eg, other early care and education facilities; schools; state child care licensing personnel; law enforcement and fire officials; emergency management personnel and first responders; pediatricians and other health professionals; public health agencies; clinics; hospitals; volunteer agencies, including Red Cross and other known groups likely to provide shelter and related services)
  8. Continuity of operations planning, including backing up or retrieving health and other key records/files and managing financial issues such as paying employees and bills during the aftermath of the disaster
  9. Contingency plans for various situations that address
    1. Emergency contact information and related procedures to maintain in contact with staff, families, community contacts, vendors, etc
    2. How the facility will care for children and account for them, until the parent/guardian or other authorized adult has been appropriately identified and has accepted responsibility for their care
    3. Acquiring, stockpiling, storing, and cycling provisions to keep updated emergency food/water and supplies that might be needed to care for children and staff for a minimum of 3 days and up to 7 days if sheltering in place is required or when removal to an alternate location is required
    4. Administering medicine and implementing other instructions as described in individual special care plans
    5. Procedures that might be implemented in the event of an infectious disease outbreak, epidemic, or other infectious disease emergency (eg, reviewing relevant immunization records, conducting daily health checks, keeping symptom records, implementing tracking procedures and corrective actions, modifying exclusion and isolation guidelines, coordinating with schools, reporting or responding to notices about public health emergencies)
    6. Procedures for staff to follow in the event that they are on a field trip or are in the midst of transporting children when an emergency or disaster situation arises
    7. Staff responsibilities and assignment of tasks (facilities should recognize that staff can and should be utilized to assist in facility preparedness and response efforts; however, they should not be hindered in addressing their own personal or family preparedness efforts, including evacuation)
    8. Actions to be followed when no authorized person arrives to pick up a child

Specific Written Emergency/Disaster Action Plans

The following are emergency/disaster action plans currently used in early care and education programs. Caregivers/teachers should be aware of the differences between each action plan and when to implement the appropriate actions.

 

Evacuation
An evacuation is carried out to move students and staff out of the building. These drills often accompany fire drills and require students and staff to leave and move to a nearby, predetermined location.2

 

An evacuation plan should include all the following components3:

  1. Information, diagrams, and/or maps on classroom and building locations, including locations of all exits, doors, and stairways
  2. Maps of evacuation routes in each classroom, including
    1. Primary and secondary evacuation routes
    2. Locations of the primary and secondary assembly areas
    3. Locations of fire alarm manual pull stations, fire extinguishers, smoke detectors, sprinkler heads, and sprinkler control valves
  3. Directions for how staff will be notified and what they will do when they need to immediately evacuate the building and proceed to assembly areas (staff and children should be advised to evacuate as quickly and as safely as possible and should not attempt to secure or collect personal items during an evacuation, if it would compromise their safety or the safety of the children they care for)
  4. Recommendation that (when feasible) each classroom should take their portable first aid kit with emergency information, medications, and other documents
  5. Description of how staff will monitor/track children, including a requirement that attendance should be taken immediately before evacuating and once at the assembly area
  6. Steps to notify parents in an emergency

 

Shelter in Place

A shelter in place is carried out during severe weather and other environmental hazard/threat situations with the goal of keeping people safe while remaining indoors.2,4 Early care and education programs should have students, staff, and visitors take shelter in predetermined rooms with access to a telephone, stored disaster supplies, and, ideally, a bathroom. Facility and classroom doors should all remain shut and locked, depending on the situation.

A shelter-in-place plan should include all the following components5:

 

  1. Details on how to notify staff and children that a shelter-in-place drill (or another code word) is occurring, such as verbally announce “shelter-in-place” or other communication term.
  2. Recommendations for staff as to whether they should bring children inside or relocate to another nearby facility.
  3. Instructions to bring children and staff to the predetermined area(s) within the building/home.
    1. Depending on the nature of the emergency, when outside air quality is compromised, select interior room(s) without windows or vents that has adequate space to accommodate all children and staff.
    2. Close and lock all windows and doors.
    3. If necessary, staff should shut off the building’s heating systems, gas, air conditioners, and exhaust fans and switch valves to the closed position.
    4. If necessary, seal all cracks around the doors and any vents into the room with duct tape or plastic sheeting.
  4. Attendance should be taken to ensure everyone is present and accounted for in the area.
  5. No outside access is permitted, but early care and education programs may allow activities within the predetermined area to continue.
  6. Early care and education staff should follow established procedures for assisting children and/or staff with special health care needs. Bring medications, special health care plans, and assistive devices for communication and mobility.
  7. Early care and education staff should follow established procedures for addressing children’s (especially infants and toddlers) nutrition and hygiene needs.
  8. Provide developmentally appropriate activities (a list of ideas can be determined in advance and included in the written plan).
  9. Continue the shelter-in-place drill until the early care and education program director or designee announces the end of the drill.

 

Lockdown

A lockdown is used when there is a perceived threat/danger inside the building.2 A lockdown is carried out to secure all children and staff within their classrooms by locking the doors, directing people to hide or stay away from windows and doors, and sometimes asking people to remain calm and quiet. No children or staff members should be in the hallways during a lockdown. The plan should include protocols on when to unlock/open doors and should be developed in collaboration with local law enforcement officials.

 

A lockdown plan should include all the following components6:

 

  1. Notify children that a lockdown is occurring by verbally announce “lockdown” or other communication term.
  2. If children are outside, bring them inside.
  3. Instruct people to go to the nearest room or the designated location away from danger and bring first aid/disaster and emergency supply kits.
  4. Lock the classroom doors and windows, cover the windows, and turn off lights and audio equipment. Use tables, cabinets, or other heavy furniture to block doors/windows, if needed.
  5. Children should be asked to remain seated on the floor, away from doors and windows.
  6. Attendance should be taken to ensure all children are accounted for and remain inside the room.
  7. If relevant, instruct staff and children that everyone will ignore any fire alarm activation.
  8. Set cell phones to silent or vibrate.
  9. Activate the emergency communication/notification plan, contact outside staff and families, inform them of the situation, and explain that they cannot enter the building right now and if they are nearby, they may need to find a safe location.
  10. Staff should follow established procedures to remain calm and help children stay quiet. Examples include holding hands, gently rocking back and forth, using modified hand gestures that relate to a song without singing (eg, heads, shoulders, knees, and toes; eensy-weensy spider), making eye contact with each child, or offering pacifiers to infants.
  11. Staff should follow established procedures for assisting children and/or staff with special health care needs. Bring medications, care plans, and assistive devices for communication and mobility into the area where people are located.
  12. Staff should follow established procedures for addressing children’s (especially infants and toddlers) nutrition and hygiene needs.
  13. Remain in the room until the early care and education program director or designee announces the end of the lockdown.

Details in the emergency/disaster plans should be reviewed and updated biannually and immediately after any relevant event to incorporate any best practices or lessons learned into the document.

Facilities should identify which agency or agencies would be the primary contact for early care and education regulations, evacuation instructions, and other directives that might be communicated in various emergency or disaster situations.

Staff Support/Training

Staff should receive training on emergency/disaster planning and response. Training can be provided by individual groups or people such as emergency management agencies, educators, child care health consultants (CCHCs), health professionals, hospital or health care coalition personnel, law enforcement or fire officials, or emergency personnel qualified and experienced in disaster preparedness and response. Training could also be developed with a community team identified to assist the program with these efforts. The training should address

  1. Why it is important for early care and education programs to prepare for disasters and to have an emergency/disaster plan
  2. Different types of emergency and disaster situations and when and how they may occur
    1. Natural disasters
    2. Exposure to agents (ie, biological, chemical, radiological, nuclear, or explosive) that may be intentional (terrorism) or accidental
    3. Outbreaks, epidemics, or other infectious disease emergencies
  3. The special and unique needs of children at various ages and developmental stages and appropriate responses to children’s physical and emotional needs during and after the disaster, including information on consulting with pediatric disaster experts
  4. How to obtain support for staff members in coping/adjusting after a disaster/emergency
  5. Providing first aid and medications and accessing emergency health care in situations in which there are not enough available resources
  6. Contingency planning, including the ability to be flexible, to improvise, and to adapt to ever-changing situations
  7. Developing personal and family preparedness plans
  8. Strategies for supporting and communicating with families
  9. Floor plan/layout and appropriate safety considerations
  10. Location of emergency documents, supplies, medications, and equipment needed by children and staff with special health care needs
  11. Typical community, county, and state emergency procedures (including information on state disaster and pandemic influenza plans, emergency operation centers, and the incident command structure)
  12. Community resources for post-event support, such as agencies with mental health consultants, counselors, and safety consultants
  13. Which individuals or agency representatives have the authority to close early care and education programs and schools and when and why this might occur
  14. Insurance and liability issues
  15. New advances in technology, communication efforts, and disaster preparedness strategies customized to meet children’s needs

Facilities should determine how often they will conduct drills/tests, or “practice use” of an evacuation, shelter in place, or lockdown, as well as the communication options/planning mechanisms that are selected. These drills/tests should be held at least annually, but some could also be held on a biannual or quarterly basis. After an event or practice drill, the staff should meet to review what happened and identify any needed changes to the written plan or protocols.

Communicating With Parents/Guardians

Facilities should share detailed information about facility disaster planning and preparedness with parents/guardians when they enroll their children in the program, including

  1. Portions of the emergency/disaster plan relevant to parents/guardians or the public
  2. Procedures and instructions for what parents/guardians can expect if something happens at the facility
  3. Description of how parents/guardians will receive information and updates during or after a potential emergency or disaster situation
  4. Situations that might require parents/guardians to have a contingency plan regarding how their children will be cared for in the unlikely event of a facility closure

Recovery After a Disaster

In the recovery time frame after a disaster, early childhood professionals, early care and education health and safety experts, CCHCs, health care professionals, and researchers with expertise in child development or early care and education may be asked to support the development of or help to implement emergency, temporary, or respite child care. These individuals may also be asked to assist with caring for children in shelters or other temporary housing situations. Disaster recovery can take months or even years, so it is wise to plan for how the program will address any ongoing support needs of the children, families, and staff in these situations. Refer to Standard 5.1.1.5: Environmental Audit of Site Location for more information on assessing building safety following a disaster.

RATIONALE

The only way to prepare for disasters is to consider various worst case or unique scenarios and to develop contingency plans. By brainstorming and thinking through a variety of what-if situations and developing records, protocols/procedures, and checklists (and testing/practicing these), facilities will be better able to respond to an unusual emergency or disaster situation.

 

Providing clear, accurate, and helpful information to parents/guardians as soon as possible is crucial. Sharing written policies with parents/guardians when they enroll their child, informing them of routine practices, and letting them know how they will receive information and updates, on a daily basis as well as during a disaster or emergency, will help them understand what to expect. Notifying parents/guardians about emergencies or disaster situations without causing alarm or prompting inappropriate action is challenging. The content of such communications will depend on the situation. Sometimes, it will be necessary to provide information to parents/guardians while a situation is evolving and before all details are known. In a serious situation, the federal government, the governor, or the state or county health official may announce or declare a state of emergency, a public health emergency, or a disaster.

Ignoring fire alarm activation during a lockdown or lockdown drill is used to protect children from an intruder either in or outside of the building, as the fire alarm could trigger everyone to leave the building, which would perhaps put them in the path of the intruder. Explaining this up front will help adults and children comply with this approach in an emergency.

Identifying and connecting with the appropriate key contact(s) before a disaster strikes is crucial for many reasons but particularly because the identified official may not know how to contact or connect with individual early care and education programs. In addition, representatives within the local school system (especially school administrators and school nurses) may have effective and more direct connections to the state emergency management or disaster preparedness and response system. If early care and education programs do not typically communicate with the schools in their area on a regular basis, staff can consider establishing a direct link to and partnership with school representatives already involved in disaster planning and response efforts.

Early care and education programs, as well as pediatricians, are rarely considered or included in disaster planning or preparedness efforts; unfortunately, the needs of children are, therefore, often overlooked. Children have important physical, physiological, developmental, and psychological differences from adults that can and must be anticipated in disaster planning, response, and recovery processes. Including considerations for children in state plans is a requirement beginning to be implemented in 2019. Caregivers/teachers, pediatricians, health care professionals, and child advocates can prepare to assume a primary mission of advocating for children before, during, and after a disaster.7

COMMENTS

Disaster planning and response protocols are unique and typically customized to the type of emergency or disaster; geographical area; identified needs and available resources; applicable federal, state, and local regulations; and the incident command structure in place at the time. The US Department of Homeland Security and the Federal Emergency Management Agency (FEMA) operate under a set of principles and authorities described in various laws and the National Planning Frameworks (https://www.fema.gov/national-planning-frameworks). Each state is required to maintain a state disaster preparedness plan and a separate plan for responding to a pandemic influenza. These plans may be developed by separate agencies, and the point person or the key contact for an early care and education program can be the state emergency coordinator, a representative in the state department of health, an individual associated with the agency that licenses child care facilities for that state, or another official. The state child care administrator is a key contact for any facility that receives federal support.

 

ADDITIONAL RESOURCES

Ready.gov. Plan ahead for disasters. www.ready.gov. Accessed August 21, 2019

US Office of Human Services, Emergency Preparedness and Response. https://www.acf.hhs.gov/ohsepr. Accessed August 21, 2019

Centers for Disease Control and Prevention, Center for Preparedness and Response. Ready Wrigley. https://www.cdc.gov/cpr/readywrigley/. Reviewed October 15, 2018. Accessed August 21, 2019
TYPE OF FACILITY
Center, Early Head Start, Early Head Start, Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.2.4.4 Written Plan for Seasonal and Pandemic Influenza
9.2.4.9 Policy on Actions to Be Followed When No Authorized Person Arrives to Pick Up a Child
Appendix NN: First Aid and Emergency Supply Lists
REFERENCES
  1. American Academy of Pediatrics. PedFACTs: Pediatric First Aid for Caregivers and Teachers. 2nd ed. Burlington, MA: Jones & Bartlett Learning; 2014

  2. American Academy of Pediatrics. School safety during emergencies: what parents need to know. HealthyChildren.org website. https://www.healthychildren.org/English/safety-prevention/all-around/Pages/Actions-Schools-Are-Taking-to-Make-Themselves-Safer.aspx. Updated June 7, 2015. Accessed August 21, 2019

  3. US General Services Administration. Sample child care evacuation plan. https://www.gsa.gov/resources-for/citizens-consumers/child-care/child-care-services/for-professionals-providers/emergency-management/sample-child-care-evacuation-plan. Reviewed October 11, 2018. Accessed August 21, 2019

  4. National Center on Early Childhood Health and Wellness, US Department of Health and Human Services Administration for Children and Families Office of Head Start. Emergency Preparedness Manual for Early Childhood Programs. https://eclkc.ohs.acf.hhs.gov/sites/default/files/pdf/emergency-preparedness-manual-early-childhood-programs.pdf. Accessed August 21, 2019

  5. University of California San Francisco California Childcare Health Program. Sample announced shelter-in-place drill. https://cchp.ucsf.edu/sites/cchp.ucsf.edu/files/Sample-Drill-Shelter-in-Place.pdf. Published 2016. Accessed August 21, 2019

  6. University of California San Francisco California Childcare Health Program. Sample announced lockdown drill. https://cchp.ucsf.edu/sites/cchp.ucsf.edu/files/Sample-Drill-Lockdown.pdf. Published 2016. Accessed August 21, 2019

  7. Quinn M, Gillooly D, Kelly S, Kolassa J, Davis E, Jankowski S. Evaluation of identified stressors in children and adolescents after Super Storm Sandy. Pediatr Nurs. 2016;42(5):235–241

NOTES

Content in the STANDARD was modified on 02/27/2020.

9.2.4.4: Written Plan for Seasonal and Pandemic Influenza


The facility should have a written plan for seasonal and pandemic influenza (flu) to limit and contain influenza-related health hazards to the staff, children, their families and the general public. The plan should include information on:

  1. Planning and coordination:
    1. Forming a committee of staff members, parents/guardians, and the child care health consultant to produce/review a plan for dealing with the flu each year including specific plans if there is a flu pandemic;
    2. Reviewing the seasonal flu plan during and after flu season so that key staff could discuss how the program would plan for a more serious outbreak or pandemic;
    3. Assigning one person to identify reliable sources of information regarding the seasonal flu strain or pandemic flu outbreak considering local, state and national resources, monitor public health department announcements and other guidance, and forward key information to staff and parents/guardians as needed (the child care health consultant can be especially helpful with this);
    4. Including the infection control policy and procedure (see below) and a communication plan (see below) in the seasonal flu plan;
    5. Including a communication plan (see below), the infection control policy and procedure (see below), and the child learning and program operations plan (see below) in the pandemic flu plan. In addition the pandemic flu plan should include:
    6. Identification of who in the program’s community has legal authority to close child care programs if there is a public health emergency or pandemic;
    7. A list of key contacts such as representatives at the local/state health departments and agencies that regulate child care and their plans to combat or address seasonal or pandemic influenza (programs can extend an invitation for consultation from these departments when formulating the plan).
    8. Development of a plan of action for addressing key business continuity and programmatic issues relevant to pandemic flu;
    9. Communication to parents/guardians encouraging them to have a back-up plan for care for their children if the program must be closed;
    10. Collaboration with those in charge of the community’s planning to find other sources of meals for low-income children who receive subsidized meals in child care in case of a closure;
    11. Knowledge of services in the community that can help staff, children, and their families deal with stress and other problems caused by a flu pandemic;
    12. Communicate with other child care programs in the area to share information and possibly share expertise and resources.
  2. Communications plan:
    1. Developing a plan for keeping in touch during the flu and/or pandemic with staff members and children’s families;
    2. Ensuring staff and families have read and understand the flu and/or pandemic plan and understand why it’s needed;
    3. Communicating reliable information to staff and children’s families on the issues listed below in their languages and at their reading levels:
    4. How to help control the spread of flu by handwashing/cleansing and covering the mouth when coughing or sneezing (see http://www.cdc.gov/flu/school/);
    5. How to recognize a person that may have the flu, and what to do if they think they have the flu (see http://www.pandemicflu.gov);
    6. How to care for family members who are ill (see https://www.cdc.gov/flu/pdf/freeresources/general/influenza_flu_homecare_guide.pdf);
    7. How to develop a family plan for dealing with a flu pandemic (see https://www.cdc.gov/flu/pandemic-resources/index.htm).
  3. Infection control policy and procedures:
    1. Developing a plan for keeping children who become ill at the child care facility away from other children until the family arrives, such as a fixed place for holding children who are ill in an area of their usual caregiving room or in a separate room where interactions with unexposed children and staff will be limited;
    2. Establishing and enforcing guidelines for excluding children with infectious diseases from attending the child care facility (1);
    3. Teaching staff, children, and their parents/guardians how to limit the spread of infection (see http://www.cdc.gov/flu/school);
    4. Maintaining adequate supplies of items to control the spread of infection;
    5. Educating families about the influenza vaccine, including that experts recommend yearly influenza vaccine (and an influenza-specific vaccine, for example H1N1, if necessary) for everyone, however, if there is a vaccine shortage, priority should be given to children and adolescents six months through eighteen years of age, caregivers/teachers of all children younger than five years of age, and health care professionals (see http://www.cdc.gov/flu/);
    6. Staff caring for all children should receive annual vaccination against influenza (and an influenza-specific vaccine such as what was used during the 2009 H1N1 pandemic, if necessary) each year, preferably before the start of the influenza season (as early as August or September) and as long as influenza is circulating in the community, immunization should continue through March or April;
    7. Maintaining accurate records when children or staff are ill with details regarding their symptoms and/or the kind of illness (especially when influenza was verified through testing);
    8. Practicing daily health checks of children and adults each day for illness;
    9. Determining guidelines to support staff members to remain home if they think they might be ill and a mechanism to provide paid sick leave so they can stay home until completely well without losing wages.
  4. Child learning and program operations:
    1. Plan how to deal with program closings and staff absences;
    2. Support families in continuing their child’s learning if the child care program or preschool is closed;
    3. Plan ways to continue basic functions (meeting payroll, maintaining communication with staff, children, and families) if modifications to program planning are necessary or the program is closed.

The facility should also include procedures for staff and parent/guardian training on this plan.

Some of the above plan components may be beyond the scope of ability in a small family child care home. In this case, the caregiver/teacher should work closely with a child care health consultant to determine what specific procedures can be implemented and/or adapted to best meet the needs of the caregiver/teacher and the families s/he serves.

RATIONALE
Yearly or seasonal influenza is a serious illness that requires specific management to keep children healthy. A pandemic flu is a flu virus that spreads rapidly across the globe because most of the population lacks immunity (1,2). The goals of planning for an influenza pandemic are to save lives and to reduce adverse personal, social, and economic consequences of a pandemic. Pandemics, while rare, are not new. In the twentieth century, three flu pandemics were responsible for more than fifty million deaths worldwide, including more than 20 million deaths in the United States (2).
The 2009 influenza A (H1N1) pandemic was the first in the 21st century that resulted in between 151,700 and 575,400 deaths worldwide (2). As it is not possible to predict with certainty when the next flu pandemic will occur or how severe it will be, seasonal flu management and preparation is essential to minimize the potentially devastating effects (1-4).
COMMENTS
The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) recommend annual influenza vaccination for children and caregivers/teachers in child care settings (1,2,5,6). Vaccination is the best method for preventing flu and its potentially severe complications in children (1,2,5,6). The CDC and AAP recommend children and adolescents six months through eighteen years of age, for all adults including household contacts, caregivers/teachers of all children younger than five years of age, and health care professionals get the flu vaccine. Certain groups of children are at increased risk for flu complications. Child care health consultants are very helpful with finding and coordinating the local resources for this planning. In addition most state and/or local health departments have resources for pandemic flu planning.

For additional resources, see:

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.2.4.3 Disaster Planning, Training, and Communication
9.4.1.2 Maintenance of Records
Appendix A: Signs and Symptoms Chart
Appendix G: Recommended Childhood Immunization Schedule
Appendix H: Recommended Adult Immunization Schedule
REFERENCES
  1. Aronson, S. S., T. R. Shope, eds. 2017. Managing infectious diseases in child care and schools: A quick reference guide, pp. 43-48. 4th Edition. Elk Grove Village, IL: American Academy of Pediatrics.
  2. American Academy of Pediatrics. Influenza In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. 31st Edition. Itasca, IL:  American Academy of Pediatrics; 2018: 476-477
  3. Centers for Disease Control and Prevention. 2016. Preventing the flu: Good habits can help stop germs. https://www.cdc.gov/flu/protect/habits.htm.
  4. American Academy of Pediatrics. 2017. Influenza/pandemics. https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Children-and-Disasters/Pages/Influenza-Pandemics.aspx
  5. Centers for Disease Control and Prevention. 2016. Children, the flu, and the flu vaccine. https://www.aap.org/en-us/Documents/disasters_dpac_InfluenzaHandout.pdf
  6. American Academy of Pediatrics. 2015. Influenza prevention and control. Strategies for early education and child care programs. https://www.aap.org/en-us/Documents/disasters_dpac_InfluenzaHandout.pdf

9.2.4.5: Emergency and Evacuation Drills/Exercises Policy

Content in the STANDARD was modified on 05/21/2019.


Early care and education programs should have a written policy documenting that emergency drills or exercises are regularly practiced for geographically appropriate emergencies, natural disasters and violent/hostile intruder events.

a. Evacuation emergencies (eg, fires, floods, gas leaks, chemical spills)

b. Shelter-in-place emergencies (eg, tornados, earthquakes, threatening person outside)

c. Lockdown emergencies (eg, violent/hostile intruders, threatening/dangerous animals)

Early care and education programs should check their state licensing and regulations for specific drill requirements, including timing and frequency details. Staff members, children, and parents should be notified prior to a drill practice.1

All drills/exercises should be recorded. More information on evacuation and shelter-in-place drill records can be found in Standard 9.4.1.16. Depending on the type of disaster, shelter-in-place and lockdown drills may take place within the early care and education program. Examples include earthquakes or tornadoes, where the drill might involve moving to a certain location within the building (eg, basements, away from windows). Evacuation drills/exercises should be practiced at various times of the day, including nap time; during varied activities; and from all exits. Early care and education programs should keep a roster of all children during the drill (Standard 9.2.4.6 Use of Daily Roster During Evacuation Drills). Children with special health care needs and disabilities should be included in all drills to determine if additional attention or accommodations may be needed.2

Caregivers/teachers are encouraged to invite first responders to become part of their emergency planning, training, and drills.2 Early care and education programs should time evacuation procedures. Staff should aim to evacuate all persons in the specific number of minutes recommended by local fire officials (for fire evacuation), law enforcement officials, or emergency response personnel. A fire evacuation procedure should be approved and certified in writing by a fire inspector (for centers) or by a local fire department representative (for large and small family child care homes) during an annual on-site visit or other times at which an evacuation drill is observed and the facility is inspected for fire safety hazards.

During evacuation drills or when moving children from areas of potential danger, designated evacuation cribs can be used to evacuate infants and/or children with special health care needs or disabilities, if rolling is possible on the evacuation/exit route(s).3

In family child care homes, it is possible that infant rooms or napping areas are located on levels other than the main level, making written approval of the program’s evacuation plan by the fire inspector or representative from the local fire department especially important.

RATIONALE

Regular emergency and evacuation drills/exercises constitute an important safety practice in areas where natural disasters and/or violent/hostile intruder events might occur. The routine practice of such drills fosters a calm, competent response to a natural or human-generated disaster when it occurs.4 Unannounced live drills with no prior notification to staff members, children, or parents/guardians may cause unnecessary and significant emotional distress.1 The extensive turnover of both staff and children, in addition to the changing developmental abilities of the children who participate in evacuation procedures in early care and education programs, necessitate frequent practice of the exercises. Representatives and first responders from local fire and police departments can contribute their expertise when observing evacuation plans and drills and gain familiarity with the facility and the facility’s plans in the event they are called on to respond in an emergency.

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.2.4.3 Disaster Planning, Training, and Communication
9.2.4.6 Use of Daily Roster During Evacuation Drills
9.4.1.16 Evacuation and Shelter-In-Place Drill Record
REFERENCES
  1. Schonfeld DJ, Rossen E, Woodard D. Deception in schools—when crisis preparedness efforts go too far. JAMA Pediatr. 2017;171(11):1033–1034

  2. State Capacity Building Center, Office of Child Care, US Department of Health and Human Services Administration for Children and Families. Emergency preparedness, response, and recovery: hostile intruders. How do states and territories plan for and respond to hostile intruder incidents? https://childcareta.acf.hhs.gov/sites/default/files/public/hostile_intruder_0.pdf. Published September 2017. Accessed December 20, 2018

  3. National Center on Early Childhood Health and Wellness, US Department of Health and Human Services Administration for Children and Families Office of Head Start. Emergency Preparedness Manual for Early Childhood Programs. https://eclkc.ohs.acf.hhs.gov/sites/default/files/pdf/emergency-preparedness-manual-early-childhood-programs.pdf. Accessed December 20, 2018

  4. US General Services Administration. Sample child care evacuation plan. https://www.gsa.gov/resources-for/citizens-consumers/child-care/child-care-services/for-professionals-providers/emergency-management/sample-child-care-evacuation-plan. Reviewed October 11, 2018. Accessed December 20, 2018

NOTES

Content in the STANDARD was modified on 05/21/2019.

9.2.4.6: Use of Daily Roster During Evacuation Drills


The center director or his/her designees should use the daily class roster(s) in checking the evacuation and return to a safe space for ongoing care of all children and staff members in attendance during an evacuation drill. In centers caring for more than thirty children enrolled, the center director should assign one caregiver per classroom, the responsibility of bringing the class roster on evacuation drills and accounting for every child and classroom staff at the onset of the evacuation, at the evacuation site and upon return to a safe place. The center director or designee should account for all non-classroom staff, volunteers, and visitors during the evacuation drill process using the program’s sign-in/sign-out system.

Small and large family home child caregivers/teachers should count or use a daily roster to be sure that all children and staff are safely evacuated and returned to a safe space for ongoing care during an evacuation drill.

RATIONALE
There must be a plan to account for all the children and adults in a facility at the time of an evacuation. Assigning responsibility to use a roster(s) in a center, or count the children and adults in a large or small family child care home, ensures that all children and adults are accounted for. Practice accounting for children and adults during evacuation drills makes it easier to do in an emergency situation.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.2.4.7 Sign-In/Sign-Out System

9.2.4.7: Sign-In/Sign-Out System


The facility should have a sign-in/sign-out system to track who enters and exits the facility. The system should include name, contact number, relationship to facility (e.g., parent/guardian, vendor, guest, etc.) and recorded time in and out.
RATIONALE
This system helps to maintain a secure environment for children and staff. It also provides a means to contact visitors if needed (such as a disease outbreak) or to ensure all individuals in the building are evacuated in case of an emergency.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.2.4.8 Authorized Persons to Pick Up Child
9.2.4.9 Policy on Actions to Be Followed When No Authorized Person Arrives to Pick Up a Child
9.2.4.10 Documentation of Drop-Off, Pick-Up, Daily Attendance of Child, and Parent/Provider Communication

9.2.4.8: Authorized Persons to Pick Up Child

Content in the STANDARD was modified on 08/27/2020.


During the enrollment process, the legal guardian(s) of the child should be established and documented along with clarification and documentation of any custody issues and court orders. A noncustodial parent should not be allowed to pick up a child without permission from the custodial parent.

Also, during enrollment, names, addresses, and telephone numbers of persons authorized to take a child out of the early care and education program should be documented.

Early care and education program staff should establish a written policy for identifying individuals for whom the parents/guardians have given prior written authorization to pick up their child, such as requiring photo ID or including a photo of each authorized person in the child’s file.

If there is a circumstance in which the parent/guardian or other authorized person is not able to pick up the child, another individual may pick up a child if they are authorized to do so by the parent/guardian in authenticated communication. This communication can be

  • A witnessed phone conversation in which the caller provides prespecified identifying information (ie, passwords). The telephone authorization should be confirmed by a return call to the parents/guardians.
  • Written permission (paper, email, or text message) that includes the name, address of the individual picking up the child, and current date.1
  • The individual authorized to pick up the child must show valid identification (photo ID) during pickup.

Policies and procedures should address how the early care and education program will handle the situation if a parent/guardian arrives who is intoxicated or otherwise incapable of bringing the child home safely. Caregivers/teachers should not attempt to handle on their own an unstable (ie, intoxicated or aggressive) parent/guardian who wants to enter the facility but whose behavior poses a risk to the children. Early care and education programs have the right to deny access to anyone who poses a potential risk to children enrolled in the early care and education program.2

Should an unauthorized individual attempt to pick up a child without the early care and education program receiving prior communication with the parent/guardian, the parent/guardian should be contacted immediately. If the parent/guardian does not provide authenticated communication about the individual, the child will not be permitted to leave the early care and education program. The early care and education program should document information about the individual attempting to pick up the child. If the individual does not leave and their behavior is concerning to the early care and education staff, or if the child is abducted by force, the police should be contacted immediately with a detailed description of the individual and any other obtainable information, such as a license plate number.1

Early care and education programs should consider having a child car seat policy stating all authorized persons who pick up a child must have an age-appropriate car seat to transport the child. This policy is discussed with parents/guardians during the enrollment process. Repeated failure to comply with the policy may be grounds for dismissal. Many early care and education programs have extra car seats on hand to lend in case a parent/guardian forgets one.

RATIONALE

Releasing a child into the care of an unauthorized person may put the child at risk. If the caregiver/teacher does not know the person, it is the caregiver’s/teacher’s responsibility to verify that the person picking up the child is authorized to do so. This requires checking the written authorization in the child’s file and verifying the identity of the person.

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.2.4.9 Policy on Actions to Be Followed When No Authorized Person Arrives to Pick Up a Child
REFERENCES
  1. Child Care Law Center. Know the law about who may pick up a child from child care. http://childcarelaw.org/wp-content/uploads/2014/06/Know-the-Law-About-Who-May-Pick-a-Child-Up-From-Child-Care-in-California.pdf. Published June 2014. Accessed May 18, 2020

  2. Cal Health & Safety Code §1596.857(g)

NOTES

Content in the STANDARD was modified on 08/27/2020.

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

Content in the STANDARD was modified on 08/27/2020.


Early care and education programs should have a written policy identifying actions to be taken when no authorized person arrives to pick up a child. The plan should be developed in consultation with the child care health consultant, local law enforcement, and child protective services. The plan should also be shared with each child’s parent or guardian during the enrollment process, so that these individuals understand what to expect in this type of situation.

In the event that no authorized person arrives to pick up a child, the early care and education program should attempt to reach each authorized contact listed in the child’s record. If these efforts fail, the program should immediately implement the written policy on actions to be followed when no authorized person arrives to pick up a child.

RATIONALE

Early care and education programs are responsible for all the children in their care. If an authorized person does not come to pick up a child, and one cannot be reached, caregivers/teachers must know what authority to call and to whom they can legally and safely release the child. This is to ensure the safety of the child and to protect the early care and education program from legal action.

COMMENTS

ADDITIONAL RESOURCES

Pennsylvania Chapter of the American Academy of Pediatrics. Model Child Care Health Polices. Aronson SS, ed. 5th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2014

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.2.4.8 Authorized Persons to Pick Up Child
NOTES

Content in the STANDARD was modified on 08/27/2020.

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


Child care programs should have policies that include:

  1. A daily attendance record should be maintained, listing the times of arrival and departure of the child, as well as the person dropping off and picking up;
  2. Parents/guardians are expected to communicate (confirmation required) with the caregiver/teacher/program on a daily basis by a specified time if their child will not be in attendance;
  3. The caregiver/teacher/program must communicate as early as possible (within one hour) with the parent/guardian if there is no communication from the parent/guardian about a child’s absence. If the caregiver/teacher/program is unable to reach the child’s parent/guardian, emergency contacts will be notified;
  4. A timely method of communication (phone, email, text, etc.) between the parent/guardian and the caregiver/teacher/program should be agreed upon at the time of enrollment;
  5. A printed roster should be available in the event of an evacuation drill or evacuation to account for the children in care.
RATIONALE
Operational control to accommodate the health and safety of individual children requires basic information regarding each child in care. This standard ensures that the facility knows which children are receiving care at any given time including evacuation. It aids in the surveillance of child:staff ratios, knowledge of potentially infectious diseases (i.e., influenza), planning for staffing, and provides data for program planning. Accurate record keeping also aids in tracking the amount (and date) of service for reimbursement and allows for documentation in the event of child abuse allegations or legal action involving the facility. Furthermore, each year, twenty to forty children die from hyperthermia after being left/locked in a car or van. Some of these unfortunate deaths include children whose parents/guardians meant to drop their child off at a child care program or preschool; thus, timely communication with these parents/guardians could prevent death from hyperthermia (1,2).
COMMENTS
Time clocks and cards can serve as verification, but they should be signed by the adult who drops off and picks up the child each day. Some notification system should be used to alert the caregiver/teacher whenever the responsibility for the care of the child is being transferred to or from the caregiver/teacher to another person.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.2.4.7 Sign-In/Sign-Out System
Appendix F: Enrollment/Attendance/Symptom Record
REFERENCES
  1. Guard, A., S. S. Gallagher. 2005. Heat related deaths to young children in parked cars: An analysis of 171 fatalities in the United States, 1995-2002. Injury Prevention 11:33-37.
  2. Null, J. 2010. Hyperthermia deaths of children in vehicles. San Francisco State University. http://ggweather.com/heat/.

9.2.5 Transportation Policies

9.2.5.1: Transportation Policy for Centers and Large Family Homes


Written policies should address the safe transport of children by vehicle to or from the facility, including field trips, home pick-ups and deliveries, and special outings. The transportation policy should include:

  1. Licensing of vehicles and drivers;
  2. Vehicle selection to safely transport children, based on vehicle design and condition;
  3. Operation and maintenance of vehicles;
  4. Driver selection, training, and supervision;
  5. Child:staff ratio during transport;
  6. Accessibility to first aid kit, emergency ID/contact and pertinent health information for passengers, cell phone, or two-way radio;
  7. Permitted and prohibited activities during transport;
  8. Backup arrangements for emergencies;
  9. Use of seat belt and car safety seat, including booster seats;
  10. Drop-off and pick-up plans;
  11. Plan for communication between the driver and the child care facility staff;
  12. Maximum travel time for children (no more than forty-five minutes in one trip);
  13. Procedures to ensure that no child is left in the vehicle at the end of the trip or left unsupervised outside or inside the vehicle during loading and unloading the vehicle;
  14. Use of passenger vans.
RATIONALE
Motor vehicle crashes are the leading cause of death in children two to fourteen years of age in the United States (1). It is necessary for the safety of children to require that the caregiver/teacher comply with requirements governing the transportation of children in care, in the absence of the parent/guardian. Not all vehicles are designed to safely transport children, especially young children. The National Highway Traffic Safety Administration (NHTSA) recommends that preschool and school aged children should not be transported in twelve- or fifteen-passenger vehicles due to safety concerns (2,3). Children have died because they have fallen asleep and been left in vehicles. Others have died or been injured when left outside the vehicle when thought to have been loaded into the vehicle. The process of loading and unloading children from a vehicle can distract caregivers/teachers from adequate supervision of children either inside or outside the vehicle. Policies and procedures must account for the management of these risks.
COMMENTS
Maintenance should include an inspection checklist for every trip. Vehicle maintenance service should be performed according to the manufacturer’s recommendations or at least every three months.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home
RELATED STANDARDS
9.2.5.2 Transportation Policy for Small Family Child Care Homes
REFERENCES
  1. National Safety Council (NSC). 2009. Injury facts. 2009 ed. Chicago: NSC.
  2. National Highway Traffic Safety Association. Safecar.gov. http://www.safercar.gov.
  3. National Highway Traffic Safety Association. Passenger van safety. http://www.safercar.gov/Vehicle+Shoppers/Passenger+Van+Safety/.

9.2.5.2: Transportation Policy for Small Family Child Care Homes


Written policies should address the safe transport of children by vehicle to and from the small family child care home for any reason while the children are attending child care. Policies should include field trips or special outings. The following should be provided for:

  1. Child:staff ratio during transport;
  2. Backup arrangements for emergencies;
  3. Use of seat belt and car safety seat, including booster seats;
  4. Accessibility to first aid kit, emergency ID/contact and pertinent health information for passengers, and cell phone or two-way radio;
  5. Licensing of vehicles and drivers;
  6. Maintenance of the vehicles;
  7. Safe use of air bags;
  8. Maximum travel time for children (no more than forty-five minutes in one trip);
  9. Procedures to ensure that no child is left in the vehicle at the end of the trip or left unsupervised outside or inside the vehicle during loading and unloading the vehicle;
  10. Use of passenger vans.
RATIONALE
Motor vehicle crashes are the leading cause of death for children between one and fourteen years of age in the United States (1). It is necessary for the safety of children to require that the caregiver comply with minimum requirements governing the transportation of children in care, in the absence of the parent/guardian. Children have died because they have fallen asleep and left in vehicles. Others have died or been injured when left outside the vehicle when thought to have been loaded into the vehicle. The process of loading and unloading children from a vehicle can distract caregivers/teachers from adequate supervision of children either inside or outside the vehicle. Policies and procedures should account for the management of these risks.
TYPE OF FACILITY
Early Head Start, Head Start, Small Family Child Care Home
RELATED STANDARDS
9.2.5.1 Transportation Policy for Centers and Large Family Homes
REFERENCES
  1. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. 2008. Web-based injury statistics query and reporting system. http://www.cdc.gov/ncipc/wisqars/.

9.2.6 Play Area Policies

9.2.6.1: Policy on Use and Maintenance of Play Areas


Child care facilities should have a policy on the use and maintenance of play areas that address the following:

  1. Safety, purpose, and use of indoor and outdoor equipment for gross motor play;
  2. Selection of age-appropriate equipment;
  3. Supervision of indoor and outdoor play spaces;
  4. Staff training (to be addressed as employees receive training for other safety measures);
  5. Recommended inspections of the facility and equipment, as follows:
    1. Inventory, once at the time of purchase, and updated when changes to equipment are made in the playground;
    2. Audits of the active (gross motor) play areas (indoors and outdoors) by an individual with specialized training in playground inspection, once a year;
    3. Monthly inspections to check for U.S. Consumer Product Safety Commission (CPSC) recalled or hazard warnings on equipment, broken equipment or equipment in poor repair that requires immediate attention;
    4. Daily safety check of the grounds for safety hazards such as broken bottles and toys, discarded cigarettes, stinging insect nests, and packed surfacing under frequently used equipment like swings and slides;
    5. Whenever injuries occur.

For centers, the policy should be written. Documentation of the recommended inspections should be maintained in a master file.

RATIONALE
Properly laid out outdoor play spaces, age-appropriate, properly designed and maintained equipment, installation of energy-absorbing surfaces, and adequate supervision of the play space by caregivers/teachers/parents/guardians help to reduce both the potential and the severity of injury (2). Indoor play spaces must also be properly laid out with care given to the location of equipment and the energy-absorbing surface under the equipment. A written policy with procedures is essential for education of staff and may be useful in situations where liability is an issue. The technical issues associated with the selection, maintenance, and use of playground equipment and surfacing are complex and specialized training is required to conduct annual inspections. Active play areas are associated with the most frequent and the most severe injuries in child care (1).
COMMENTS
Increasing awareness and understanding of issues in child safety highlight the importance of developing and maintaining safe play spaces for children in child care settings (3). Parents/guardians expect that their child will be adequately supervised and will not be exposed to hazardous play environments, yet will have the opportunity for free, creative play.

To obtain information on identifying a Certified Playground Safety Inspector (CPSI) to inspect a playground, contact the National Recreation and Park Association (NRPA) at http://www.nrpa.org/Content.aspx?id=3531.

The National Program for Playground Safety (NPPS) is another source of information on playground safety at http://www.uni.edu/playground/.

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.2.6.2 Reports of Annual Audits/Monthly Maintenance Checks of Play Areas and Equipment
9.2.6.3 Records of Proper Installation and Maintenance of Facility Equipment
REFERENCES
  1. Rivara, F. P., J. J. Sacks. 1994. Injuries in child day care: An overview. Pediatrics 94:1031-33.
  2. U.S. Consumer Product Safety Commission. 2008. Public playground safety handbook. Washington, DC: CPSC. http://www.cpsc.gov/cpscpub/pubs/325.pdf.
  3. Quality in Outdoor Environments for Child Care. POEMS Website. http://www.poemsnc.org.

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


Report forms should be used to record the results of the annual audits of the indoor and outdoor play areas and monthly maintenance inspections of play equipment and surfaces. Corrective actions taken to eliminate hazards and reduce the risk of injury should be included in the reports. The forms should be filed in the facility’s master file. The forms should be reviewed by the facility annually and should be retained for the number of years required by the state’s statute of limitations.
RATIONALE
Written records of annual audits of the indoor and outdoor play areas, monthly maintenance inspections and appropriate corrective action are necessary to reduce the risk of potential injury. Annual review of such records provides a mechanism for periodic monitoring and improvement of equipment and surface type and quality (1).
COMMENTS
Individual jurisdictions may have specific regulations regarding information, records, equipment, policies, and procedures.

A sample site checklist is provided in Model Child Care Health Policies, available at http://www.ecels-healthychild
carepa.org/content/MHP4thEd Total.pdf.

For more information regarding facility equipment, contact ASTM International (ASTM) at http://www.astm.org, the U.S. Consumer Product Safety Commission (CPSC) at http://www.cpsc.gov, and the National Program for Playground Safety (NPPS) at http://www.uni.edu/playground/.

For information about playground safety see the Public Playground Safety Handbook, available at http://www.cpsc
.gov/cpscpub/pubs/325.pdf and Outdoor Home Playground Safety Handbook available at http://www.cpsc.gov/cpsc
pub/pubs/324.pdf.

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.2.6.1 Policy on Use and Maintenance of Play Areas
REFERENCES
  1. U.S. Consumer Product Safety Commission. 2010. Public playground safety handbook. http://www.cpsc.gov/cpscpub/pubs/325.pdf.

9.2.6.3: Records of Proper Installation and Maintenance of Facility Equipment


The facility should maintain all information and records pertaining to the manufacture, installation, and regular inspection of facility equipment. Recordkeeping on play area equipment is specified in Standard 9.2.6.2. No second-hand equipment should be used in areas occupied by children, unless all pertinent data, including checking for recalls and the manufacturer’s instructions, can be obtained from the previous owner or from the manufacturer. All equipment should meet ASTM International (ASTM) standards.
RATIONALE
Information regarding manufacture, installation, and maintenance of equipment is essential so that the staff can follow appropriate instructions regarding installation, repair, and maintenance procedures. Also, in the event of recalls, the information provided by the manufacturer allows the owner to identify the applicability of the recall to the equipment on hand. Products used in areas occupied by children must have these instructions for identification, maintenance, repair, and reference in case of recall.
COMMENTS
Individual jurisdictions may have specific regulations regarding information, records, equipment, policies, and procedures.

For more information regarding facility equipment requirements, contact the ASTM at http://www.astm.org and the U.S. Consumer Product Safety Commission (CPSC) at http://www.cpsc.gov.

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.2.6.1 Policy on Use and Maintenance of Play Areas

9.3 Human Resource Management

9.3.0

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


Centers and large family child care homes should have and implement written human resource management policies. All written policies should be reviewed and signed by the employee affected by them upon hiring and annually thereafter.

These policies should address:

  1. A wage scale with merit increases;
  2. Sick leave;
  3. Vacation leave;
  4. Family, parental, medical leave;
  5. Personal leave;
  6. Educational benefits and professional development expectations;
  7. Health insurance and coverage for occupational health services;
  8. Social security or other retirement plan;
  9. Holidays;
  10. Workers’ compensation or a disability plan as required by the number of staff;
  11. Maternity/paternity benefits;
  12. Overtime/compensatory time policy;
  13. Grievance procedures;
  14. Probation period;
  15. Grounds for termination;
  16. Training of new caregivers/teachers and substitute staff;
  17. Personal/bereavement leave;
  18. Disciplinary action;
  19. Periodic review of performance;
  20. Exclusion policies pertaining to staff illness;
  21. Staff health appraisal;
  22. Professional development leave.
RATIONALE
Written human resource management provides a means of staff orientation and evaluation essential to the operation of any organization. Caregivers/teachers who are responsible for compliance with policies must have reviewed and understood the policies.

The quality and continuity of the child care workforce is a main determiner of the quality of care (1). Nurturing the nurturers is essential to prevent burnout and promote retention. Fair labor practices apply to child care settings. Caregivers/teachers should be considered as worthy of benefits as workers in other career areas.

Medical coverage should include the cost of the health appraisals and immunizations required of caregivers/teachers. Information abounds about the incidence of infectious disease for children in child care settings (2). Staff members come into close and frequent contact with children and their excretions and secretions and are vulnerable to these illnesses. In addition, many caregivers/teachers are women who are planning a pregnancy or who are pregnant, and they may be vulnerable to the potentially serious effects of infection on the outcome of pregnancy.

Sick leave is important to minimize the spread of infectious diseases and maintain the health of staff members. Sick leave may promote recovery from illness and thereby decreases the further spread or recurrence of illness.

Benefits contribute to higher morale and less staff turnover, thus promoting quality child care (3). Lack of benefits is a major reason reported for high turnover of child care staff (4).

COMMENTS
Staff benefits may be appropriately addressed in human resource management and in state and federal labor standards. Many options are available for providing leave benefits, professional development opportunities, and education reimbursements, ranging from partial to full employer contribution, based on time employed with the facility.

The Center for the Child Care Workforce (CCW) has developed model work standards for both center-based staff and family child care home caregivers/teachers with specific recommendations for these elements of human resource management. Model work standards serve as a tool to help programs assess the quality of the work environment and set goals to make improvements. More information on the CCW is available at http://www.aft.org/node/10415.

A policy of encouraging sick leave, even without pay, or of permitting a flexible schedule will allow the caregiver/teacher to take time off when needed for illness. An acknowledgment that the facility does not provide paid leave but does give time off will begin to address workers’ rights to these benefits and improve quality of care. There may be other nontraditional ways to achieve these benefits.

The subsidy costs of staff benefits will need to be addressed for child care to be affordable to parents/guardians.

Caregivers/teachers should be encouraged to have health insurance. Health benefits can include full coverage, partial coverage (at least 75% employer paid), or merely access to group rates. Some local or state child care associations offer reduced group rates for health insurance for child care facilities and individual caregivers/teachers.

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home
REFERENCES
  1. Crosland, K. A., G. Dunlap, W. Sager, et al. 2008. The effects of staff training on the types of interactions observed at two group homes for foster care children. Research on Social Work 18:410-20.
  2. Kimberlin, D.W., Brady, M.T., Jackson, M.A., Long, S.S., eds. 2015. Red book: 2015 report to the committee of infectious diseases. 30th Ed. Elk Grove Village, IL: American Academy of Pediatrics. 
  3. Klinker, J. M., D. Rile, M. A. Roach. 2005. Organizational climate as a tool for child care staff retention. Young Children 60:90-95.
  4. Whitebook, M., D. Bellm. 1999. Taking on turnover: An action guide for child care center teachers and directors. Washington, DC: Center for the Child Care Workforce.

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


Small family child care home caregivers/teachers should develop policies for themselves, which are reviewed and revised annually.

These policies should address the following items:

  1. Vacation leave;
  2. Holidays;
  3. Professional development leave;
  4. Sick Leave;
  5. Scheduled increases of small family child care home fees.

If there are assistants or other employees in the home, the following should also be included in the policies:

  1. Educational benefits;
  2. Personal leave;
  3. Family, parental, medical leave;
  4. Health insurance and coverage for occupational health services;
  5. Social security or other retirement plan;
  6. Overtime/compensatory time policy;
  7. Workers’ compensation or a disability plan as required by the number of staff;
  8. Minimally, breaks totaling thirty minutes over an eight-hour period of work, or as required by state labor laws;
  9. Grievance procedures;
  10. Probation period;
  11. Grounds for termination;
  12. Training of new caregivers/teachers and substitute staff;
  13. Personal/bereavement leave;
  14. Disciplinary action;
  15. Periodic review of performance;
  16. Exclusion policies pertaining to staff illness;
  17. Staff health appraisal.
RATIONALE
Written human resource management provides a means of staff orientation and evaluation essential to the operation of any organization. Caregivers/teachers who are responsible for compliance with policies must have reviewed and understood the policies.

The quality and continuity of the child care workforce is a main determiner of the quality of care (1). Nurturing the nurturers is essential to prevent burnout and promote retention. Fair labor practices apply to child care settings. Caregivers/teachers should be considered as worthy of benefits as workers in other career areas.

Medical coverage should include the cost of the health appraisals and immunizations required of caregivers/teachers. Information abounds about the incidence of infectious disease for children in child care settings (2). Staff members come into close and frequent contact with children and their excretions and secretions and are vulnerable to these illnesses. In addition, many caregivers/teachers are women who are planning a pregnancy or who are pregnant, and they may be vulnerable to the potentially serious effects of infection on the outcome of pregnancy.

Sick leave is important to minimize the spread of infectious diseases and maintain the health of staff members. Sick leave may promote recovery from illness and thereby decreases the further spread or recurrence of illness.

Benefits contribute to higher morale and less staff turnover, thus promoting quality child care (3). Lack of benefits is a major reason reported for high turnover of child care staff (4).

COMMENTS
The Center for the Child Care Workforce (CCW) has developed model work standards for both center-based staff and family child care home caregivers/teachers with specific recommendations for these elements of human resource management. Model work standards serve as a tool to help programs assess the quality of the work environment and set goals to make improvements. More information on the CCW is available at http://www.aft.org/node/10415.

Caregivers/teachers should be encouraged to have health insurance. Some local or state child care associations offer reduced group rates for health insurance for individual caregivers/teachers.
TYPE OF FACILITY
Early Head Start, Head Start, Small Family Child Care Home
REFERENCES
  1. Crosland, K. A., G. Dunlap, W. Sager, et al. 2008. The effects of staff training on the types of interactions observed at two group homes for foster care children. Research on Social Work 18:410-20.
  2. Klinker, J. M., D. Rile, M. A. Roach. 2005. Organizational climate as a tool for child care staff retention. Young Children 60:90-95.
  3. Kimberlin, D.W., Brady, M.T., Jackson, M.A., Long, S.S., eds. 2015. Red book: 2015 report to the committee of infectious diseases. 30th Ed. Elk Grove Village, IL: American Academy of Pediatrics. 
  4. Whitebook, M., D. Bellm. 1999. Taking on turnover: An action guide for child care center teachers and directors. Washington, DC: Center for the Child Care Workforce.

9.4 Records

9.4.1 Facility Records/Reports

9.4.1.1: Facility Insurance Coverage


Facilities should carry the following insurance:

  1. Injury insurance on children;
  2. Liability insurance;
  3. Vehicle insurance on any vehicle owned or leased by the facility and used to transport children;
  4. Property insurance.

Small and large family child care home caregivers/teachers should carry this insurance if available.

RATIONALE
Reasonable protection against liability action through proper insurance is essential for reasons of economic security, peace of mind, and public relations. Requiring insurance reduces risks because insurance companies stipulate compliance with health and safety regulations before issuing or continuing a policy. Property insurance is desirable since the costs of adverse events occurring at a facility can easily cause a financial disaster that can disrupt children’s care. Protection, via insurance, should be secured to provide stability and protection for both the individuals and the facility. Liability insurance carried by the facility provides recourse for parents/guardians of children enrolled in the event of negligence.
COMMENTS
The liability insurance should include coverage for administration of medications, as well as for unintentional injuries and illnesses. Individual health injury coverage may be documented by evidence of personal health insurance coverage as a dependent.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

9.4.1.2: Maintenance of Records


The facility should maintain the following records:

  1. A copy of the facility’s license, insurance coverage, child care regulations or registration, all inspection reports, correction plans for deficiencies, and any legal actions;
  2. Physical health records for any adult who has direct contact with children;
  3. Training records of the caregiver/teacher and any assistants;
  4. Criminal history records and child abuse and neglect records, as required by state licensing regulations;
  5. Results of well-water tests where applicable;
  6. Results of lead tests;
  7. Insurance records;
  8. Child health records;
  9. Attendance records and sign-in/sign-out records, as well as authorization for pick-up;
  10. List of reportable diseases;
  11. Incident reports;
  12. Fire extinguisher records and smoke detector and carbon monoxide detector battery checks;
  13. Evacuation, emergency, and shelter-in-place drill records;
  14. Play area and equipment warranty, maintenance, and inspection records;
  15. Consultation records;
  16. Medication administration logs; and
  17. Nutrition and food service records.

The length of time to maintain records should follow state regulation requirements. A sample of a state regulation is below.

RATIONALE
Operational control to accommodate the health and safety of individual children requires that information regarding each child in care be kept and made available on a need-to-know basis. These records and reports are necessary to protect the health and safety of children in care.

An organized, comprehensive approach to injury prevention and control is necessary to ensure that a safe environment is provided for children in child care. Such an approach requires written plans, policies, and procedures, and record keeping so that there is consistency over time and across staff and an understanding between parents/guardians and caregivers/teachers about concerns for, and attention to, the safety of children.

COMMENTS
A file of all purchased equipment and toys with warranty information and model numbers will help identify items that have hazard warnings or are recalled by the U.S. Consumer Product Safety Commission (CPSC). A photo of the purchased items can be added to the file.

A sample of state regulations for length of time to maintain records is below.

Retention of Records

  1. Documentation of the previous twelve months activity should be available for review. Records should be accessible during the hours the facility is open and operating.
  2. For licensing purposes, children’s information should be kept on file a minimum of one year from date of discharge from the facility.
  3. For licensing purposes, personnel records should be kept on file a minimum of one year from termination of employment from the facility.
  4. For licensing purposes, staff training certificates and continuing education certificates should be kept on file for a minimum of five years for currently employed staff (1).
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.2.6.2 Reports of Annual Audits/Monthly Maintenance Checks of Play Areas and Equipment
9.2.6.3 Records of Proper Installation and Maintenance of Facility Equipment
9.4.1.1 Facility Insurance Coverage
9.4.1.6 Availability of Documents to Parents/Guardians
9.4.1.8 Records of Illness
9.4.1.9 Records of Injury
9.4.1.10 Documentation of Parent/Guardian Notification of Injury, Illness, or Death in Program
9.4.1.11 Review and Accessibility of Injury and Illness Reports
9.4.1.12 Record of Valid License, Certificate, or Registration of Facility
9.4.1.13 Maintenance and Display of Inspection Reports
9.4.1.14 Written Plan/Record to Resolve Deficiencies
9.4.1.15 Availability of Reports on Inspections of Fire Protection Devices
9.4.1.16 Evacuation and Shelter-In-Place Drill Record
9.4.1.17 Documentation of Child Care Health Consultation/Training Visits
9.4.1.18 Records of Nutrition Service
9.4.2.1 Contents of Child’s Records
9.4.2.2 Pre-Admission Enrollment Information for Each Child
9.4.2.3 Contents of Admission Agreement Between Child Care Program and Parent/Guardian
9.4.2.4 Contents of Child’s Primary Care Provider’s Assessment
9.4.2.5 Health History
9.4.2.6 Contents of Medication Record
9.4.2.7 Contents of Facility Health Log for Each Child
9.4.3.2 Maintenance of Attendance Records for Staff Who Care for Children

9.4.1.3: Written Policy on Confidentiality of Records


The facility should establish and follow a written policy on confidentiality of the records of staff and children that ensures that the facility will not disclose material in the records (including conference reports, service plans, immunization records, and follow-up reports) without the written consent of parents/guardians for children, or of staff for themselves. Consent forms should be in the native language of the parents/guardians, whenever possible, and communicated to them in their normal mode of communication. Foreign language interpreters should be used whenever possible to inform parents/guardians about their confidentiality rights. At the time when facilities obtain prior, informed consent from parents/guardians for release of records, caregivers/teachers should inform parents/guardians who may be looking at the records (e.g., child care health consultants, mental health consultants, and specialized agencies providing services).

Written releases should be obtained from the child’s parent/guardian prior to forwarding or sharing information and/or the child’s records to other service providers. The content of the written procedures for protecting the confidentiality of medical and social information should be consistent with federal, state, and local guidelines and regulations and should be taught to caregivers/teachers. Confidential medical information pertinent to safe care of the child should be provided to facilities within the guidelines of state or local public health regulations. However, under all circumstances, confidentiality about the child’s medical condition and the family’s status should be preserved unless such information is released at the written request of the family, except in cases where child maltreatment is a concern or to determine compliance with licensing regulations. In such cases, state laws and regulations apply.

The director of the facility should decide who among the staff may have confidential information shared with them. Clearly, this decision must be made selectively, and all caregivers/teachers should be taught the basic principles of all individuals’ rights to confidentiality. Caregivers/teachers should not disclose or discuss personal information regarding children and their families with any unauthorized person. Confidential information should be seen by and discussed only with staff members who need the information in order to provide services. Caregivers/teachers should not discuss confidential information about families in the presence of others in the facility.

Procedures should be developed and a method established to ensure accountability and to ensure that the exchange is being carried out. The child’s record should be available to the parents/guardians for inspection at all times.

If other children are mentioned in a child’s record that is authorized for release, the confidentiality of those children should be maintained. The record should be edited to remove any information that could identify another child.

Caregivers/teachers should not disclose or discuss personal information regarding children and their families with any unauthorized person. Confidential information should be seen by and discussed only with staff members who need the information in order to provide services. Caregivers/teachers should not discuss confidential information about families in the presence of others in the facility.

RATIONALE
Confidentiality must be maintained to protect the child and family and is defined by law (1). Serving children and families involves significant facility responsibilities in obtaining, maintaining, and sharing confidential information. Each caregiver/teacher must respect the confidentiality of information pertaining to all families, staff, and volunteers served (2).

Someone in each facility must be authorized to make decisions about the sharing of confidential information, and the director is the logical choice. The decision about sharing information must also involve the parent/guardian(s). Sharing of confidential information should be selective and should be based on a need-to-know and on the parent’s/guardian’s authorization for disclosure of such information (3).

Requiring written releases ensures confidentiality. Continuity of care and information is invaluable during childhood when growth and development are rapidly changing. Providing consent forms in the native language of the parents/guardians and providing an interpreter to explain the confidentiality policy and procedures helps to insure that the signed consent is informed consent.

The California Childcare Health Program developed with the Child Care Law Center, “Consent for Exchange of Information Form” that can be viewed at: http://ucsfchildcarehealth.org/pdfs/forms/CForm_ExchangeofInfo.pdf.

COMMENTS
Parental trust in the caregiver is the key to the caregiver’s ability to work toward health promotion and to obtain needed information to use in decision making and planning for the child’s best interest. Assurance of confidentiality fosters this trust. When custody has been awarded to only one parent, access to records must be limited to the custodial parent. In cases of disputed access, the facility may need to request that the parents/guardians supply a copy of the court document that defines parental rights. Operational control to accommodate the health and safety of individual children requires basic information regarding each child in care.

Release formats may vary from state to state and within facilities. User friendly forms furnished for all caregivers/teachers may facilitate the exchange of information.

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.4.2.8 Release of Child’s Records
REFERENCES
  1. U.S. Congress. 1974. Family Educational Rights and Privacy Act (FERPA). 20 USC Sec 1232.
  2. U.S. Department of Health and Human Services (DHHS), Office for Civil Rights. HIPAA administrative simplification statute and rules. Washington, DC: DHHS. http://www.hhs.gov/ocr/privacy/hipaa/administrative/index.html.
  3. U.S. Department of Education. FERPA regulations. http://www2.ed.gov/policy/gen/reg/ferpa/.

9.4.1.4: Access to Facility Records


The designated person in charge should have access to the records necessary to manage the facility and should allow regulatory staff access to the facility and records.
RATIONALE
Those with responsibility must have access to the information required to carry out their duties and make reasonable decisions.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home
RELATED STANDARDS
9.4.1.5 Availability of Records to Licensing Agency
9.4.1.11 Review and Accessibility of Injury and Illness Reports

9.4.1.5: Availability of Records to Licensing Agency


Where these standards require the facility to have written policies, reports, and records, these documents should be available to the licensing agency for inspection. In addition, the facility should make available any other policies, reports, or records that are required by the licensing agency that are not specified in these standards.
RATIONALE
The licensing agency monitors policies, reports, and records required to determine the facility’s compliance with licensing regulations. Inspection of the policies, reports, and records required by licensing regulations may also include inspection of those addressed by the standards.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.4.1.4 Access to Facility Records

9.4.1.6: Availability of Documents to Parents/Guardians


In an easily available space that parents/guardians are made aware of and able to access, facilities should make available the following items:

  1. The facility’s license, child care regulations, or registration, which also includes information on how to file a complaint and the telephone number for filing complaints with the regulatory agency;
  2. A statement informing parents/guardians about how they may obtain a copy of the licensing or registration requirements from the regulatory agency;
  3. Inspection certificates;
  4. Reports of any legal sanctions and documentation that all required corrections have been completed;
  5. A notice that inspection reports/certificates, legal actions, and compliance letters are available for inspection in the facility;
  6. Accreditation certificates;
  7. Quality rating score, if applicable;
  8. Evacuation route;
  9. Emergency evacuation procedures, including fire evacuation and weather related evacuation procedures, to be posted in each room of the center;
  10. Procedures for the reporting of child abuse and neglect consistent with state law and local law enforcement and child protective service contacts;
  11. Notice announcing the “open-door policy” (parents/guardians may visit at any time and will be admitted without delay);
  12. The action the facility will take to handle a visitor’s request for access if the caregiver/teacher is concerned about the safety of the children;
  13. A current weekly menu of any food or beverage served in the facility to the children for parents/guardians and caregivers/teachers including changes in the menus as they are served; the facility should provide copies of menus to parents/guardians, if requested, and copies of menus served should be kept on file for six months;
  14. A statement of nondiscrimination for programs participating in the U.S. Department of Agriculture (USDA) Child and Adult Care Food Program (CACFP) and for programs who receive Child Care Assistance Child Care Development Block Grant (CCDBG) funds;
  15. Policy manual (health and safety policies, nutrition and oral health policies, etc.);
  16. A copy of the policy and procedures for discipline, including the prohibition of corporal punishment;
  17. Legible safety rules for the use of swimming and built-in wading pools if the facility has such pools (safety rules should be posted conspicuously on the pool enclosure);
  18. Phone numbers and instructions for contacting the fire department, police, emergency medical services, physicians, dentists, rescue and ambulance services, and the poison center, child abuse reporting hotline; the address of the facility; and directions to the facility from major routes north, south, east, and west (this information should be conspicuously posted adjacent to the telephone);
  19. A list of reportable infectious diseases as required by the state and local health authorities;
  20. Employee rights and safety standards as required by the Occupational Safety and Health Administration (OSHA) and/or state agencies;
  21. Breastfeeding policy that includes information and guidance for mothers on how to store and transport human milk;
  22. A notice of what, where and when pesticides have been applied within or around the program’s property (this notice should be put up forty-eight hours in advance of any pesticide use);
  23. Reports of lead concentration and water quality.
RATIONALE
Each local and/or state regulatory agency gives official permission to certain persons to operate child care programs by virtue of their compliance with regulations. Therefore, documents relating to investigations, inspections, and approval to operate should be made available to consumers, caregivers/teachers, concerned persons, and the community. Posting other documents listed in this standard increases access to parents/guardians over having the policies filed in a less accessible location.

Awareness of the child abuse and neglect reporting requirements and procedures is essential to the prevention of child abuse. State requirements may differ, but those for whom the reporting of child abuse and neglect is mandatory usually include child care personnel. Information on how to call and how to report should be readily available to parents/guardians and caregivers/teachers.

The open-door policy may be the single most important method for preventing maltreatment of children in child care (1). When access is restricted, areas observable by the parents/guardians may not reflect the care the children actually receive.

A roster helps parents/guardians see how facility responsibility is assigned and know which children receive care in their child’s group.

Primary caregiver assignments foster and channel meaningful communication between parents/guardians and caregivers/teachers.

Children are offered nutritious foods that help assure that children can meet the minimum daily requirements of nutrients. A child care facility is not responsible for the children receiving all of their nutrients. Parents/guardians need to know what food and beverages their children receive while in child care. Menus filed should reflect last-minute changes so that parents/guardians and any nutritionist/registered dietitian who reviews these documents can get an accurate picture of what was actually served. Food allergies should be posted for caregivers/teachers to view easily while still maintaining confidentiality from the public.

Parents/guardians and caregivers/teachers must have a common basis of understanding about what disciplinary measures are to be used to avoid conflict and promote consistency in approach between caregivers/teachers and parents/guardians. Corporal punishment may be physical abuse or become abusive very easily.

Parents/guardians have a right to see any reports and notices of any legal actions taken against the facility that have been sustained by the court. Since unfounded suits may be filed, knowledge of which could undermine parent/guardian confidence, only actions that result in corrections or judgment needs to be made accessible.

Pool safety requires reminders to users of pool rules. Making pool rules available serves as reminder that all pool rules must be strictly adhered to for the safety of the children.

In an emergency, phone numbers must be immediately accessible.

COMMENTS
Compliance can be measured by asking for the location of documents and how accessible they are.

A sample telephone emergency list is provided in Healthy Young Children from the National Association for the Education of Young Children (NAEYC) at http://www.naeyc.org.

When it is possible to translate documents into the native language of the parents/guardians of children in care, it increases the level of communication between facility and parents/guardians.

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.2.1.6 Written Discipline Policies
9.2.4.3 Disaster Planning, Training, and Communication
9.4.1.2 Maintenance of Records
9.4.1.12 Record of Valid License, Certificate, or Registration of Facility
9.4.1.13 Maintenance and Display of Inspection Reports
9.4.1.14 Written Plan/Record to Resolve Deficiencies
9.4.1.18 Records of Nutrition Service
REFERENCES
  1. Murph, J. R., S. D. Palmer, D. Glassy, eds. 2005. Health in child care: A manual for health professionals. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics.

9.4.1.7: Requirements for Compliance of Contract Services


The facility should assure that any contracted services will comply with all applicable standards and state regulations.
RATIONALE
Whether the director or family child care provider contracts for a service directly or hires an agency to provide the services to be performed, children’s safety must be protected and their growth and development supported by strict adherence to applicable standards and state regulations.
COMMENTS
The contract language should not only specify the requirement for compliance, but should also define methods for monitoring and for redress. An example of such a contract is a food service contract or a temporary service agency contract that provides substitute caregivers/teachers.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

9.4.1.8: Records of Illness


In situations where illnesses are reported by a parent/guardian or become evident while a child or staff member is at the facility and may potentially require exclusion, the facility should record the following:

  1. Date and time of the illness;
  2. Person(s) affected;
  3. Description of the symptoms;
  4. Response of the staff to these symptoms;
  5. Persons notified (such as a parent/guardian, primary care provider, or the local health department representative, if applicable), and their response;
  6. Name of person completing the form.
RATIONALE
Recording the occurrence of illness in a facility and the response to the illness, as well as reviewing the daily patterns, characterizes and defines the frequency of the illness, suggests whether an outbreak has occurred, may suggest an effective intervention (improved sanitation and handwashing best practices initially), and provides documentation for administrative purposes.
COMMENTS
Surveillance for symptoms can be accomplished easily by using a combined attendance and symptom records. Any symptoms can be noted when the child is signed in and the daily health check is performed, with added notations made during the day when additional symptoms appear. Simple forms, for a weekly or monthly period, that record data for the entire group help caregivers/teachers spot patterns of illness for an individual child or among the children in the group or center.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.4.1.2 Maintenance of Records
9.4.1.10 Documentation of Parent/Guardian Notification of Injury, Illness, or Death in Program
Appendix F: Enrollment/Attendance/Symptom Record

9.4.1.9: Records of Injury


When an injury occurs in the facility that results in first aid or medical attention for a child or adult, the facility should complete a report form that provides the following information:

  1. Name, sex, and age of the injured person;
  2. Date and time of injury;
  3. Location where injury took place;
  4. Description of how the injury occurred, including who (name, address, and phone number) saw the incident and what they reported, as well as what was reported by the child;
  5. Body part(s) involved;
  6. Description of any consumer product involved;
  7. Name and location of the staff member responsible for supervising the child at the time of the injury;
  8. Actions taken by staff members on behalf of the injured following the injury as well as specifically whether emergency medical services and/or professional dental/medical care was required;
  9. Recommendations of preventive strategies that could be taken to avoid future occurrences of this type of injury;
  10. Name of person who completed the report;
  11. Name, address, and phone number of the facility;
  12. Signature of the parent/guardian of the child injured or signature of the adult injured and the date signature obtained (recommended that the signature be obtained the same day as the injury);
  13. If parent/guardian of child was notified at time of injury;
  14. Documentation that written report was sent home the day of the injury, regardless of parental signature.

Examples of injuries that should be documented include:

  1. Child maltreatment (physical, sexual, emotional, and neglect abuse);
  2. Bites that are continuous in nature, break the skin, left a mark, and cause significant pain;
  3. Falls, burns, broken limbs, tooth loss, other injury;
  4. Motor vehicle injury;
  5. Aggressive/unusual behavior;
  6. Ingestion of non-food substances;
  7. Medication error;
  8. Blows to the head;
  9. Death.

Three copies of the injury report form should be completed. One copy should be given to the child’s parent/guardian (or to the injured adult). The second copy should be kept in the child’s (or adult’s) folder at the facility. A third copy should be kept in a chronologically filed injury log that is analyzed periodically to determine any patterns regarding time of day, equipment, location or supervision issues. This last copy should be kept in the facility for the period required by the state’s statute of limitations. If required by state regulations, a copy of an injury report for each injury that required medical attention should be sent to the state licensing agency.

Based on the logs, the facility should plan to take corrective action. Examples of corrective action include: adjusting schedules, removing or limiting the use of equipment, relocating equipment or furnishings, and/or increasing supervision.

RATIONALE
Injury patterns and child abuse and neglect can be discerned from such records and can be used to prevent future problems (1,2). Known data on typical injuries (scanning for hazards, providing direct supervision, etc.) can also how to prevent them. A report form is also necessary for providing information to the child’s parents/guardians and primary care provider and other appropriate health or state agencies.
COMMENTS
Caregivers/teachers should report specific products that may have played a role in the injury to the U.S. Consumer Product Safety Commission (CPSC) via their toll-free consumer hotline: 800-638-2772 (TTY 800-638-8270) or online at http://www.cpsc.gov/talk.html. This data helps CPSC respond with needed recalls. Multi-copy forms can be used to make copies of an injury report simultaneously for the child’s record, for the parent/guardian, for the folder that logs all injuries at the facility, and for the regulatory agency.

Facilities should secure the parent’s/guardian’s signature on the form at the time it is presented to the parent/guardian.

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.2.4.1 Written Plan and Training for Handling Urgent Medical Care or Threatening Incidents
9.4.1.10 Documentation of Parent/Guardian Notification of Injury, Illness, or Death in Program
9.4.1.11 Review and Accessibility of Injury and Illness Reports
Appendix DD: Injury Report Form for Indoor and Outdoor Injuries
Appendix EE: America’s Playgrounds Safety Report Card
Appendix KK: Authorization for Emergency Medical/Dental Care
Appendix CC: Incident Report Form
REFERENCES
  1. Murph, J. R., S. D. Palmer, D. Glassy, eds. 2005. Health in child care: A manual for health professionals. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics.
  2. ChildCare.net. Incident reports. http://www.childcare.net/library/incidentreports.shtml.

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


The facility should document that a child’s parent/guardian was notified immediately in the event of a death of their child, of an injury or illness of their child that required professional medical attention, or if their child was lost/missing.

Documentation should also occur noting when law enforcement was notified (immediately) in the event of a death of a child or a lost/missing child.

The facility should document in accordance with state regulations, its response to any of the following events:

  1. Death;
  2. Serious injury or illness that required medical attention;
  3. Reportable infectious disease;
  4. Any other significant event relating to the health and safety of a child (such as a lost child, a fire or other structural damage, work stoppage, or closure of the facility).

The caregiver/teacher should call 9-1-1 to insure immediate emergency medical support for a death or serious injury or illness. They should follow state regulations with regard to when they should notify state agencies such as the licensing agency and the local or state health department about any of the above events.

RATIONALE
The licensing agency should be notified according to state regulations regarding any of the events listed above because each involves special action by the licensing agency to protect children, their families, and/or the community. If death, serious injury, or illness or any of the events in item d) occur due to negligence by the caregiver/teacher, immediate suspension of the license may be necessary. Public health staff can assist in stopping the spread of the infectious disease if they are notified quickly by the licensing agency or the facility (1,2). The action by the facility in response to an illness requiring medical attention is subject to licensing review.

A report form that records death, maltreatment, serious injury or illness is also necessary for providing information to the child’s parents/guardians and primary care provider, other appropriate health agencies, law enforcement agency, and the insurance companies covering the parents/guardians and the facility.

COMMENTS
Guidance on policies for parental notification of child maltreatment reports should be sought from child care health consultants or local child abuse prevention agencies. Surveillance for symptoms can be accomplished easily by using a combined attendance and symptom record. Any symptoms can be noted when the child is signed in, with added notations made during the day when additional symptoms appear. Simple forms, for a weekly or monthly period, that record data for the entire group help caregivers/teachers spot patterns of illness for an individual child or among the children in the group or center.

Multi-copy forms can be used to make copies of an injury report simultaneously for the child’s record, for the parent/guardian, for the folder that logs all injuries at the facility, and for the licensing agency. Facilities should secure the parent/guardian’s signature on the form at the time it is presented to the parent/guardian.

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.2.4.1 Written Plan and Training for Handling Urgent Medical Care or Threatening Incidents
9.4.1.9 Records of Injury
9.4.1.11 Review and Accessibility of Injury and Illness Reports
Appendix F: Enrollment/Attendance/Symptom Record
Appendix DD: Injury Report Form for Indoor and Outdoor Injuries
Appendix EE: America’s Playgrounds Safety Report Card
Appendix CC: Incident Report Form
REFERENCES
  1. Aguero, J., M. Ortega-Mendi, M. Eliecer Cano, A. Gonzalez de Aledo, J. Calvo, L. Viloria, P. Mellado, T. Pelayo, A. Fernandez-Rodriguez, L. Martinez-Martinez. 2008. Outbreak of invasive group A streptococcal disease among children attending a day-care center. Pediatr Infect Dis J 27:602-4.
  2. Galil, K., B. Lee, T. Strine, C. Carraher, A. L. Baughman, M. Eaton, J. Montero, J. Seward. 2002. Outbreak of varicella at a day-care center despite vaccination. N Engl J Med 347:1909-15.

9.4.1.11: Review and Accessibility of Injury and Illness Reports

Content in the STANDARD was modified on 10/16/2018.


The injury and illness log should be reviewed by caregivers/teachers at least semiannually and inspected by licensing staff and child care health consultants at least annually. In addition to maintaining a record for documentation of liability, forms should be used to identify patterns of injury and illness occurring in child care that are amenable to risk reduction or prevention.

RATIONALE

Surveillance for symptoms can be accomplished easily by using a combined attendance and symptom record. Any symptoms can be noted when the child is signed in, with added notations made during the day when additional symptoms appear.

 

Injury patterns and child abuse and neglect can be detected from such records and can be used to prevent future problems (1). A report form is also necessary for providing information to the child’s parents/guardians, primary care provider, and other appropriate health agencies. Simple forms, for a weekly or monthly period, that record data for the entire group help caregivers/teachers identify patterns of illness for an individual child or among the children in the group or center. Child care health consultants can be especially helpful by identifying patterns of illness or injury and suggesting interventions to reduce the risk of future illnesses or injuries.

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.2.4.1 Written Plan and Training for Handling Urgent Medical Care or Threatening Incidents
9.4.1.9 Records of Injury
9.4.1.10 Documentation of Parent/Guardian Notification of Injury, Illness, or Death in Program
Appendix F: Enrollment/Attendance/Symptom Record
REFERENCES
  1. Jackson AM, Kissoon N, Greene C. Aspects of abuse: recognizing and responding to child maltreatment. Curr Probl Pediatr Adolesc Health Care. 2015;45(3):58–70

NOTES

Content in the STANDARD was modified on 10/16/2018.

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


Every facility should hold a valid license or certificate, or documentation of, registration prior to operation as required by the local and/or state statute.
RATIONALE
Licensing registration provides recognition that the facility meets regulatory requirements which are written to insure that children are cared for by qualified staff in a safe environment that supports the children’s development and protects them from maltreatment while they are in child care programs.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

9.4.1.13: Maintenance and Display of Inspection Reports


The facility should maintain and display, in one central area within the facility, current copies of inspection reports required by the state licensing office. These reports and documentation may include the following:

  1. Licensing/registration reports;
  2. Fire inspection reports;
  3. Sanitation inspection reports;
  4. Building code inspection reports;
  5. Plumbing, gas, and electrical inspection reports;
  6. Termite and other insect inspection report;
  7. Zoning approval;
  8. Results of all water tests;
  9. Evacuation and shelter-in-place drill records;
  10. Any accreditation certificates and/or quality rating score, if applicable;
  11. Reports of any legal actions and documentation that all required corrections have been completed;
  12. Results of lead tests;
  13. Insurance records;
  14. Playground inspection report, equipment inspection/maintenance records and reports,
  15. Child care health consultant’s assessment reports that do not pertain to any specific children.
RATIONALE
Facility safeguarding is not achieved by one agency carrying out a single regulatory program. Total safeguarding is achieved through a multiplicity of regulatory programs and agencies (1). Licensing staff, consumers, and concerned individuals benefit from having documents of regulatory approval and legal action in one central location. Parents/guardians, staff, consultants, and visitors should be able to assess the extent of evaluation and compliance of the facility with regulatory and voluntary requirements. Accreditation documentation provides additional information about surveillance and quality improvement efforts of the facility (2).
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.2.4.3 Disaster Planning, Training, and Communication
9.2.4.4 Written Plan for Seasonal and Pandemic Influenza
9.2.4.5 Emergency and Evacuation Drills/Exercises Policy
9.2.6.2 Reports of Annual Audits/Monthly Maintenance Checks of Play Areas and Equipment
9.4.1.1 Facility Insurance Coverage
9.4.1.16 Evacuation and Shelter-In-Place Drill Record
REFERENCES
  1. National Association for Regulatory Administration (NARA). 2009. Recommended best practices for human care and regulatory agencies. The NARA Vision Series Part 1. http://www.naralicensing
    .org/associations/4734/files/Recommended Best Practices.pdf.
  2. National Association for Regulatory Administration (NARA). 2010. Strong licensing: The foundation for a quality early care and education system; NARA’s call to action. http://www.naralicensing.org/associations/4734/files/NARA_Call_to_Action.pdf.

9.4.1.14: Written Plan/Record to Resolve Deficiencies


When deficiencies are identified during annual policy and performance reviews by the licensing department, funding agency, or accreditation organization, the director or small or large family child care home caregiver/teacher should follow a written plan for resolution, developed with the regulatory agency.

This plan should include the following:

  1. Description of the problem;
  2. Proposed timeline for resolution;
  3. Designation of responsibility for correcting the deficiency;
  4. Description of the successful resolution of the problem.
RATIONALE
A written plan or contract for change may be required and is more likely to achieve the desired change (1).
COMMENTS
Simple problems amenable to immediate correction do not require extensive documentation. For these, a simple notation of the problem and that the problem was immediately corrected will suffice. However, a notation of the problem is necessary so that recurring problems of the same type can be addressed by a more lasting solution.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
REFERENCES
  1. National Association for Regulatory Administration (NARA). 2000. The NARA licensing curriculum. Lexington, KY: NARA.

9.4.1.15: Availability of Reports on Inspections of Fire Protection Devices


A report of the inspection and maintenance of fire extinguishers, smoke detectors, carbon monoxide detectors, or other fire prevention mechanisms should be available for review. The report should include the following information:

  1. Location of the fire extinguishers, smoke detectors, carbon monoxide detectors, or other equipment;
  2. Date the inspection was performed and by whom;
  3. Condition of the equipment;
  4. Description of any service provided for the equipment.

Fire extinguishers should be inspected semi-annually. Smoke detectors should be inspected monthly. Carbon monoxide detectors should be checked monthly.

Inspections should be performed in compliance with local and/or state regulations.

RATIONALE
A fire extinguisher may lose its effectiveness over time. It should work properly at any time in case it is needed to put out a small fire or to clear an escape path (1). Since chemicals tend to separate within the canister, maintenance instructions should be followed.

Smoke detectors are often powered by batteries and will need to be checked monthly to ensure they are in operating condition.

COMMENTS
Caregivers/teachers can do the inspection themselves, since many fire extinguishers are equipped with gauges that can be read easily.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
REFERENCES
  1. U.S. Fire Administration. Home fire prevention. http://www.usfa.dhs.gov/citizens/all_citizens/home_fire_prev/index.shtm.

9.4.1.16: Evacuation and Shelter-In-Place Drill Record

Content in the STANDARD was modified on 05/21/2019.


Records of the practiced emergency drill procedures and reviewed emergency policies should be completed regularly and kept on file. Staff training in proper record-keeping should be conducted annually.

 

Administrators should check with their state regulations and licensing requirements to adhere to the frequency of emergency drills and keep a record of the date, time, and name of the individual drill reviewer when each of the following drills are performed1: 

  • Evacuation emergencies (eg, fires, floods, gas leaks, chemical spills)
  • Shelter-in-place emergencies (eg, tornados, earthquakes, threatening person outside)
  • Lockdown emergencies (eg, violent/hostile intruders, threatening/dangerous animals)

Early care and education programs should see Standard 9.2.4.3 for additional information on procedures and policies for these drills during geographically appropriate emergencies, natural disasters and violent/hostile intruder events.

RATIONALE

Routine practice and documentation of emergency evacuation plans fosters calm, competent use in an emergency and an opportunity to reevaluate and improve plans.

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.2.4.3 Disaster Planning, Training, and Communication
9.2.4.4 Written Plan for Seasonal and Pandemic Influenza
9.2.4.5 Emergency and Evacuation Drills/Exercises Policy
REFERENCES
  1. National Fire Protection Association. School fire safety. https://www.nfpa.org/Public-Education/By-topic/Property-type-and-vehicles/School-fires. Accessed December 20, 2018

NOTES

Content in the STANDARD was modified on 05/21/2019.

9.4.1.17: Documentation of Child Care Health Consultation/Training Visits


Documentation of child care health/early childhood mental health consultation visits should be maintained in the facility’s files. Documentation should include at least the following:

  1. Name of child care health/early childhood mental health consultant;
  2. Date and time of visit;
  3. Recipient(s) of service;
  4. Reason for the visit/phone/internet consultation;
  5. Type of service provided;
  6. Recommendations;
  7. Follow-up, if any.

All training or education provided by child care health consultants for early care and education professionals should be documented in a manner that can be used to meet professional development requirements or documentation. Recommendations and improvement plans should be provided to the staff.

RATIONALE
Child care health consultants, including mental health consultants, licensing agents, health departments, and fellow caregivers/teachers should reinforce the importance of appropriate health behavior. Documentation of health consultation by a child care health consultant or other health professional provides a record of the assessed need in a facility, the strategies to make improvements, and the barriers that result from implementing strategies. The documentation can also be useful in evaluating the effectiveness of the services provided (1).

The documentation from the child care health consultant should take the form of a quality improvement plan that includes goals, objectives, timeline, and financial considerations. All encounters should be documented by the child care health consultant. The child care health consultant should use the same standards as would be used to document “patient care” the patient or client in this case is the child care business.

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
REFERENCES
  1. Norwood, S. L. 2003. Nursing consultation: A Framework for working with communities. 2nd ed. Upper Saddle River, NJ: Prentice Hall.

9.4.1.18: Records of Nutrition Service


The facility should maintain records covering the nutrition services budget, expenditures for food, menus, numbers and types of meals served daily with separate recordings for children and adults, inspection reports made by health authorities, nutrition education and recipes. Copies should be maintained in the facility files for six months or according to state/local regulations.
RATIONALE
Food service records permit efficient and effective management of the facility’s nutrition component and provide data from which a nutritionist/registered dietitian can develop recommendations for program improvement. If a facility is large enough to employ a supervisor for food service who holds certification equivalent to the Food Service Manager’s Protection (Sanitation) Certificate, records of this certification should be maintained (1).
COMMENTS
For information on the USDA’s Child and Adult Care Food Program (CACFP) and resources for child care, including feeding infants, see the Child Care Providers page on USDA’s Food and Nutrition Website http://www.fns
.usda.gov/tn/childcare.html and MyPlate for Preschoolers Website http://www.choosemyplate.gov/specificaudiences.html.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
Appendix Q: MyPlate: Make It Yours
Appendix C: Nutrition Specialist, Registered Dietitian, Licensed Nutritionist, Consultant, and Food Service Staff Qualifications
Appendix R: Choose MyPlate: 10 Tips to a Great Plate
Appendix S: Physical Activity: How Much Is Needed?
REFERENCES
  1. U.S. Department of Agriculture. 2000. Child and Adult Care Food Program; Improving management and program integrity; Proposed rule. 7 CFR 226. http://www.fns.usda.gov/cnd/Care/Regs-Policy/policymemo/2000-2003/2000-09-12.pdf.

9.4.1.19: Community Resource Information


The facility should obtain or have access to a community resource file that is updated at least annually. This resource file should be made available to parents/guardians as needed. For families who do not speak English, community resource information should be provided in the parents’/guardians’ native language or through the use of interpreters (1).
RATIONALE
Posting resources in a public place is a service to the community.
COMMENTS
In many communities, community agencies (such as resource and referral agencies) offer community resource files and may be able to supply updated information or service directories to local caregivers/teachers. Even small family child care home caregivers/teachers will be able to maintain a list of telephone numbers of human services, such as that published in the telephone directory. If a resource file is maintained, it must be updated regularly and should be used by a caregiver/teacher knowledgeable about health and the community (i.e., Health Advocate).

Local resource and referral agencies, mental health services, WIC (Women, Infants, and Children), Child Find, Legal Aid, specialty clinics serving the developmentally disabled, poison centers, social services, community health centers, hospitals, private physicians, state child health insurance programs (SCHIP), medical homes, food banks and pantries, energy/housing assistance, churches, child care payment assistance, public health nurses, Head Start, the American Red Cross, public schools, early intervention programs, and county extension services, faith-based organizations, local government agencies are examples of potential resources.

For locating community resources, see the Maternal and Child Health Library Community Services Locator at http://www.mchlibrary.info/KnowledgePaths/kp_community.html. American Academy of Pediatrics’ State Chapter Child Care Contacts are available at http://www.healthychildcare.org.

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
REFERENCES
  1. Gonzalez-Mena, J. 2007. 50 early childhood strategies for working and communicating with diverse families. Upper Saddle River, NJ: Pearson Merrill Prentice Hall.

9.4.2 Child Records

9.4.2.1: Contents of Child’s Records


The facility should maintain a file for each child in one central location within the facility. This file should be kept in a confidential manner but should be immediately available to the child’s caregivers/teachers (who should have parental/guardian consent for access to records), the child’s parents/guardians, and the licensing authority upon request.

The file for each child should include the following:

  1. Pre-admission enrollment information;
  2. Admission agreement signed by the parent/guardian at enrollment;
  3. Initial health care professional assessment, completed and signed by the child’s primary care provider and based on the child’s most recent well care visit and containing a complete immunization record as recommended at http://www.aap.org/immunization/ and a statement of any special needs with a care plan for how the program should accommodate these special needs (this should be on file preferably at enrollment or a two week written plan should be provided upon admission);
  4. Updated health care professional assessments should be completed from the initial assessment filed except that such assessments should be at the recommended intervals by the American Academy of Pediatrics (AAP) until the age of two years and annually thereafter;
  5. Health history to be completed by the parent/guardian at admission, preferably with staff involvement;
  6. Medication record, maintained on an ongoing basis by designated staff;
  7. Authorization form for emergency medical care (see Appendix KK: Authorization for Emergency Medical/Dental Care for an example; this form should not be used for routine problems or when the parent can be reached);
  8. Any written informed consent forms signed by the parent/guardian allowing the facility to share the child’s health records with other service providers.
RATIONALE
The health and safety of individual children requires that information regarding each child in care be kept and made available on a need-to-know basis. Prior informed, written consent of the parent/guardian is required for the release of records/information (verbal and written) to other service providers, including process for secondary release of records. Consent forms should be in the native language of the parents/guardians, whenever possible, and communicated to them in their normal mode of communication. Foreign language interpreters should be used whenever possible to inform parents/guardians about their confidentiality rights (1).
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.4.1.3 Written Policy on Confidentiality of Records
9.4.2.4 Contents of Child’s Primary Care Provider’s Assessment
Appendix I: Recommendations for Preventive Pediatric Health Care
Appendix KK: Authorization for Emergency Medical/Dental Care
REFERENCES
  1. American Academy of Pediatrics, Committee on Pediatric Emergency Medicine. 2007. Policy statement: Consent for emergency medical services for children and adolescents. Pediatrics 120:683-84.

9.4.2.2: Pre-Admission Enrollment Information for Each Child


The file for each child should include the following pre-admission enrollment information (pre-admission requirements may be waived to comply with the federal McKinney-Vento Homeless Assistance Act regarding health and health records):

  1. The child’s name, address, sex, and date of birth;
  2. The full names of the child’s parents/guardians, and their home and work addresses and telephone numbers, which should be updated quarterly (telephone contact numbers should be confirmed by a call placed to the contact number during the facility’s hours of operation);
  3. The names, addresses, and telephone numbers of at least two additional persons to be notified in the event that the parents/guardians cannot be located (telephone information should be confirmed and updated as specified in item b) above);
  4. The names and telephone numbers of the child’s medical home provider and main sources of specialty medical care (if any), emergency medical care, and dental care;
  5. The child’s health payment resource or health insurance;
  6. Written instructions (in the form of a care plan) of the parent/guardian and the child’s primary care provider for any special dietary needs or special needs due to a health condition or allergy; or any other special instructions from the parent/guardian;
  7. Scheduled days and hours of attendance;
  8. In the event that a custody or guardianship order has been issued regarding the child, legal documentation evidencing the child’s custodian or guardian;
  9. Enrollment date, reason for entry in child care, and fee arrangements;
  10. Signed permission to act on parent/guardian’s behalf for emergency treatment;
  11. Authorization to release child to designated individuals other than the custodial parent/guardian.

The emergency information in items a) through e) above should be obtained in duplicate with original parent/guardian signatures on both copies. One copy should be in the child’s confidential record and one copy should be easily accessible at all times. This information should be updated quarterly and as necessary. A copy of the emergency information must accompany the child to all offsite excursions.

RATIONALE
These records and reports are necessary to protect the health and safety of children in care. An organized, comprehensive approach to illness and injury prevention and control is necessary to ensure that a healthy and safe environment is provided for children in child care. Such an approach requires written plans, policies, procedures, and record-keeping so that there is consistency over time and across staff and an understanding between parents/guardians and caregivers/teachers about concerns for, and attention to, the safety of children.

Emergency information is the key to obtaining needed care in emergency situations (1). Caregivers/teachers must have written parental permission to allow them access to information they and emergency medical services personnel may need to care for the child in an emergency (1). Contact information must be verified for accuracy. Health payment resource information is usually required before any non-life-threatening emergency care is provided.

COMMENTS
Duplicate records are easily made by scanning copies or making photocopies.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.2.4.8 Authorized Persons to Pick Up Child
9.2.4.9 Policy on Actions to Be Followed When No Authorized Person Arrives to Pick Up a Child
9.2.4.10 Documentation of Drop-Off, Pick-Up, Daily Attendance of Child, and Parent/Provider Communication
Appendix BB: Emergency Information Form for Children with Special Health Care Needs
Appendix KK: Authorization for Emergency Medical/Dental Care
REFERENCES
  1. Murph, J. R., S. D. Palmer, D. Glassy, eds. 2005. Health in child care: A manual for health professionals. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics.

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


The file for each child should include an admission agreement signed by the parent/guardian at enrollment. The admission agreement should contain the following topics and documentation of consent:

  1. General topics:
    1. Operating days and hours;
    2. Holiday closure dates;
    3. Payment for services;
    4. Drop-off and pick-up procedures;
    5. Family access (visiting site at any time when their child is there and admitted immediately under normal circumstances) and involvement in child care activities;
    6. Name and contact information of any primary staff person designation, especially primary caregivers/teachers designated for infants and toddlers, to make parent/guardian contact of a caregiver/teacher more comfortable.
  2. Health topics:
    1. Immunization record;
    2. Breast feeding policy;
    3. For infants, statement that parent/guardian(s) has received and discussed a copy of the program’s infant safe sleep policy;
    4. Documentation of written consent signed and dated by the parent/guardian for:
    5. Any health service obtained for the child by the facility on behalf of the parent/guardian. Such consent should be specific for the type of care provided to meet the tests for “informed consent” to cover on-site screenings or other services provided;
    6. Administration of medication for prescriptions and non-prescription medications (over-the-counter [OTC]) including records and special care plans (if needed).
  3. Safety topics:
    1. Prohibition of corporal punishment in the child care facility;
    2. Statement that parent/guardian has received and discussed a copy of the state child abuse and neglect reporting requirements;
    3. Documentation of written consent signed and dated by the parent/guardian for:
    4. Emergency transportation;
    5. All other transportation provided by the facility;
    6. Planned or unplanned activities off-premises (such consent should give specific information about where, when, and how such activities should take place, including specific information about walking to and from activities away from the facility);
    7. Swimming, if the child will be participating;
    8. Release of any information to agencies, schools, or providers of services;
    9. Written authorization to release the child to designated individuals other than the parent/guardian.
RATIONALE
These records and reports are necessary to protect the health and safety of children in care.

These consents are needed by the person delivering the medical care. Advance consent for emergency medical or surgical service is not legally valid, since the nature and extent of injury, proposed medical treatment, risks, and benefits cannot be known until after the injury occurs, but it does allow the parent/guardian to guide the caregiver/teacher in emergency situations when the parent/guardian cannot be reached (1). See Appendix KK: Authorization for Emergency Medical/Dental Care for an example.

The parent/guardian/child care partnership is vital.

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.2.1.3 Enrollment Information to Parents/Guardians and Caregivers/Teachers
Appendix KK: Authorization for Emergency Medical/Dental Care
REFERENCES
  1. American Academy of Pediatrics, Committee on Pediatric Emergency Medicine. 2007. Policy statement: Consent for emergency medical services for children and adolescents. Pediatrics 120:683-84.

9.4.2.4: Contents of Child’s Primary Care Provider’s Assessment


The file for each child should include an initial health assessment completed and signed by the child’s primary care provider. This should be on file preferably at enrollment and no later than within six weeks of admission. (Requirements may be waived to comply with the federal McKinney-Vento Homeless Assistance Act regarding health and health records.) It should include:

  1. Immunization Records;
  2. Growth Assessment – may include percentiles of weight, height, and head circumference (under age of two); recording body mass index (BMI) and percentile for age is especially helpful in those children age two years and older who are over or underweight;
  3. Health Assessment – includes descriptions of any current acute and/or chronic health issues and should also include any findings from an exam or screening that may need follow-up, e.g., vision, hearing, dental, obesity, or nutritional screens or tests for lead, anemia, or tuberculosis (these health concerns may require a care plan and possibly a medication plan [see h) below]);
  4. Developmental Issues – includes descriptions of concerns and the child’s special needs in a child care setting, (for example, a vision or hearing deficit, a developmental variation, prematurity, or an emotional or behavioral disturbance);
  5. Significant physical findings so that caregivers/teachers can note if there are changes from baseline and report those findings;
  6. Dates of Significant Illnesses and/or Injuries;
  7. Allergies;
  8. Medication(s) List – includes dosage, time and frequency of administration of any ongoing prescription or non-prescription (over-the-counter [OTC]) medication that the person with prescriptive authority recommends for the child. This list would also include information on recognizing side-effects and responding to them appropriately and it may also contain the same information for intermittent use of a fever reducer medication;
  9. Dietary modifications;
  10. Emergency plans;
  11. Other special instructions for the caregiver/teacher;
  12. Care Plan – (if the child has a special health need as indicated by c) or d) above) includes routine and emergency management plans that might be required by the child while in child care. This plan also includes specific instructions for caregiver/teacher observations, activities or services that differ from those required by typically developing children and should include specific instructions to caregivers/teachers on how to provide medications, procedures, or implement modifications required by children with asthma, severe allergic reactions, diabetes, medically-indicated special feedings, seizures, hearing impairments, vision problems, or any other condition that requires accommodation in child care;
  13. Parent’s/Guardian’s assessment and concerns (4).

For children up the age of three years, health care professional assessments should be at the recommended intervals indicated by the American Academy of Pediatrics (AAP) (3). For all other children, the Health Care Professional Assessment updates should be obtained annually. It should include any significant health status changes, any new medications, any hospitalizations, and any new immunizations given since the previous health assessment. This health report will be supplemented by the health history obtained from the parents/guardians by the child care provider at enrollment.

RATIONALE
The requirement of a health report for each child reflecting completion of health assessments and immunizations is a valid way to ensure timely preventive care for children who might not otherwise receive it and can be used in decision-making at the time of admission and during ongoing care (2). This requirement encourages families to have a primary care provider (medical home) for each child where timely and periodic well-child evaluations are done. The objective of timely and periodic evaluations is to permit detection and treatment for improved oral, physical, mental, and emotional/social health (1,3). The reports of such evaluations provide a conduit for communication of information that helps the primary care provider and the caregiver/teacher determine appropriate services for the child. When the parent/guardian carries the request for the report to the primary care provider, concerns of the caregiver/teacher can be delivered by the parent/guardian to the child’s primary care provider and consent for communication is thereby given. The parent/guardian can give written consent for direct communication between the primary care provider and the caregiver/teacher so that the forms can be faxed or mailed.

Quality child care requires information about the child’s health status and need for accommodations in child care (2).

COMMENTS
The purpose of a health care professional assessment is to:
  1. Give information about a child’s health history, special health care needs, and current health status to allow the caregiver/teacher to provide a safe setting and healthy experience for each child;
  2. Promote individual and collective health by fostering compliance with approved standards for health care assessments and immunizations;
  3. Document compliance with licensing standards;
  4. Serve as a means to ensure early detection of health problems and a guide to steps for remediation;
  5. Serve as a means to facilitate and encourage communication and learning about the child’s needs among caregivers/teachers, primary care providers, and parents/guardians.

This approach is usually the most efficient, effective and least costly since the primary care provider has the child, the family member, and the record in hand, to provide the information that the child care facility should have. When the data are requested separate from the visit to the primary care provider for the health assessment, the record must be pulled from the file and the information retrieved from the notes in the file. Some health care facilities charge families for the cost of the additional work to complete forms either at the time of a health care visit or later. Collaborating in reducing the burden of form completion by writing in as much information as is known before giving the forms to the primary care provider helps foster effective communication. Many primary care providers appreciate having identifying information filled in on the form about the child care facility, the child, the family and a note about any concerns to be addressed.

Caregivers/teachers may offer a four-week grace period during which the parent/guardian can arrange to get this assessment. The health history can serve as an interim health assessment during this grace period.

Health data should be presented in a form usable for caregivers/teachers to help identify any special needs for care. Local Early Periodic Screening and Diagnostic Treatment (EPSDT) program contractor, if available, should be called upon to help with liaison and education activities. In some situations, screenings may be performed at the facilities, but it is always preferable that the child have a medical home and primary care provider who screens the child and provides the information. When clinicians do not fill out forms completely enough to assist the caregiver/teacher in understanding the significance of health assessment findings or the unique characteristics of a child, the caregiver/teacher should obtain parental consent to contact the child’s primary care provider to explain why the information is needed and to request clarification.

Health assessments should be in a format easily usable by caregivers/teachers to identify any special needs for care.

A child’s primary care provider is a key resource to families when racial, ethnic, socioeconomic, or educational disparities create barriers to the child receiving regular dental care. He or she can perform an oral examination and conduct an oral health risk assessment and triage for infants and young children. Children with suspected oral problems should see a dentist immediately, regardless of age or interval.

The American Academy of Pediatrics (AAP) and Bright Futures recommend vision/hearing and dental screenings are:

  1. Vision/hearing at every well care visit (with objective measures of visual acuity by four years and audiometry measures of hearing by five years of age); and
  2. Dental exam at one year (or sooner if there are suspected oral problems) (3).
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.4.2.1 Contents of Child’s Records
9.4.2.5 Health History
Appendix FF: Child Health Assessment
Appendix O: Care Plan for Children with Special Health Care Needs
REFERENCES
  1. Hagan, J. F., J. S. Shaw, P. M. Duncan, eds. 2008. Bright futures: Guidelines for health supervision of infants, children, and adolescents. 3rd ed. Elk Grove Village, IL: American Academy of Pediatrics.
  2. Murph, J. R., S. D. Palmer, D. Glassy, eds. 2005. Health in child care: A manual for health professionals. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics.
  3. American Academy of Pediatrics, Committee on Practice and Ambulatory Medicine, Bright Futures Steering Committee. 2007. Policy statement: Recommendations for preventive pediatric health care. Pediatrics 120:1376.
  4. Crowley A. A., G. C. Whitney. 2005. Connecticut’s new comprehensive and universal early childhood health assessment form. J School Health 75:281-85.

9.4.2.5: Health History


The file for each child should include a health history completed by the parent/guardian at admission, preferably with staff involvement. This history should include the following:

  1. Identification of the child’s medical home/primary care provider and dental home;
  2. Permission to contact these professionals in case of emergency;
  3. Chronic diseases/health issues currently under treatment;
  4. Developmental variations, sensory impairment, serious behavior problems or disabilities that may need consideration in the child care setting;
  5. Description of current physical, social, and language developmental levels;
  6. Current medications, medical treatments and other therapeutic interventions;
  7. Special concerns (such as allergies, chronic illness, pediatric first aid information needs);
  8. Specific diet restrictions, if the child is on a special diet;
  9. Individual characteristics or personality factors relevant to child care;
  10. Special family considerations;
  11. Dates of infectious diseases;
  12. Plans for medical emergencies;
  13. Any special equipment that might be needed;
  14. Special transportation adaptations.
RATIONALE
A health history is the basis for meeting the child’s medical and psychosocial needs in the child care setting. This information must be obtained and reviewed at admission by the significant caregiver/teacher. This information may be the only health information on file for up to the first four weeks following enrollment.
COMMENTS
This history will complement the child’s health history which is completed by the primary care provider.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.4.2.1 Contents of Child’s Records

9.4.2.6: Contents of Medication Record


The file for each child should include a medication record maintained on an ongoing basis by designated staff for all prescription and non-prescription (over-the-counter [OTC]) medications. State requirements should be checked and followed. The medication record for prescription and non-prescription medications should include the following:

  1. A separate consent signed by the parent/guardian for each medication the caregiver/teacher has permission to administer to the child; each consent should include the child’s name, medication, time, dose, how to give the medication, and start and end dates when it should be given;
  2. Authorization from the prescribing health professional for each prescription and non-prescription medication; this authorization should also include potential side effects and other warnings about the medication (exception: non-prescription sunscreen and insect repellent always require parental/guardian consent but do not require instructions from each child’s individual medical provider);
  3. Administration log which includes the child’s name, the medication that was given, the dose, the route of administration, the time and date, and the signature or initials of the person administering the medication. For medications given “as needed,” record the reason the medication was given. Space should be available for notations of any side-effects noted after the medication was given or if the dose was not retained because of the child vomiting or spitting out the medication. Documentation should also be made of attempts to give medications that were refused by the child;
  4. Information about prescription medication brought to the facility by the parents/guardians in the original, labeled container with a label that includes the child’s name, date filled, prescribing clinician’s name, pharmacy name and phone number, dosage/instructions, and relevant warnings. Potential side effects and other warnings about the medication should be listed on the authorization form;
  5. Non prescription medications should be brought to the facility in the original container, labeled with the child’s complete name and administered according to the authorization completed by the person with prescriptive authority;
  6. For medications that are to be given or available to be given for the entire year, a Care Plan should also be in place (for instance, inhalers for asthma or epinephrine for possible allergy);
  7. Side effects.
RATIONALE
Before assuming responsibility for administration of prescription or non-prescription medicine, facilities must have written confirmation of orders from the prescribing health professional that includes clear, accurate instructions and medical confirmation of the child’s need for medication while in the facility. Caregivers/teachers should not administer medication based solely on a parent’s/guardian’s request. Proper labeling of medications is crucial for safety (1). Both the child’s name and the name and dose of the medication should be clear. Medications should never be removed from their original container. All containers should have child resistant packaging. Potential side-effects are usually included on prescription and OTC medications if the packaging is left intact (2).

Medications may have side-effects, and parents/guardians might not be aware that their child is experiencing those symptoms unless they are recorded and reported. Serious medication side-effects might require emergency care. Adjustments or additional medications might help those symptoms if the prescribing health professional is made aware of them. Children who do not tolerate medications may vomit or spit up the medication. Notation should be made if any of the medication was retained in those cases. Children may also vigorously refuse medications, and plans to deal with this should be made (1,2).

The Medication Log is a legal document and should be kept in the child’s file for as long as required by state licensing requires.

COMMENTS
A curriculum for child care providers on safe administration of medications in child care is available from the American Academy of Pediatrics at: http://www.healthychildcare.org/HealthyFutures.html.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.2.3.9 Written Policy on Use of Medications
9.4.2.1 Contents of Child’s Records
Appendix AA: Medication Administration Packet
REFERENCES
  1. Healthy Child Care America. 2010. Healthy futures: Medication administration in early education and child care settings. American Academy of Pediatrics. http://www.healthychildcare.org/HealthyFutures.html.
  2. American Academy of Pediatrics, Council on School Health. 2009. Policy statement: Guidance for the administration of medication in school. Pediatrics 124:1244-51.

9.4.2.7: Contents of Facility Health Log for Each Child


The file for each child should include a facility health log maintained on an ongoing basis by designated staff. The facility health log should include:

  1. Staff and parent/guardian observations of the child’s health status, behavior, and physical condition;
  2. Response to any treatment provided while the child is in child care, and any observable side effects;
  3. Notations of health-related referrals and follow-up action;
  4. Notations of health-related communications with parents/guardians or the child’s primary care provider;
  5. Staff observations of changes in and assessments of the child’s learning and social activity;
  6. Documentation of planned communication with parents/guardians and a list of participants involved;
  7. Documentation of parent/guardian participation in health education.
RATIONALE
A facility health log maintained by caregivers/teachers can document staff’s observations and concerns that may lead to intervention decisions.
COMMENTS
The facility health log is a confidential, chronologically-oriented location for the recording of staff observations, patterns of illness, and parent/guardian concerns. It can be followed and can become guidelines for intervention, if needed.

Facility observation logs provide useful information over time on each child’s unique characteristics. Parents/guardians and caregivers/teachers can use these logs in planning for the child’s needs. On occasion, the child’s primary care provider can use them as an aid in diagnosing health conditions.

“Hands-on” opportunities for parents/guardians to work with their own child or others in the company of caregivers/teachers should be encouraged and documented.

Staff notations on communication with parents/guardians can be in a parent/guardian log separate from the child’s health record.

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.4.1.6 Availability of Documents to Parents/Guardians
Appendix F: Enrollment/Attendance/Symptom Record
Appendix AA: Medication Administration Packet

9.4.2.8: Release of Child’s Records


The parents’/guardians’ written requests to release their child’s records must be specific about to whom the record is being released, for what purpose, and what parts of the record are being copied and sent. Upon parent/guardian request, designated portions or all of the child’s records should be copied and released to specific individuals named and authorized in writing by the parents/guardians to receive this information. The original records and the written requests should be retained by the facility.
RATIONALE
The facility must retain the original records in case legal defense is required, but parents/guardians have the right to know and have the full contents of the records. Sending the record to another source of service for the child may enhance the ability of other service providers to provide appropriate care for the child and family.
COMMENTS
Parents/guardians may want a copy of the record themselves or may want the record sent to another source of care for the child. An effective way to educate parents/guardians on the value of maintaining the child’s developmental and health information is to have them focus on their own child’s records. Such records should be used as a mutual education tool by parents/guardians and caregivers/teachers. Facilities may charge a reasonable fee for making a copy.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.4.1.3 Written Policy on Confidentiality of Records

9.4.3 Staff Records

9.4.3.1: Maintenance and Content of Staff and Volunteer Records


Individual files for all staff members and volunteers, should be maintained in a central location within the facility and should contain the following:

  1. The individual’s name, birth date, address, and telephone number;
  2. The position application, which includes a record of work experience and work references; verification of reference information, education, and training; and records of any checking for background screenings, driving records, criminal records, and/or listing in child abuse registry;
  3. The health assessment record, a copy of which, having been dated and signed by the employee’s primary care provider, should be kept in a confidential file in the facility; this record should be updated by another health appraisal when recommended by the staff member’s primary care provider or supervisory or regulatory/certifying personnel;
  4. The name and telephone number of the person, primary care provider, or health facility to be notified in case of emergency;
  5. The job description or the job expectations for staff and substitutes;
  6. Required licenses, certificates, and transcripts;
  7. The date of employment or volunteer assignment;
  8. A signed statement of agreement that the employee understands and will abide by the following:
    1. Regulations and statutes governing child care;
    2. Human resource management and procedures;
    3. Health policies and procedures;
    4. Discipline policy;
    5. Guidelines for reporting suspected child abuse, neglect, and sexual abuse;
    6. Confidentiality policy.
  9. The date and content of staff and volunteer orientation(s);
  10. A daily record of hours worked, including paid planning time and parent/guardian conference time;
  11. A record of professional development completed by each staff member and volunteer, including dates and clock or credit hours;
  12. Written performance evaluations.
RATIONALE
Complete identification of staff, paid or volunteer, is an essential step in safeguarding children in child care. Maintaining complete records on each staff person employed at the facility is a sound administrative practice. Employment history, a daily record of days worked, performance evaluations, a record of benefits, and who to notify in case of emergency provide important information for the employer. Licensors will check the records to assure that applicable licensing requirements are met (such as identifying information, educational qualifications, health assessment on file, record of continuing education, signed statement of agreement to observe the discipline policy, and guidelines for reporting suspected child abuse, neglect, and sexual abuse).

Emergency contact information for staff, paid or volunteer is needed in child care in the event that an adult becomes ill or injured at the facility.

The signature of the employee confirms the employee’s notification of responsibilities that might otherwise by overlooked by the employee.

COMMENTS
If a small family child care home has employees, this standard would apply.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.2.1.1 Content of Policies
9.2.1.3 Enrollment Information to Parents/Guardians and Caregivers/Teachers
9.2.1.6 Written Discipline Policies
9.3.0.1 Written Human Resource Management Policies for Centers and Large Family Child Care Homes
9.4.1.3 Written Policy on Confidentiality of Records

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


Centers and large family child care homes should keep daily attendance records listing the names of each caregiver/teacher and/or substitute in attendance, the hours each individual worked, and the names of the children in their care. When a caregiver/teacher, substitute provider and/or volunteer cares for more than one group of children during their hours worked, daily attendance records will reflect the names of the children cared for during each block of time.
RATIONALE
Promoting the health and safety of individual children requires keeping records regarding supervision of each child in care. This standard ensures that the facility knows which children are receiving care at any given time and who is responsible for directly supervising each child. It also aids in the surveillance of child:staff ratios and provides data for program planning. Past attendance records are essential in conducting complaint investigations including child abuse.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home
RELATED STANDARDS
9.4.3.1 Maintenance and Content of Staff and Volunteer Records

9.4.3.3: Training Record


The director of a center or a large or small family child care home should provide and maintain documentation or participate in the state’s training/professional development registry of training/professional development received by, or provided for, staff. For centers, the date of the training, the number of hours, the names of staff participants, the name(s) and qualification(s) of the trainer(s), and the content of the training (both orientation and continuing education) should be recorded in each staff person’s file or in a separate training file. If the state has a training/professional development registry, the director should provide training documentation to the registry.

Small family child care home caregivers/teachers should keep a written record of training acquired and certificates containing the same information as the documentation recommended for centers and large homes.

RATIONALE
The training record should be used to assess each employee’s need for additional training and to provide regulators with a tool to monitor compliance. Continuing education with course credit should be recorded and the records made available to staff members to document their applications for licenses/certificates or for license upgrading. All accrediting bodies for child care facilities, homes and centers, require documentation of training.

In many states, small family child care home caregivers/teachers are required to keep records of training.

COMMENTS
Colleges issue transcripts, workshops can issue certificates, and facility administrators can maintain individual training logs.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
9.4.3.1 Maintenance and Content of Staff and Volunteer Records