text:
Arizona Health and Safety Policy Manual
Child Care Centers
Prepared by the Arizona State School Readiness Board Governor 's Office of Children, Youth and Families Spring, 2006
Copyright 2006 by State of Arizona
State School Readiness Board Governor 's Office for Children, Youth and Families Phoenix, AZ Copyright 2006 by State of Arizona All rights reserved. Permission is given to reproduce this manual, in whole or in part, for educational or personal use, provided such copies are not disseminated for profit and each copy bears the statement, "Copyright 2006 by State of Arizona. All rights reserved. Used with permission." Published 2006
For additional copies of this document contact: State School Readiness Board Governor 's Office of Children, Youth and Families 1700 W. Washington Street, Suite 101 Phoenix, AZ 85007 http://www.governor.state.az.us/cyf/school_readiness/index_school_readiness.html (602) 542-3620 Downloadable version at: http://www.governor.state.az.us/cyf/school_readiness/childcare_manual.html
Library of Congress Control Number: 2006900836
The resources listed below have provided information and inspiration to create this manual for Arizona child care centers. We thank their writers and developers for their hard work and insight. American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care. (2002) Caring for our children, national health and safety standards: Guidelines for out-of-home care programs (2nd ed.) Elk Grove Village, IL: American Academy of Pediatrics and Washington, DC: American Public Health Association. Florida Children's Forum. (2004) Health and safety handbook (3rd ed.). Tallahassee, FL: Author. Healthy Child Care Montana. (2002) An orientation manual for child care health consultants. Missoula, MT: Author. Tacoma-Pierce Health Department. (2002). Promoting healthy child care, a health care plan for child care centers. Tacoma, WA: Author. Special thanks to the writers of the curriculum developed for the National Training Institute for Child Care Health Consultants (NTICCHC), and to the NTICCHC staff at the University of North Carolina at Chapel Hill.
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page i
Table of Contents
Forward ............................................................................................................................................ v Acknowledgements ......................................................................................................................... vi How to Use This Manual ................................................................................................................. 1 Getting Started................................................................................................................................. 2 Emergency Contacts ...................................................................................................................... 3 Emergency Procedures .................................................................................................................. 4 First Aid ............................................................................................................................................ 5 First Aid Staff ............................................................................................................................... 5 Contents of the First Aid Kit ........................................................................................................ 6 Updating the Emergency Plan .................................................................................................... 6 Shelter-in-Place ............................................................................................................................... 7 Contents of the Disaster Supply Kit ............................................................................................ 8 Emergency Evacuation Drills ......................................................................................................... 9 Child Care Health Consultant ......................................................................................................... 11 Staff Orientation and Training ........................................................................................................ 12 Orientation .................................................................................................................................. 12 Ongoing Staff Training ................................................................................................................ 13 Training Requirements ................................................................................................................ 14 Professional Recognition ............................................................................................................ 14 Enrolling Children for Care............................................................................................................. 15 The Emergency Information and Immunization Record Card (EIIRC) ........................................ 15 Confidentiality ............................................................................................................................. 15 HIPAA.......................................................................................................................................... 16 Statement of Services ................................................................................................................. 16 Health Care for Kids ........................................................................................................................ 17 Assuring Children Have Health Care .......................................................................................... 17 Early and Periodic Screening, Diagnostic and Treatment (EPSDT) ........................................... 18 Educating Parents About Routine Check-Ups ............................................................................ 18 Immunizations ................................................................................................................................. 19 Immunization Requirements ....................................................................................................... 19 Recommended (but not required) Vaccines ................................................................................ 20 Guidelines for Excluding Sick Children and Staff ........................................................................ 21 Arrival Health Check ................................................................................................................... 21 Signs and Symptoms for Exclusion ............................................................................................ 21 When A Child Becomes Sick During the Day .............................................................................. 22 Reporting Communicable Diseases .............................................................................................. 23 Reportable Diseases ................................................................................................................... 24 Infection Control .............................................................................................................................. 25 General Hygiene ......................................................................................................................... 25 Sanitizers .................................................................................................................................... 25 Laundry ....................................................................................................................................... 26 Cleaning Supplies ....................................................................................................................... 26 Cleaning Schedule ...................................................................................................................... 26 Hand Washing .................................................................................................................................. 28 Hand Washing Supplies .............................................................................................................. 28 Hand Washing Steps .................................................................................................................. 29 Appropriate Hand Washing Times ............................................................................................. 29
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page ii
Diapering .......................................................................................................................................... 31 Diapers ........................................................................................................................................ 31 Diapering Supplies and Equipment ............................................................................................. 31 Diapering Steps .......................................................................................................................... 32 Contact With Body Fluids ............................................................................................................... 34 Blood Contact or Exposure ......................................................................................................... 35 Environmental Health...................................................................................................................... 36 Lead ............................................................................................................................................ 36 Air Pollution ................................................................................................................................. 37 Pesticides ................................................................................................................................... 37 Safe Water .................................................................................................................................. 37 On-Site Sewage System (Septic System) ................................................................................. 38 Pet Health ......................................................................................................................................... 39 Pets In Our Classrooms .............................................................................................................. 39 Pet Guidelines ............................................................................................................................. 39 Medication Management ................................................................................................................. 40 Medication Management Guidelines ........................................................................................... 40 Six "Rights" of Medication Administration ................................................................................... 41 Parent/Guardian Written Permission........................................................................................... 41 Container Labels ......................................................................................................................... 42 Medication Storage ..................................................................................................................... 42 Medication Documentation Guidelines ....................................................................................... 43 Food Service .................................................................................................................................... 44 Parent-Provided Meal Service ................................................................................................... 44 Caterers ...................................................................................................................................... 45 Food Service Activities ................................................................................................................ 45 Dishwashing ................................................................................................................................ 45 Nutrition............................................................................................................................................ 46 Helping Children Develop Healthy Attitudes About Food ............................................................ 46 Food Safety ................................................................................................................................. 47 Infant Feeding .................................................................................................................................. 48 Bottle and Infant Food Storage ................................................................................................... 48 Bottle and Infant Food Preparation ............................................................................................. 48 Infant Food .................................................................................................................................. 49 Feeding Infants ........................................................................................................................... 49 Supporting Breastfeeding Mothers and Infants........................................................................... 50 Safe Infant Sleep.............................................................................................................................. 52 Sleep Position ............................................................................................................................. 52 Sleeping Environment ................................................................................................................. 52 Child Abuse and Neglect ................................................................................................................ 54 Staff Training ............................................................................................................................... 54 Recognizing Abuse and Neglect ................................................................................................. 54 Immediate Interventions .............................................................................................................. 56 Accusations of Abuse Made Against Program Staff .................................................................... 57 Oral Health ....................................................................................................................................... 58 General Guidelines for Promoting Oral Health ........................................................................... 58 Mouth Care ................................................................................................................................. 58 Weather Safety................................................................................................................................. 60 Sun Safety .................................................................................................................................. 60 Amount of Time Children and Adults Spend in the Sun .............................................................. 60 Appropriate Clothing for Children and Adults .............................................................................. 60 Sunscreen/Sunblock Creams and Lotions ................................................................................. 61 Sunglasses ................................................................................................................................. 61 Physical Activity .............................................................................................................................. 62
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page iii
Playgrounds ..................................................................................................................................... 63 Transportation Guidelines .............................................................................................................. 64 Vehicles ...................................................................................................................................... 64 Drivers ........................................................................................................................................ 65 Transportation Guidelines .......................................................................................................... 65 Field Trips ................................................................................................................................... 66 Children With Special Health Care Needs ..................................................................................... 68 Developing a Care Plan .............................................................................................................. 68 Gathering Information ................................................................................................................. 68 Agreements ................................................................................................................................. 68 Staff Health....................................................................................................................................... 70 Infectious Disease Risks ............................................................................................................. 70 Musculoskeletal Injuries .............................................................................................................. 71 Falls ............................................................................................................................................ 71 Environmental Hazards ............................................................................................................... 72 Stress in the Child Care Environment ......................................................................................... 72 Health Care ................................................................................................................................. 73 Review and Signature Page............................................................................................................ 74 Early Childhood Resources............................................................................................................ 75 Toolkit ............................................................................................................................................... 77
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page iv
The Arizona Health and Safety Policy Manual for Child Care Centers has been prepared for you...child care program staff. While rules, regulations, and resource documents provide standards for programs, developing policies to meet those standards is left to individual child care programs. Uncertainty about what should be included in health and safety policies discourages child care staff from preparing policy documents for their centers. The Arizona Health and Safety Policy Manual for Child Care Centers contains policies, forms, and parent materials to help child care centers promote health and safety in their programs. Arizona Health and Safety Policy Manual for Child Care Centers is designed as a simple, easy to use supplement to Arizona Child Care Licensure Regulations. The "fill-in-the-blank" format of the Arizona Health and Safety Policy Manual for Child Care Centers makes it easy for programs to develop their own policy manual. A Toolkit section, at the back of the manual, contains forms and links to materials that match pertinent policies. The Arizona Health and Safety Policy Manual for Child Care Centers has been reviewed for consistency with Arizona Department of Health Services Child Care Licensure Rules and Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs. The Arizona Health and Safety Policy Manual for Child Care Centers was prepared by Arizona Child Care Health Consultants and the State School Readiness Board. Child Care Health Consultants are valuable resources for assisting with the development of health and safety policies but are not yet widely available in Arizona. Governor Janet Napolitano, through the efforts of the State School Readiness Board, is working to create a system of child care health consultants across the state. These nurses and health professionals are available to provide consultation, training and technical assistance to programs in matters of health and safety. Thank you for partnering with us so that all children in Arizona are safe, healthy and ready to succeed!
Nadine Mathis Basha Chair, State School Readiness Board
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page v
State School Readiness Board, Governor 's Office of Children, Youth and Families gratefully acknowledges the organizations and individuals who made this manual possible
for generous financial support with additional funding through a grant from the U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, State Maternal and Child Health Early Childhood Comprehensive Systems (SECCS) Grant Program and the U.S. Department of Health and Human Services, Administration for Children and Families, Child Care Bureau, Healthy Child Care America Program
We would like to thank Arizona Child Care Health Consultants Kathleen M. Ford, RN, BC and Karen H. Liberante, RN, BC for their contributions to this manual.
The nationwide effort by the U.S. Department of Health and Human Services, Health Resources and Services Administration; the U.S. Department of Health and Human Services, Maternal and Child Health Bureau; and the National Training Institute for Child Care Health Consultants to ready health and early childhood professionals to provide information on health and safety issues has led to a proliferation of information on child care health and safety. Information and guidelines from these organizations, as well as Arizona's own experience and written works, have informed the writing of this manual.
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page vi
How to Use This Manual
Arizona Health and Safety Policy Manual for Child Care Centers is intended for use by child care centers that already meet the criteria established for child care facilities licensure according to the Arizona Administrative Code, Title 9, Chapter Five. This manual does not include a restatement of these criteria. In areas where health, early childhood education, and caregiving have progressed more rapidly than the rule-making process, we suggest policies and procedures for the care of young children that are more comprehensive than the criteria stated in the Arizona Administrative Code. For example, in 1995, the American Academy of Pediatrics issued a recommendation to place infants on their backs for sleep. Changes resulting from this recommendation have reduced the occurrence of Sudden Infant Death Syndrome (SIDS, also known as crib death) cases among U.S. children by half. However, back sleeping is not yet reflected in Arizona's child care facilities licensure criteria. Please note that some conventions have been put into place for the ease of both the writers and the readers: The term "health care provider" refers to many types of health professionals that provide services for children, including those making medical diagnoses and recommending treatment. "Health care provider" includes pediatricians, medical specialists, family practice physicians, nurse practitioners, and physician's assistants. We use "parents" to refer to the adults legally responsible for the care and supervision of the child. We recognize that many children are in the care of foster parents, grandparents, other family members, etc. The Computer icon directs you to forms or documents mentioned in the text or to additional resources. If you are using the portable document format (PDF) version of this manual, links can be activated by clicking on URL. You will need Adobe Reader to view most of the forms and resources referenced in this manual. Get a free version of Adobe Acrobat Reader at: http://www.adobe.com/products/acrobat/readstep2_allversions.html
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 1
Getting Started
1. Fill in the blanks to make the manual useful for daily operations, staff orientation and training, and for quick action in emergencies. Complete blank spaces with the information requested. For example, if the information needed is "responsible person," this may be a name, but more likely will be a staff position, such as Director, Lead Teacher or Cook. 2. Review the manual. Determine which policies apply to your program. Make a list of supplies required and tasks to be completed before policies are put into place. 3. Tasks in numbered lists need to be completed in the specified order. 4. Discuss policy changes with staff and parents. Ask staff and parents to support your desire to provide quality care for children. 5. Documents such as the Statement of Services required by the Arizona Department of Health Services and your Parent Handbook may need to be updated to reflect new policies. 6. See the Resources and Toolkit sections in the back of the manual. The Resources section lists agencies, organization, and websites that may provide helpful information. The Toolkit section contains forms and links to materials your center can use to implement suggested policies. 7. Check the website at: http://www.governor.state.az.us/cyf/school_readiness/ childcare_manual.html for updates to policies, forms, and materials, and for new information about efforts in Arizona to improve the quality of early childhood education programs in our state. 8. Review policies for needed revisions every six months. Document your review on the Review and Signature Page (pg. 74).
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 2
Emergency Contacts
Our program's name is _________________________________________________. The address is _______________________________________________________. The nearest major cross streets are ______________________________________. Special instructions for finding facility _____________________________________. Our phone number is _______________________. Give: 1. 2. 3. 4. 5. The nature of the emergency Address where you need help Age of the victim Condition of the victim (e.g.; conscious? breathing? bleeding?) Your name
Do NOT hang up until the emergency operator or rescuers tell you to do so. Have a copy of the Emergency Information and Immunization Record Card ready for emergency personnel. Important Numbers: Child Care Licensure: Child Protective Services: Fire: Hospital: Local Health Department: Poison Center: Police: Rape Crisis Center: Suicide Prevention Hotline: Woman's Shelter: Other: AHCCCS 1-800-334-5283 KidsCare 1-877-764-5437
If Emergency Medical Services are activated, notify your licensing or certification agency within 24 hours.
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 3
Emergency Procedures
Serious Medical Emergencies Serious medical emergencies include those in which a person is at risk of permanent injury or death, is unconscious or becoming increasingly less responsive, can't breathe, has complications after a blow to the head, and those in which a person's condition seems to be getting rapidly worse, or any other condition which cannot be managed with first aid procedures. Serious medical emergencies need immediate attention. 1. In the event of a serious medical emergency involving a child or adult, a staff member stays with the victim and, if necessary, provides first aid. 2. The designated staff person contacts the Emergency Medical System and � � � describes the situation gives the physical location of the emergency gives the center's phone number and stays on the line until told to hang up
3. ____________________ (designated staff) contacts the parent or, if the parent cannot be reached, the child's emergency contact person. 4. Emergency transportation for necessary medical care is determined by the emergency response team and/or parent. A staff member follows the child to the hospital and remains with the child until the parent(s) arrive. 5. ____________________ (designated staff) completes an injury/ illness report form as soon after the incident as possible. 6. The incident report is signed by the parent. A copy of the incident report is given to parent and a copy is kept on file at the center. Incident reports are kept ____________________ (location, e. g., child's file, injury accident logbook). 7. Incident reports are reviewed at least semiannually by ____________________
(designated staff).
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 4
First Aid
First Aid Staff When children are in our care, staff with current training in age-appropriate CPR and first aid training are always on site. We encourage all staff to be CPR and first aid certified. Staff trained in first aid and CPR accompany children on field trips and while children are being transported. Staff treat an illness or injury as described in our first aid manual: ________________________________________________________________
(name of manual, e.g.; American Red Cross First Aid Manual)
An injury or illness and treatment is documented by _______________________ (designated staff) in _____________________________
(e.g.; Ouch Report, log book)
First Aid Kits ____________________ (designated staff) is responsible for assuring our first aid kit(s) are fully stocked.
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 5
Contents of the First Aid Kit a) b) c) d) e) f) g) h) i) j) k) l) m) n) o) p) q) r) s) t) Disposable, nonporous gloves (latex or vinyl) Scissors Antiseptic solutions or wipes, liquid soap Adhesive strip bandages in assorted sizes Bandage tape (adhesive tape) Sterile gauze pads Plastic bags (at least 1 gallon-size) for gauze, and other materials used in handling bloody items Sterile flexible roller gauze Triangular bandages and elastic bandages (AceTM type or similar product) Eye dressing Pen/pencil and note pad Cold pack Current first aid guide Coins for use in a pay phone Water Small plastic or metal splints Safety pins A non-glass thermometer Tweezers List of emergency phone numbers, parents' home and work phone numbers, and the Poison Control Center phone number Bolded items are required by Arizona Child Care Center Rules. First aid kit(s) is/are kept ________________________________________(locations). A fully-stocked first aid kit is located in each program vehicle that transports children and a fully-stocked kit is taken on all field trips. Updating the Emergency Plan The names of all individuals certified for CPR and first aid, and the location of all first aid kits, are included our program's Emergency Plan located ____________________
The Emergency Plan is updated yearly by ____________________ (designated staff).
Recommended Accident, Evacuation and Emergency Plan http://www.azdhs.gov/als/childcare/ccc_forms/emergency.pdf Safety Information Flipchart http://www.azdhs.gov/phs/owch/pdf/safety.pdf
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 6
We are prepared for both natural and man-caused emergencies. In Arizona, thunderstorms, flooding, overturned trucks, leaking railcars, or other dangerous situations may require us to remain in the building until authorities advise us that it is safe to leave or we are directed to evacuate. If we are advised to Shelter-in-Place, everyone must remain in the building until authorities advise us it is safe to leave or evacuate. This is a precaution intended to keep everyone safe. 1. In the event this program is instructed by local authorities to Shelter-in-Place, children and adults, including visitors, will go to ____________________ (room or rooms), taking any cellular telephones with them. � � � � In a weather emergency we will shelter in ground floor rooms. In a chemical event emergency, we will shelter in top floor rooms. We will choose interior rooms, with no windows or few windows, if available. We will select rooms with a telephone and toilet, if possible.
2. ____________________ (designated staff) will bring the program's Disaster Supply Kit and Emergency Information and Immunization Record Cards into the shelter room(s). 3. ____________________ (designated staff) will close and lock all windows, exterior doors, and any other openings to the outside. If told there is danger of explosion, window shades, blinds, or curtains will also be closed. Also, if directed to do so by authorities ____________________ (designated staff) will: � � Turn off all fans, heating and air conditioning systems. Use duct tape and plastic sheeting (heavier than food wrap) to seal all cracks around doors and any vents into the room(s).
4. ____________________ (designated staff) will place signs that say, "Sheltering-inPlace" in windows and on outside doors. 5. ____________________ (designated staff) will write down the names of everyone in the room and answer telephone inquiries from parents and authorities. 6. ____________________ (designated staff) is responsible for assuring our Disaster Supply Kit(s) is fully stocked and for rotating and replacing perishable supplies including food, water and batteries.
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 7
Contents of the Disaster Supply Kit Items for our Disaster Kit are selected to meet the needs of our location, the ages of the children in our program and their specific needs. We stock 3 days of supplies for the maximum number of children and adults who might be present. Contents of the Disaster Supply Kit will include: � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Copies of Emergency Information and Immunization Record Cards for children and emergency information for adults Radio and extra batteries Flashlights and extra batteries Water (3 day supply) for drinking and sanitary needs Food (3 day supply, non-perishable) Manual can openers and items to open food containers Plastic/paper kitchen supplies Plastic garbage bags, large and medium size Paper towels Bleach Cleaner/sanitizer (LysolTM or similar products) Soap Toilet paper Sanitary pads/tampons Hand sanitizer or moist hand wipes Lighter or matches Non-porous gloves (latex or vinyl) Pencils, pens, tape, paper Money (include small bills and coins) Hand tools (hammer, pliers, wrench, Phillips head and straight blade screwdriver) Duct tape Waxed paper, aluminum foil Books and games Diapers if needed (3 day supply) Bucket (a bucket with a trash can liner can serve as a toilet in an emergency) ____________________ (other item specific to your program) ____________________ (other item specific to your program) ____________________ (other item specific to your program) ____________________ (other item specific to your program)
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 8
Emergency Evacuation Drills
There are a variety of emergency situations that require staff to relocate the children or remove them from harm's way. Our emergency evacuation plan can be found ____________________ (where). We practice this plan ____________________ (how often). Our practice includes: � � Evacuations to a safe place outside the building in the event of an emergency such as a fire or chemical hazard. Shelter-in-Place procedures, which contain the staff and children within the building, and proceeding according to directions from emergency personnel. Sounding an alert, by pre-arranged code, to persons within the building to avoid certain areas (such as the front lobby), in a situation where an immediate danger, such as the presence of an aggressive intruder (i.e., making verbal threats, has a weapon) is present. Identifying the location of telephones and/or securing immediate access to a cell phone that is adequately charged. Posting accurate maps of the premises showing the locations of exit doors, hallways, closets, windows, etc. Picking up and bringing along the crate/box containing the shoes of any napping children. Ensuring Emergency Information and Immunization Record Cards for each child are evacuated with the children. Ensuring an Evacuation Packet is evacuated with the children. The Evacuation Packet includes a facility map, and photos of each room, bathroom, hallway and storage area, etc., showing the locations of windows, furniture, equipment and doorways. Evacuation Packets should also include diapers, formula, bottles of drinking water, and emergency phone numbers. The Evacuation Packet is located ____________________ (where).
� � � � �
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 9
Emergency drills are held on a routine basis, but are not formally scheduled. During the emergency drills staff proceed as though a real emergency were occurring. The goal of Emergency Drills is to evacuate people from the building to a designated safe place within 2 minutes. An emergency fire drill that takes place at nap time is conducted at least annually. This drill may necessitate a notice to parents, as children may be tired, cranky or frightened after the experience. It is vital that staff know what to do, as children are most likely to be frightened and uncooperative in an emergency situation.
Fire Drill and Smoke Detector Battery Check Log http://www.azdhs.gov/als/forms/ccgh5.pdf
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 10
Child Care Health Consultant
Our program utilizes the services of a Child Care Health Consultant (CCHC) or Child Care Nurse Consultant (CCNC). This person is a health or early childhood professional with special training in promoting health and safety in child care programs. The health consultant assists our program in developing care plans for children with special health care needs, creating health and safety policies that protect the health and safety of children and staff, reviewing children's immunization and health records, and in a variety of other ways. The health consultant is available to us for on site visits and by telephone. Our Consultant also assists us by providing health and safety-related staff trainings, and linking staff and families with community health resources. The name of our Consultant is _____________________________ (name and credential). Our Consult is affiliated with ____________________________________ (organization). Our Consultant's phone number is _________________________.
"Health Consultants and Trainers", Journal of the National Association for the Education of Young Children http://www.journal.naeyc.org/btj/200403/consultants.asp
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 11
Staff Orientation and Training
Orientation New staff who come to work for our program complete an orientation on critical health and safety issues before they work with children. Orientation of new staff is overseen by ____________________ (designated staff). New staff orientation always includes basic information related to: Topic
Bloodborne pathogens
Includes These Basics
Recognizing risks Cleaning body fluid spills Hepatitis B vaccine Infectious disease Body mechanics and injury prevention Exposure to toxins Stress reduction Recognizing and reporting abuse/neglect Caring for abused/neglected children Documentation Arrival health check Taking a temperature Exclusion guidelines Reportable diseases Required documentation How to give/routes of administration Hand washing Diapering procedures Room tasks Cleaning schedules Safe playgrounds Indoor safety Drowning prevention Safe storage of toxic materials Back sleeping position Tummy time Bedding issues Crib maintenance Non-responsive infant Hand washing Handling food service items Sanitizing food preparation/eating surfaces Infant formula preparation Outdoor play schedules Shade Use of sunscreen Appropriate clothing
Include orientation to the facility's Exposure Control Plan
Caregiver health
Child abuse and neglect
Communicable disease
Medication management Hygiene and sanitation
Injury prevention
Drowning prevention for programs with pools or swimming activities For infant caregivers and all staff and volunteers who may be assigned to the infant room
Safe infant sleep
Sanitary food service
Sun safety
Sun protection for children and staff
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 12
Ongoing Staff Training Our staff receive ongoing training related to health and safety through educational sessions provided by our program, training sessions with guest speakers, community college and university course work, and attendance at workshops and conferences. A minimum of 25% of staff training hours are in the areas of health and safety including the subject areas below: Topic
Bloodborne pathogens Caregiver health
Includes These Basics
Recognizing risks Cleaning body fluid spills Hepatitis B vaccine Infectious disease Body mechanics and injury prevention Exposure to toxins Stress reduction Recognizing and reporting abuse/neglect Caring for abused/neglected children Documentation Brain research Developmental screening Signs and symptoms Exclusion guidelines Reportable diseases Hand washing Diapering procedures Immunizations Emergency preparedness Shelter-in-place Evacuation Fire extinguisher Weather emergencies Americans With Disabilities Act How to create a plan of care How to adapt activities Clean air Toxic exposure prevention Waste disposal Noise reduction Safe playgrounds Indoor safety Drowning prevention Safe storage of toxic materials How to refer families for services Who may qualify Importance of well-child visits Required documentation How to give/routes of administration Precautions Healthy food Healthy eating behavior
How Often Comment
Annually Give updates to the facility's Exposure Control Plan
Child abuse and neglect Child growth and development Communicable disease
Every 2 years Every 2 years Annually
Enrolling children with special health care needs Environmental health
Every 2 years
Does NOT include training for care of specific child or condition
Every 2 years
Injury prevention
Drowning prevention for programs with pools or swimming activities Keep appropriate application forms on site
Medical Home, KidsCare, AHCCCS Medication management Nutrition
Every 2 years
Every 2 years
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 13
Oral health Safe infant sleep
Includes These Basics
Tooth/mouth care Referring to oral health professionals Back sleeping position Tummy time Bedding issues Crib maintenance Non-responsive infant Hand washing Handling food service items Sanitizing food preparation/eating surfaces Outdoor play schedules Shade Use of sunscreen Appropriate clothing Restraints Vehicle management Documentation Safe driving habits Transporting children with special needs
How Often Comment
Every 2 years Annually For infant caregivers and all staff and volunteers who may be assigned to the infant room Include infant food/bottle service if appropriate Sun protection for children and staff
Sanitary food service Sun safety
Transportation safety
Content will depend on responsibilities
Training Requirements Annual, minimum training requirements for child care center staff are specified in the Arizona Child Care Rules and Regulations. ____________________ (designated staff) is responsible for assuring that all staff members meet these minimum requirements. Professional Recognition We encourage staff to participate in the Statewide Child Care and Early Education Development System (S*CCEEDS), a registry for child care and early education professionals. Whenever possible, we utilize trainers who are registered with the S*CCEEDS system. We also encourage staff to affiliate with local, state and national child care organizations, such as affiliates of the National Association for the Education of Young Children (NAEYC), National Early Childhood Program Accreditation Commission (NECPA), Association for Christian Schools International (ACSI), Association Montessori Internationale, American Montessori Society, and National Accreditation Commission for Early Care and Education. These organizations are a source of up-to-date information and professional support. They also hold workshops and conferences that can help satisfy the need for annual training.
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 14
Enrolling Children for Care
Our program works collaboratively with parents to promote the health of children. When a child enrolls in our facility, we ask for information regarding the child's health. Our program ____________________ (does or does not) ask for documentation of a health care provider's physical examination of the child within the last six months. During scheduled parent conferences, which take place ____________________ (how often), we update the child's health information kept in our files, including information about developmental screenings and blood lead testing. We also discuss health-related staff observations and parents' goals related to their child's health. The Emergency Information and Immunization Record Card (EIIRC) At enrollment, the Emergency, Information and Immunization Record (EIIRC) card is completed, dated and signed by the parent. This card is often referred to as the "blue card" because, traditionally, this form is on blue paper for easy identification of the original containing signatures. The Emergency Information and Immunization Record Card (EIIRC) includes basic information regarding the child's legal name, address, telephone numbers, birth date and parental custody status, as well as current information regarding the child's general health, emergency contact names and phone numbers, names of health care provider(s), and a copy of the child's immunization record. Every copy of the Emergency Information and Immunization Record Card (EIIRC) must have a copy of the child's immunization record(s) attached. Our Emergency Information and Immunization Record Cards (EIIRC) are filed in a three-ring notebook or a small file that is light and portable. The Emergency Information and Immunization Record Cards are to be evacuated with the staff and children during emergencies. We ask parents to review and update the Emergency Information and Immunization Record Cards every three months in order to capture changes in phone numbers, family information and updated immunizations. ____________________ (designated staff) is responsible for this process. Confidentiality Files containing information about daily activities, parental notifications, illness, injuries, or observations about a child are kept on-site, and are accessible to authorized staff. Confidential records are maintained in a locked, restricted filing system accessible to ____________________ (designated staff).
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 15
HIPAA The Health Insurance Portability and Accountability Act (HIPAA) of 2002 has added increased protection of health records. Our program cannot directly call a child's health care provider to request information about the child's health status or recent visits. If we need information from the health care provider, we will ask parents to obtain the information for us. This includes immunization records, treatment information and medication requests, when needed. Parents may choose to sign a waiver that allows our program to speak directly with the child's health care provider. We may ask that this notice of waiver be placed on the medical chart kept by the child's health care provider. While our program respects the privacy of a child's health information, we are required by law to disclose medical information for public health activities such as the investigation or reporting of communicable diseases, or reporting suspected child abuse and neglect. We may also be required to disclose information to law enforcement officers, Child Protective Services, Arizona Department of Health Services Office of Child Care Licensure staff or a coroner. Statement of Services We provide a written Statement of Services to parents at the time of enrollment. Some of our health and safety procedures are found in the Statement of Services including: � � � � � � � � � � � � � � � A description of the facility's child care service classifications Hours of operation Child enrollment and disenrollment procedures Charges, fees, and payment requirements for child care services Child admission and release requirements Discipline guidelines and methods Transportation procedures Field trip requirements and procedures Responsibilities and participation of parents in facility activities A description of all activities and programs Liability insurance carried by the licensee Medication administration procedures Emergency medical procedures A notice stating inspection reports are available upon request A provision stating that the facility is regulated by the Arizona Department of Health Services, including the Department's address and telephone number
Emergency Information and Immunization Record Card (English) http://www.azdhs.gov/als/forms/ccgh11.pdf Emergency Information and Immunization Record Card (Spanish) http://www.azdhs.gov/als/forms/ccgh12.pdf
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 16
Health Care for Kids
Assuring Children Have Health Care Our program believes that children's health care needs are best met by an ongoing relationship with a health care provider who is able to monitor the child's growth and development, provide routine preventive care (such as immunizations), and offer counseling to parents on health, psychological, and behavioral issues. The family also needs to be able to obtain care for a sick child and be referred to appropriate specialists when needed. When uninsured children enroll in our program ____________________ (designated staff) will provide parents with information related to programs which may link the family with health care services. Each time the Emergency Information and Immunization Record Card (EIIRC) is updated we will ask about the child's current source of primary care and offer health program information. KidsCare KidsCare is Arizona's health insurance for low-income children. Children age 18 and younger who qualify can get medical, dental and vision services. To qualify a child must be age 18 or younger, a resident of Arizona (either a U.S. citizen or a qualified eligible immigrant--regardless of the immigration status of the parents), not currently covered by other health insurance, and meet income guidelines. KidsCare is administered by the Arizona Health Care Cost Containment System (AHCCCS). AHCCCS The Arizona Health Care Cost Containment System (AHCCCS) is Arizona's Medicaid program. AHCCCS was created to provide health care to those who cannot afford to pay for health insurance. There are eligibility/income requirements that applicants must meet in order to qualify for AHCCCS. Applicants must be residents of Arizona (either U.S. citizens or qualified eligible immigrants), not currently covered by other health insurance, and meet income guidelines. Medical Home Project The Arizona Medical Home Project offers primary health care services to children from low-income families who have no other source of care. The Medical Home Project does not provide emergency care or care for chronic conditions. School nurses (and in some locations county public health nurses) assist families whose children need pediatric, dental or vision care with the application process. County Health Department Well Child Services Many county health departments provide well child check-ups. County health departments can tell you about services that are available to children.
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 17
Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Well child visits to a health care provider for assessments and screenings are important from infancy. Although every child is unique, there is a typical pattern of growth and development for each age. This pattern can be altered by heredity, disease, living conditions or injury. The effects of developmental delays or health conditions can often be minimized if recognized and treated early. Well child check-ups for children covered by KidsCare or AHCCCS are standardized. That means visits take place at certain ages and that specific screenings and tests can be anticipated. This schedule is referred to as Early and Periodic Screening, Diagnostic and Treatment or EPSDT. Although there is a link between Medicaid (AHCCCS) insurance coverage and EPSDT, the screening criteria serves as a desirable framework for health assessments by any health care provider for any child during the early years of growth and development. The EPSDT Visit Schedule includes visits at these ages:
� � � � � � � At birth 3-4 days By first month Two months Four months Six months Twelve months � � � � � � � Eighteen months Two years Three years Four years Five years Six years Every two years thereafter, throughout childhood and adolescence
EPSDT and other medically necessary services may be provided by physicians, dentists, nurse practitioners, psychologists, audiologists, etc, as well as other certified or licensed professionals recognized by the State of Arizona. Educating Parents About Routine Check-Ups When we update children's immunization records, we ask about current health insurance coverage and recent visits to the health care provider. Information about recent visits and insurance coverage is recorded on our Medical Home Planning Guide by ____________________ (designated staff). We take the time to talk with parents about the importance of routine check-ups and follow-up health care. If staff members notice changes in a child's health or that developmental milestones are not being achieved, they report their observations to ____________________ (designated staff). Parents are then encouraged to seek health care for their child.
Authorization for Release of Health Information (English and Spanish) http://www.governor.state.az.us/cyf/school_readiness/manual/FORM_Auth_Release_Health_ Information_BOTH.pdf Medical Home Planning Guide http://www.governor.state.az.us/cyf/school_readiness/manual/FORM_Medical_Home_ Planning_Guide.pdf
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 18
Immunization Requirements Young children are at risk of contracting many serious diseases because of their immature immune systems. Immunizations help a child's immune system fight off diseases when the child is exposed to germs. Children enrolled in our program must have a verifiable record of up-to-date immunizations.
All children enrolled in our child care program must have written documentation of their current immunization status on file at the site. Adults who work or volunteer at our program must have documentation of their immunization history as a part of their employment record. All immunizations are monitored by ____________________ (designated staff). If a child has not received immunizations due to medical or religious reasons, a written exemption affidavit must be placed in our files. Medical exemptions are signed by a health care provider and parent. Religious exemptions must include a statement of the religious belief and must be signed by the parent on behalf of the child. We review the immunization records for children under the age of two on a quarterly basis, until the child's immunizations requirements are complete. We review the immunization records of children ages two and older annually, or until the immunization requirements are complete. When it is noted that children need immunizations, we notify parents in writing. If immunizations have not been received within 15 days, the child may not be accepted for care. The date the parent was notified of needed immunizations is recorded ____________________ (where). We never keep an original copy of a child's immunization record; this belongs to the parent. We make a photocopy of the immunization record and attach it to the Emergency Information and Immunization Record Card (EIIRC). Accurate documentation of Immunization information includes: Child's full name Birth date; month, day and year Vaccine given; i.e., MMR or DTaP, etc. Number of the dose given in the series; i.e., Dose 1 or Dose 5 Month, day and year of the immunization Health care provider or clinic name where immunizations were given
Immunizations are received in a series, meaning that it takes a period of time and a specific number of doses for immunity to be complete. Some vaccines are combined into one "shot" or injection. This reduces the need for many injections. Example; MMR is a three vaccine injection for measles, mumps and rubella.
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 19
Periodically, immunization requirements and schedules change. We frequently consult the state or local health department for the most current immunization schedule. All licensed and certified facilities/programs are audited once a year by the local (county) or state health department for immunization data, as required by the Centers for Disease Control and Prevention. This information is gathered nationwide and used to establish national vaccine needs and potential risk to vaccine preventable diseases in young children.
Recommended (but not required) Vaccines Although not required for attendance in child care centers (unless your child attends care in Maricopa County), hepatitis A vaccine is recommended for children. Hepatitis A is a viral infection of the liver that is easily spread in child care settings. Children may also spread the infection to their families. While most people who contract this disease recover, hepatitis A can cause many lost days from work, school and child care. Hepatitis A vaccine is included in the routine immunization series for children ages two and older. The hepatitis A vaccine is a two-dose series. Streptococcal pneumococcal conjugate vaccine (PCV7) is recommended for children beginning at age two months, and given as a four-dose series. This vaccine protects against a serious form of bacterial meningitis. PCV7 is included in the routine immunization series for children.
Emergency Information and Immunization Record Card (English) http://www.azdhs.gov/als/forms/ccgh11.pdf Emergency Information and Immunization Record Card (Spanish) http://www.azdhs.gov/als/forms/ccgh12.pdf Guide to the Requirements of the Arizona School Immunization Law for Parents of Children Entering School or Child Care (English) http://www.azdhs.gov/phs/immun/pdf/immun_req_eng_parents.pdf Guide to the Requirements of the Arizona School Immunization Law for Parents of Children Entering School or Child Care (Spanish) http://www.azdhs.gov/phs/immun/pdf/immun_req_spa_parents.pdf Recommended Adult Immunization Schedule http://www.cdc.gov/nip/recs/adult-schedule-bw.pdf Recommended Child and Adolescent Immunization Schedule (English and Spanish) http://www.cdc.gov/nip/recs/child-schedule-bw-print.pdf Referral Notice of Inadequate Immunization (English) http://www.azdhs.gov/als/forms/ccgh9.pdf Referral Notice of Inadequate Immunization (Spanish) http://www.governor.state.az.us/cyf/school_readiness/manual/FORM_referral_notice_ inadequate_immunize_SPA.pdf Request for Exemption to Immunization (English) http://www.azdhs.gov/als/forms/ccgh10.pdf Request for Exemption to Immunization (Spanish) http://www.governor.state.az.us/cyf/school_readiness/manual/FORM_request_exempt_ immunization_SPA.pdf Staff Immunization Record Card http://www.azdhs.gov/als/childcare/ccc_gh_forms/staff_immune.pdf
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 20
Guidelines for Excluding Sick Children and Staff
Arrival Health Check Each day when a child arrives at our program, ____________________ (designated staff) will greet the child and adult as the child is signed in. Before the adult leaves the premises, staff will determine if the child has signs or symptoms of a communicable disease, if the child has been well for the last 24 hours, and if there are visible, new injuries. Significant observations will be noted in the program's Illness and Injury Log by the staff member making the observations. If a child's temperature needs to be taken, or if discussion of the child's condition is needed, this will take place in the ____________________ (where) to respect the privacy of the child and adult. Signs and Symptoms for Exclusion Individuals arriving with the following signs and symptoms, or who develop them while at our program, cannot remain in the program.
Fever of 100� axillary (under the arm) if other signs and symptoms of illness are present (e.g. diarrhea, rash, earache, sore throat) Fever of 101� axillary (under the arm) or greater, even if no other signs and symptoms are present Sores that are open, infected, or not easily covered Vomiting more than twice in 24 hours* Diarrhea* Earache* Red eyes with discharge Lice or nits Red, draining eyes Lice or scabies Undiagnosed rash Not feeling well enough to participate in the day's activities Unusual mood or behavior that will make it difficult for staff to care for other children in the program
* Teething is NOT an acceptable explanation for these conditions. Exclude as
if teething were not taking place.
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 21
When A Child Becomes Sick During the Day If a child develops signs and symptoms of illness during the caregiving day, the child will be separated from the other children and be continually cared for in ____________________ (where). The parent will be contacted by ____________________ (designated staff) using the phone numbers listed on the Emergency Information and Immunization Record Card or other phone number provided for the day, and recorded ____________________
Parents are expected to pick up sick children within the hour to prevent the spread of infection to other children and staff, and to allow the child time to rest, recover, and be treated for the illness. Our program follows exclusion and return-to-care guidelines listed on the Arizona Department of Health Service's Communicable Disease Flipchart or as advised by the local health department. However, if program staff have concerns about a child's ability to remain in care or return to care, a note from the child's health care provider may be required. Illness and infestation is documented on our program's Illness and Infestation Log by ____________________ (designated staff).
Communicable Disease Flipchart http://www.azdhs.gov/phs/owch/pdf/commdiseases.pdf Is Your Child Well Enough to Be In Care Today? Poster http://www.governor.state.az.us/cyf/school_readiness/manual/FORM_stoplightposter_BOTH.pdf Log of Illness and Infestation http://www.azdhs.gov/als/childcare/ccc_forms/illness.pdf
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 22
Reporting Communicable Diseases
Arizona laws require our program to report when children or staff are diagnosed with specific communicable diseases. Additionally, Arizona law requires that we report outbreaks of some other infections. An "outbreak" is usually defined as more than three children in a group or 10% of the facility's population. In our program, ____________________ (designated staff) is responsible for making these reports to the local health department. Reports are made within 5 working days for most illnesses. Communicable Disease Reports, which are submitted by mail, are sent to _______________________________________________________ (mailing address). Reports may also be faxed to ____________________ (fax number). Some illnesses require a report be made by telephone. Telephone reports are called into ____________________ (phone number). Report Contents: 1. Name, address, and telephone number of the center and person making the report 2. Name of the illness being reported 3. Date and time of the onset of illness 4. Number of rooms affected 5. Number of children and adults who attend the program 6. Name, date of birth, age, address and telephone number of the sick person and whether this is a staff person or child 7. Immunization dates of individuals who are sick if the illness is a vaccine preventable disease
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 23
Reportable Diseases May be reported by telephone Campylobacteriosis Conjunctivitis (pinkeye) (outbreaks only) Cryptosporidiosis Diarrhea, nausea, or vomiting (outbreaks only) Escherichia coli O157:H7 Haemophilus influenzae type b: invasive disease Giardiasis Hepatitis A Measles Meningococcal Invasive Disease Mumps Pertussis (whooping cough) Rubella (German measles) Salmonellosis Scabies (outbreaks only) Shigellosis Streptococcal Group A infection (outbreaks only) Tuberculosis Varicella (chickenpox) We document all communicable disease reports we have made ____________________ (where).
Communicable Disease Report Form http://www.azdhs.gov/phs/oids/downloads/cdr_form.pdf Communicable Disease Reporting Requirements Statute http://www.governor.state.az.us/cyf/school_readiness/manual/FORM_disease_report_statute.pdf Communicable Disease Reporting Requirements for Schools, Child Care Establishments and Shelters http://www.azdhs.gov/phs/oids/pdf/admin_req.pdf Dear Parent and/or Health Care Provider Letter (English & Spanish) http://www.governor.state.az.us/cyf/school_readiness/manual/FORM_dear_parent_health_ provider_letter_BOTH.pdf
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 24
Infection Control
General Hygiene It is more pleasant for children and adults to work and play in a tidy facility. It is also easier to carry out cleaning and sanitizing tasks in a tidy facility. In our program, routine cleaning and sanitizing of surfaces is an important way of preventing the spread of communicable diseases.
Cleaning is a process of removing surface dirt, soil and grime from surfaces. This can includes tasks like sweeping or vacuuming, followed by washing with detergent and water and rinsing with clean water. Sanitizing reduces the number of disease-causing germs on surfaces. Sanitizing products, like dilute bleach solutions and quaternary ammonium compounds, are used on food utensils, pacifiers, and surfaces. Disinfecting is the act of killing most germs with very high heat or commercial germicidal agents.
For each cleaning and disinfection task, staff know who is responsible for doing the task, how often the task must be done, the procedure for doing the task, the supplies necessary to do the task and who is responsible for assuring needed supplies are restocked. Staff who are supervising children are not simultaneously assigned to cleaning and sanitizing tasks. ____________________ (designated staff) is responsible for ensuring needed supplies are restocked. Sanitizers In our program we use the products listed below. All bottles of cleaners and sanitizers are labeled with the contents and recipe. A Material Data Safety Sheet (MSDS) for these products is on file ____________________ (where). Recipes for using liquid chlorine bleach (5.25% sodium hypochlorite) Sanitizing Solutions Amount of Bleach Amount of Water Spray/Bucket Solutions 1 tablespoon 1 quart General cleaning and sanitizing 1/4 cup 1 gallon Soaking Solution 1 tablespoon 1 gallon
Dishes, mouthed toys. Soak for 2 minutes, air dry.
Diaper Area Solution*
* See link to guidelines, next page.
Recipe required by ADHS rules
1/2 cup
1 quart
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 25
____________________ (designated staff) is responsible for mixing bleach solutions each day
Quaternary Ammonium Compounds
Our program uses ____________________ (name of product). This product is appropriate for the surfaces on which it will be used and is used according to the manufacturer's label instructions, including dilution and contact time with surfaces.
Laundry Our program bags contaminated laundry where it became soiled. We do not carry unbagged, contaminated laundry across the facility to the laundry room. Soiled children's clothing will not be rinsed in the facility. Bulk stool or vomit may be dumped into a toilet. Clothing will be placed in a plastic bag, labeled with the child's name, and placed in a plastic-lined container reserved for this purpose. Soiled clothing will be sent home with the child. Our program washes laundry in hot water (165�F) for 20 minutes or adds 1 to 1 and 1/2 cups household bleach (5% sodium hypochlorite) to the washer, along with laundry detergent, in a regular wash cycle. Cleaning Supplies Paper towels, which are used in a single area and then discarded, are preferred for cleaning. Sponges harbor germs and should not be used. All brooms, dust pans, brushes and other items used for cleaning contaminated areas should be inaccessible to children. Mops should be rinsed after each use and hung above ground level to dry. Cleaning Schedule Development of a schedule, which can be posted as a reminder of responsibilities, will help to assure that facilities are cleaned and sanitized.
Cleaning, Disinfecting and Sanitizing Guidelines http://www.azdhs.gov/als/forms/ccgh1.pdf Selecting an Appropriate Sanitizer http://nrc.uchsc.edu/CFOC/HTMLVersion/Appendix_I.html
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 26
C = clean Area
S = sanitize C S How Often?
x x x x x x x Daily and when soiled Before and after food is served Weekly Mop daily Vacuum daily Launder weekly or when visibly soiled Vacuum daily Shampoo every 3 months or when visibly soiled, must be dry when children return Vacuum daily Shampoo monthly or when visibly soiled, must be dry when children return x Daily Weekly or when soiled Weekly, or when soiled and between use by different infants x x x Daily and when visibly soiled Weekly After use by an individual child May be sanitized in a dishwasher reaching at least 140 � F Weekly Weekly and when head lice or skin infection is identified in the room x x x x x Between use by groups Weekly or when visibly soiled Empty daily Before and after food activity; between preparing raw and cooked foods After each use; do not reuse single-use food service items Monthly or when visibly soiled
With What?
spray/bucket bleach solution spray/bucket bleach solution commerical floor cleaning product laundry detergent commercial carpet cleaning product commercial carpet cleaning product spray/bucket bleach solution laundry detergent spray/bucket bleach solution spray/bucket bleach solution spray/bucket bleach solution bleach soaking solution spray/bucket bleach solution laundry detergent spray/bucket bleach solution spray/bucket bleach solution spray/bucket bleach solution bleach soaking solution spray/bucket bleach solution spray/bucket bleach solution spray/bucket bleach solution spray/bucket bleach solution spray/bucket bleach solution spray/bucket bleach solution
Person Responsible
Child Care Areas
Countertops, tabletops, crib teething rails Cubbies Bare floors Small rugs Carpets and large area rugs (preschool rooms) Carpets and large area rugs (infant and toddler rooms) Nap pads or cots Napping sheets/blankets Cribs and crib mattresses Door and cabinet handles Telephone receivers Mouthed toys, pacifiers, food utensils Toys (not contaminated with body fluids) Dress-up clothes, stuffed toys Water tables Trash cans Food preparation and food service areas Eating utensils Refrigerator
x x x x x x
x x x x x x x
Toilet/Diapering Area
Handwashing sinks, faucets, x counter tops, soap dispensers, cabinet handles, floors Toilet seats, flush handles, door knobs, stall handles Toilet bowls/urinals Diaper changing surfaces Any surface contaminated with body fluids x x x x x Daily and when visibly soiled
x x x x
Daily and when visibly soiled Keep floors dry Daily Before and after each use Immediately
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 27
Hand Washing
Hand washing is a disease prevention practice that must be done correctly and at the appropriate time to be effective. To meet basic hygiene and sanitation standards, all children, staff, and volunteers in our program include hand washing during daily routines. We teach young children how and when to wash their hands. We regularly monitor and assist children with this activity. Children who are not able to wash their own hands have their hands washed at appropriate times by staff. Moistened towelettes or wipes are not used for routine hand washing. These disposable products are intended for use when access to a sink, liquid soap and running water is not possible, such as field trips, at the park, or in a vehicle. Alcohol-based hand sanitizers are not appropriate for children. We limit the use of alcohol-based hand sanitizers to adults. Alcohol-based hand sanitizers are kept in areas that are inaccessible to children. If children must use them, it is for situations where there is no visible soil on hands, where hand washing facilities are not available, and when an adult supervises the amount of product dispensed and rubs the child's hands together cleaning all areas. Hand washing sinks and the surrounding areas are cleaned and sanitized routinely to prevent cross contamination to children and adults from dirty water, soiled paper products, faucet handles, etc. Hand Washing Supplies
Warm, running water, with "mixit"-type faucets for temperature control Sinks that drain quickly and completely Sinks at the appropriate height for children to use safely Liquid handsoap, preferably anti-bacterial, in a wall-mounted or pump dispenser Single-use, disposable paper towels or commercial hand-drying blowers Plastic-lined, trash container for soiled paper towels
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 28
Hand Washing Steps 1. WET the hands with warm, running water. 2. APPLY LIQUID SOAP in a very small amount. 3. WASH the fronts, backs and in between the fingers using gentle pressure (friction) while rubbing the hands together. 4. RINSE all soap and soil from the hands with running water, allowing the used water to go down the drain. 5. DRY the hands completely with a disposable paper towel or commercial handblower dryer. It may take more than one paper towel to dry the hands. 6. Turn off the water with the used or a clean paper towel to prevent recontaminating the clean hands with germs and soil from the faucet handles. 7. Discard paper towels immediately into trash container. Do not use for anything else. Appropriate Hand Washing Times Adults 1. When first arriving at the program 2. Before and after giving First Aid, changing bandages or taking a temperature 3. Before and after preparing food activities, meals or snacks 4. Before and after giving medications or treatments 5. After using the toilet or assisting a child to use the toilet 6. After diapering a child 7. After prolonged coughing/sneezing episodes 8. After caring for or handling pets or their cages/enclosures 9. After tending to a sick child, adult or pet 10. After handling items soiled with body fluids such as blood, stool, urine, mucus, saliva, vomit or drainage from infected eyes, nose, sores, etc.
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 29
Children 1. When arriving at the program 2. Before eating meals or snacks 3. Before activities that can include fingers or items that can go into the mouth, such as clay, play dough, water table or food, etc. 4. After using the toilet or having a diaper changed 5. After playing with animals or pets 6. After prolonged coughing, sneezing, vomiting or wiping at the nose and mouth 7. After outdoor play, especially if before meals or nap time 8. After messy activities
Responsibilities Hand washing supplies are purchased by ____________________ (designated staff). ____________________ (designated staff) is responsible for restocking supplies in the sink areas.
Wash Your Hands! Poster http://www.governor.state.az.us/cyf/school_readiness/manual/FORM_washyourhands.pdf
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 30
Attention to sanitary diapering of infants helps prevent the spread of infectious diseases. Diapers In our program we routinely use disposable diapers provided by __________________
(parents or program).
If the parent supplies the diapers for the child, we label the package with the child's first and last name and store them within reach of the diapering area. If we provide diapers, parents complete a written permission statement allowing us to use the specific brand of diapers we have selected. We store them according to size, within easy reach of the diapering area. Disposable, moistened wipes must be stored in the original container to preserve moisture. Individual containers, brought by the parent/guardian must be labeled with the child's name. If we supply moistened wipes, parents complete a written permission statement allowing us to use the specific brand of wipes we have selected. We remove (with clean hands or freshly gloved hands) only the number of wipes that are needed for one diaper change at a time. Diapering supplies are not stored on the diapering surface. Over-the-counter diaper ointments must be purchased by the parent for the child and labeled with the child's name. If a prescription ointment (like Nystatin) is to be applied, a Medication Permission Form must be completed and signed by the parent. The ointment is labeled with the child's name, locked up and must be applied by the individual designated to give medications. We request extra sets of outer clothing for diapered children as clothing can be soiled by leaks from diapers or from spills of food or formula.
Diapering Supplies and Equipment
A diapering area must be located away from food preparation or art activity areas and be a non-absorbent, seamless, smooth and sturdy diapering surface. A sink for hand washing, with running water between 86�F and 110�F degrees, must be located adjacent to the diapering area and should not be shared with other groups or activities unrelated to diaper changing. Anti-bacterial, liquid handsoap from a dispenser, should be adjacent to the sink.
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 31
Single-use, disposable paper towels should be available for drying hands and as a paper barrier on the diapering surface, if needed. Disposable diapers, sized appropriately for the children in the group, should be within reach of the diapering area. At least 2 waterproof, sanitary containers with waterproof liners (plastic bags) and tight fitting lids; one container for soiled diapers and one container for soiled clothes should be available. Single-use, disposable latex or vinyl gloves should be available. Disposable, moistened wipes, with staff access to the storage container, selecting for one diaper change at a time, should be available. One spray bottle with mild soap and water mixture for cleaning should be available. One spray bottle with fresh 1:10 bleach and water mixture should be available for sanitizing. Self-closing, plastic bags for soiled outer clothing should be available. A change of clothing for each diapered child should be provided by the parent. Diapering Log, with current date, child's name, time-of-day, observations and caregiver's signature should be kept adjacent to the diapering area.
Diapering Steps We never leave a child unattended on the diapering surface. 1. Check supplies before bringing the child to the diapering surface. 2. Place the child on the diapering surface and remove outer clothing to the diaper. Note: if a child has visible stool, urine or blood on outer clothing, place a disposable paper towel or exam table paper on the diapering surface before starting the diapering steps. 3. Put on latex gloves and limit touching items not related to the diapering process. 4. Remove the soiled diaper. 5. Place the soiled diaper in a plastic-lined, soiled diaper container. 6. Remove any soiled clothing and place it in a self-closing, plastic bag. Label the bag with the child's name and placed it in a second, plastic-lined container.
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 32
7. Clean the child's bottom with a disposable wipe. Discard the wipe(s) in the soiled diaper container. At this time, discard any paper products placed between the child and the diapering surface for contamination protection. 8. Remove gloves at this time and discard with the soiled diaper. Take care to remove gloves by peeling them off the hands so they are inside out. NOTE: These gloves are considered contaminated at this point in the process. It is important to avoid contaminating the clean diaper and clean outer clothing. 9. With your clean, ungloved hands, put a clean diaper on the child then redress the child. 10. Wash child's hands, regardless of age, with anti-bacterial soap and running water. 11. Return the child to the activity area, crib or into the care of another adult. 12. Discard any unused or contaminated wipes, gloves, paper towels, etc., that have been placed on the diapering surface. 13. Clean and disinfect all contaminated surfaces. 14. Wash your hands with anti-bacterial soap and water. 15. On the Diapering Log, document the name of the child, current date, time-ofday and any observations of importance to the parent or other staff. Sign the Diapering Log.
Diaper Changing Log http://www.azdhs.gov/als/childcare/ccc_gh_forms/diaper.pdf Diaper Changing Procedure Chart http://www.azdhs.gov/als/childcare/ccc_gh_forms/diaper_chart.pdf
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 33
Contact With Body Fluids
Even healthy people can spread infection through direct contact with body fluids including blood, urine, stool (feces), drool (saliva), vomit, drainage from sores/rashes (pus), etc. In our program, staff act to prevent exposure to body fluids by:
Covering any open cuts or sores on children or staff with a bandage, gloves, or clothing. Wearing vinyl or latex gloves for tasks where blood or body fluids are present such as: -- Cleaning up vomit, stool, blood, urine, pus, and body fluids or other secretions -- Changing bandages, especially if blood, pus or signs of infection are present -- Cleansing or controlling bleeding wounds, or broken skin, such as nosebleeds, tooth loss, cuts, scrapes, etc. -- Changing diapers, especially with loose stools -- Handling linens, clothing, diapers, equipment or surfaces that have been soiled with blood, vomit, stool, urine or body fluids
Whenever a child or staff comes into contact with any body fluids, the area (hands, etc.) will be washed immediately with soap and warm water and dried with paper towels. All surfaces in contact with body fluids will be cleaned immediately with soap and water and disinfected with an agent such as bleach in the concentration used for disinfecting body fluids (� cup bleach/gallon of water or 1 tablespoon/quart). Used latex or vinyl gloves and cleaning material used to wipe up body fluids will be put in a plastic bag, closed with a tie, and placed in a covered waste container. Hands are always washed with soap and water after removing gloves. Any brushes, brooms, dustpans, mops, etc., used to clean up body fluids will be soaked in a disinfecting solution, and rinsed thoroughly. After soaking, cloth items and mops should be washed with hot water in a washing machine. All items are hung off the floor to dry completely. Cleaning equipment is stored safely out of children's reach.
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 34
Disposable diapers, diaper wipes, gloves, bandages, and paper towels, etc., used to clean contaminated areas, must be placed in a plastic bag and sealed before disposal in the general trash. All clothing soiled with body fluids must be changed. Children's clothes will be put in a closed, plastic bag and sent home with the child's parent. All clothing that has been soiled with urine, vomit, stool, blood or other body fluids will be placed into a separate plastic bag, labeled with the owner's name and placed in a lined, plastic container. Soiled clothing will not be placed in cubbies or diaper bags. Items to be laundered at the program will be bagged where they became soiled. Unbagged, contaminated laundry will not be carried across the facility to the laundry room. Wash contaminated laundry in hot water (165F) for 20 minutes. Add 1 - 1� cups household bleach (5% sodium hypochlorite) to the washer along with laundry detergent in a regular wash cycle. Automatic clothes dryers on hot settings assist in the germ killing process. Hands are always washed after handling soiled laundry or equipment or any other potential exposures to body fluids.
Blood Contact or Exposure When a staff person or child comes into contact with blood (e.g., staff provides first aid to a bleeding child) or is exposed to blood (e.g., blood from one person enters the cut or mucous membrane of another person), the staff person will inform _______________ (designated staff) immediately, and follow the procedure outlined in the center's Exposure Control Plan for referral medical care.
Keeping Safe When Touching Blood or Other Body Fluids, A Self-Learning Module For Early Education and Child Care Providers (includes a fill-in-the blank Exposure Control Plan) http://www.ecels-healthychildcarepa.org/content/Keeping%20Safe%20When%20Touching%20 Blood%20or%20Other%20Body%20Fluids%2012-04.pdf OSHA Bloodborne Pathogens Standard http://www.governor.state.az.us/cyf/school_readiness/manual/FORM_OSHA_bloodborne_ pathogen.pdf
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 35
Environmental Health
Because children are susceptible to environmental hazards known to be detrimental to human health, we act to protect them in these ways: Lead Lead is a highly toxic metal found in the environment, especially in paint and leadtainted soil. Lead does not break down over time. If our facility was built before 1978, we have had our facility examined by a certified professional to determine that lead is not present in our building. If our facility is near a busy road or highway, our soil has been tested for lead. Lead testing was completed by ________________________________ (professional) on __________________ (soil, paint, other) on this date __________________ (date). These recommendations were made: _______________________________________ ______________________________________________________________________ ______________________________________________________________________ Repairs were completed __________________ (date). We also do these things to reduce the risk of lead exposure in our facility:
If present, our vinyl mini-blinds are lead-free. We keep the child care facility clean. We dust regularly with a damp cloth and have a doormat outside each exterior door to reduce dust being tracked indoors. We vacuum floors daily and change the vacuum bag when it is two-thirds () full. Children wash their hands before eating and after playing outdoors. Mouthed toys are washed daily and between use by individual children. Children are served a diet rich in iron and calcium such as dark green vegetables and dairy products. We store food and liquids only in containers made of glass, plastic, or stainless steel, not in leaded crystal glassware, or imported or old pottery as these are likely to contain lead. We check all arts and crafts materials and toys for lead content. Arts and crafts materials made after 1990 state "conforms to ASTM-4236" and have no health warnings.
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 36
Air Pollution Pollution, including tobacco smoke, mold, carbon monoxide, ozone, particles from burning materials, chemical vapors, smoke, soot and dust particles in the air may be harmful to children who breath them. Pollution can cause burning eyes, a stuffy nose, and trouble breathing, including asthma episodes, in children and adults. We do these things:
Open windows and doors to provide fresh air from outside. Properly maintain our air filtering system. Vent the clothes dryer to the outside of the building. Have exhaust fans in bathrooms and kitchens. Promptly repair roof, pipe, and basement leaks. Maintain a tobacco smoke-free environment. Make sure art materials meet ASTM standards. Insure appropriate ventilation when using art materials. Check local media alerts for days when children should play indoors, such as days when there are ozone alerts.
Pesticides We limit the use of pesticides and herbicides in our program. We use non-chemical means of controlling pests and weeds. If it is necessary to use pesticides or herbicides they are applied by a licensed professional when children are not present. Material Safety Data Sheets (MSDS) for all chemicals used in pest control are kept on file __________________ (where). We wash all fruits and vegetables under running water before preparing and serving them to children. If our facility is located next to an area where spraying of pesticides and herbicides may occur (power lines, golf courses, agricultural areas), we have determined which products are used and how often in order to assess whether an hazardous situation may occur. Safe Water We follow the recommendations of the Arizona Department of Health Services and the local health department to ensure children in our care have safe water.
Our source of water is _______________________________ (name of supplier). If a private water supplier:
The water system owner/manager is _____________________________.
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 37
The water system owner/manager's phone number is __________________
(phone number).
Copies of water tests are obtained __________________ (how often) and kept __________________ (where).
In case of a water emergency, we provide drinking water by ________________
We obtain maintenance records on the water system every _________________ (how often) and keep them ____________________________________ (where).
On-Site Sewage System (Septic System) We follow the recommendations of the Arizona Department of Health Services and the local health department in the maintenance of our septic system.
Our system is pumped _____________________________________ (how often). The company who maintains our septic system is _________________________ The phone number of the company that maintains our septic system is __________________ (phone number). To help with the general maintenance of our septic system, we:
Do not flush strong chemicals such as drain cleaners, paint thinners or floor cleaners Keep cars and heavy equipment off the drain field Fix all leaks on faucets and toilets Reduce water usage Monitor for signs of failure such as foul odors inside or outside, gurgling sounds in the plumbing, sewage on the ground, backed-up sewage inside the building and slow draining fixtures
-- -- -- --
If our septic system fails, we notify the local health department and our licensing specialist.
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 38
Pet Health
Pets In Our Classrooms The decision to have pets in our classrooms is made with great care and approved by _______________ (designated staff). Pets of any kind require good care and their enclosures require cleaning. Some pets bite and scratch or are frightened of children. A new child in the classroom may have allergies that require the pet be removed from the facility. All these issues require consideration before we decide to have a pet in our facility. Parents will be notified if a new pet is planned for their child's classroom. Pet Guidelines
Animals are chosen carefully for temperament and safety. We do not keep or allow visits from ferrets, turtles, iguanas, lizards or other reptiles, birds of the parrot family, or any wild or dangerous animals. No live animals are allowed in food preparation areas. Pet enclosures are not placed near areas where children eat or food is served. Children and adults wash their hands after handling or feeding animals. Children do not clean cages. All animals are properly cared for and provided clean water, appropriate food, clean cages, and vaccinations. Food preparation/service facilities and supplies are not used to clean animal cages or aquariums. Animal food is stored separately from human food. Animal food is kept tightly closed to prevent insect infestations. Uneaten food is removed from cages promptly. We plan for the care of pets during holidays, weekends and vacations.
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 39
Medication Management
It is best if children receive medications at home. Many medications can be scheduled so children will not have to receive them while in care. However, at our program, the director, and designated staff are trained to safely administer medications and/or perform medication delivery treatments to children in our care. All instructions regarding dosage and administration route (amount, frequency, and how it goes into the body) for giving medications are followed carefully. We cannot administer a medication differently from the instructions on the medication's label without verifiable written instructions from the child's health care provider. This includes prescription and over-the-counter medications. In our facility the Director designated to administer medications or treatments is ______________________________________ (first and last name of designated staff). The facility staff members designated to administer medications or treatments are _____________________________________________________ (designated staff). Each day the name of the person responsible for giving medications is posted _______________________________ (where). Medication Management Guidelines
We have a current medication resource book, to help answer questions about medications or reactions : _______________________________ (name of book). The medication resource book is kept ____________________________ (where). A written permission form is on file, identifying the child and instructions for the medication or treatment to be given. We never administer the first dose of a medication to a child, even if the child has previously taken the medication. Medication is never transferred from its original container into another container. We do not stock medications for general use with enrolled children. All medication measures, applicators and treatment equipment are clean and sanitary for each use. All non-disposable medication measures, applicators and treatment equipment are labeled with the child's first and last name.
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 40
We return any unused medication to the parent when the date has expired or the medication is no longer being administered to the enrolled child. If a child absolutely refuses or spits out the medication, we document the time and name of the missed dose but do not re-dose. __________________ (designated staff) will notify the parent of the missed dose.
We always wash our hands before preparing to give medications or treatments. Six "Rights" of Medication Administration Staff who give medications always assure these "Rights:" � � � � � � The Right medication The Right dose The Right child The Right time The Right route The Right documentation
Parent/Guardian Written Permission A written medication consent (permit, authorization) is required for all non-prescription (also called over-the-counter) and prescription medications and/or treatments administered by staff. This written consent form includes, but is not limited to:
First and last name of the enrolled child Name of the medication and medication strength Dosage of the medication; how much and how often Method of administration, mouth, on the skin, drops in the eye, etc. Date the medication was prescribed; not more than two weeks old (Exceptions may be medications used infrequently for specific crisis intervention.) A diagnosis for the medication (why the medication is given) Prescription number and pharmacy name, if prescription medication Instructions, step-by-step, for specific treatments Parent/guardian printed name and signature Contact phone number for the parent in case of an emergency or for questions
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 41
Blank Medication Permission forms are kept _____________________ (where). Currently active medication/treatment permission forms are kept _____________________ (where). Past (completed) medication/treatment permission forms are kept _____________________ (where). Container Labels Both prescription and over-the-counter medication must come to our facility in their original containers. To be within legal guidelines, medications must be clearly identified by name and be within designated expiration dates. A medication container label must include:
Child's first and last name Date the medication was prescribed or recommended by the Health Care Provider, with expiration dates clearly marked Name of the medication and medication strength Method of administration, for example: by mouth, on the skin, in the eye, etc. Dosage of the medication, how much and how often Name of the health care provider who prescribed or recommended the medication Special considerations or information regarding the medication, i.e., give with food, do not crush, avoid direct sunlight, clean the wound first, etc. All prescription medications must have the name and phone number of the pharmacy clearly indicated. Use this number to clarify instructions or answer specific questions about the medication's use or adverse reactions.
Medication Storage All medications, non-prescription or prescription, must be stored out of reach of children and in a locked cabinet or container.
Medications requiring refrigeration are stored in a locked, leak-proof container placed on the bottom shelf of a designated refrigerator. Medications are not stored in the door of the refrigerator. Medications are not stored under dripping or uncooked foods. Should the packaging of a food item be damaged or leaking or if the food is uncooked, we move the medications to a shelf above the food item in order to avoid contamination of the medication.
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 42
Medications for staff are stored in a separate, locked container. The medication must be clearly labeled with the staff person's name and be in the original medicine containers. ( i.e., Tylenol, prescription bottles, eye drops, etc.) Any specialized treatment equipment (breathing machines, diabetes monitoring, etc.) must be labeled with the child's first and last names and be stored out of reach of children when not in use.
Refrigerated medications are stored __________________________________ (where). Non-refrigerated medications are kept ________________________________ (where). Specialized treatment equipment is kept _______________________________ (where). Medication Documentation Guidelines We document the administration of medications and treatments immediately when given in order to prevent errors. Documentation forms include a place for:
Child's first and last name Current date Name and prescription number (if any) of medication Time medication or treatment was given Dosage of medication (treatment) given Signature of the adult administering the medication or treatment. (Initials only are not acceptable, as they are not a clear identifier of the "giver.") Record any refusal, changes in behavior, or symptoms of a reaction and any actions taken after giving medication. Record the date a medication was stopped. Send unused or empty medication containers home with the parent or guardian.
In our program, administered medications and treatments are documented _________________________ (where).
Medication Consent Form http://www.azdhs.gov/als/forms/ccgh7.pdf
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 43
Food Service
Parent-Provided Meal Service (Facility does not have a licensed kitchen or parent chooses to provide meals) Parent-provided lunches will be placed in the designated refrigerator by _____________________ (designated staff). All items will be pre-cooked. In an emergency, a small variety of packaged foods are available to serve to a child who has no lunch. Lunches will be regularly reviewed to ensure the content meets the needs of growing children. _____________________ (designated staff) can provide more information about nutritious foods for lunches. We will provide milk or juice to a child if milk or juice is not provided by the parent. Food Service Provided By the Facility All meals and snacks provided by our program meet the nutritional needs of young children. Menus are planned using the guidelines provided by the United States Department of Agriculture's Child and Adult Care Food Program.
Menus are posted at least one week in advance.
At 1 year of age, babies on formula can switch to whole cow's milk. Children under two years of age need fat for brain development. At their second birthday, if growth is steady, the child can switch to low-fat or non-fat milk. All food served to children by this program will come from an approved and inspected source (grocery store, bakery, restaurant).
Home-prepared foods including birthday cupcakes and holiday treats will not be served to children.
If our program does not have a licensed kitchen for food preparation, snacks will consist of items packaged in single-servings by the commercial producer and that can be served without mixing, chopping, etc. Fresh water is available to children throughout the day in each classroom or activity area and outdoors.
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 44
Caterers Only caterers approved and inspected by the local health department are contracted to supply food for this program. Food Service Activities All food preparation activities will be carried out as described in the Arizona Food Code and local applicable rules and regulations.
Our program's cook and _____________________ (designated staff) have current food handler's cards awarded by the local health department. Food preparation and food service staff do not change diapers until food handling activities are completed for the day.
Dishwashing Our program washes dishes using a mechanical dishwasher or a 3-compartment dishwashing area approved by the local health department. When dishwashing is not available, our program uses disposable plates, cups and utensils that are used once then discarded.
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 45
We are concerned that the food served to children in our program be healthy and nutritious in order to support the growth and development of young children.
All meals and snacks provided by our program meet the nutritional needs of young children. Menus are planned using the guidelines provided by the United States Department of Agriculture's Child and Adult Care Food Program (USDACACFP). We strive to prepare tasty and nutritious foods which:
-- -- --
contain essential nutrients and food energy; have the right balance of carbohydrate, fat, and protein; are obtained from a variety of foods that are available, affordable, and enjoyable; reflect the cultural and ethnic heritage of our community; use whole, fresh or fresh frozen rather canned fruits and vegetables or juice; use whole grain breads and cereals; use boiled or baked rather than fried foods.
-- -- -- --
Lunches brought from home will be reviewed regularly to ensure the content meets the needs of growing children. _____________________ (designated staff) can provide more information about nutritious foods for lunches. Menus created by _____________________ (designated staff) are posted at least one week in advance so that parents have an opportunity to review and comment on foods that may contain allergens their child is unable to eat.
At 1 year of age, babies on formula can switch to whole cow's milk. Children under two years of age need fat for brain development. At their second birthday, if growth is steady, the child can switch to low-fat or non-fat milk. We limit foods high in sugar and fat such as cakes and cookies. Soda is not served. Helping Children Develop Healthy Attitudes About Food In our program, children learn that food is a source of energy for growing and active play.
Meals and snacks are served at the same time each day. Children are served portion sizes recommended by United States Department of Agriculture's Child and Adult Care Food Program Meal Patterns (USDA-CACFP).
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 46
-- --
If still hungry, a child may have additional servings. Second servings on vegetables, fresh fruit, and whole grain breads and cereals are offered first.
We do not insist that children clean their plates. We do not use food as a comfort, reward, or distraction. We do not withhold food as a form of discipline. Staff create a pleasant environment for meals and snacks.
Meal and snack times are not a time for lecturing or punishing.
Staff model healthy food behaviors.
Staff and children eat meals together.
We gently encourage the development of self-help skills and table manners.
Food Safety We avoid foods that can cause choking such as nuts, popcorn, hard candy, large marshmallows, large bites of meat, raw vegetables, hot dogs, cherry tomatoes, whole grapes, etc.
Round foods are cut into strips before serving. If children do not yet have their "grinding teeth" (molars), which come in between 13 and 19 months, raw vegetables are steamed until soft (but not mushy) before being served. When serving peanut butter to young children, we always use the creamy variety and spread it thinly on bread or crackers. Staff always supervise children when they are eating.
CACFP Meal Patterns http://www.fns.usda.gov/cnd/Care/ProgramBasics/Meals/Meal_Patterns.htm#Infant_Breakfast
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 47
Infant Feeding
All infant meals and snacks provided by our program meet the nutritional needs of young children. Menus are planned using the guidelines provided by the United States Department of Agriculture's Child and Adult Care Food Program (USDA-CACFP). In our program, infant formula is provided by _____________________ (parent or program). Baby foods are provided by _____________________ (parent or program). Bottle and Infant Food Storage
Full bottles will be refrigerated immediately upon arrival at the center or after mixing, unless being fed to an infant right away. Bottles are labeled with the infant's name and the date the bottle was prepared or the date the breast milk was expressed. Bottles will be stored in the coldest part of the refrigerator and not in the refrigerator door. Used bottles and infant food fed from the jar will not be put back in the refrigerator for later use. They will be discarded after one hour. Perishable foods will be stored below 45�F. _____________________ (designated staff) is responsible for monitoring the temperature of the refrigerator twice each day. A thermometer kept in the refrigerator will read between 35�F and 45�F at all times.
Bottle and Infant Food Preparation
Before preparing bottles or food, staff will wash their hands in the hand washing sink. Preparation surfaces will be cleaned and disinfected before preparing formula or food. Microwave ovens and crock pots are not used to heat formula, breast milk or baby food. Frozen breast milk is thawed overnight in the refrigerator and the bottle is warmed in a cup of warm water just before feeding.
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 48
Room Temperature Refrigerator Home Freezer -20�C Freezer
Freshly expressed breast milk Thawed breast milk (previously frozen)
1 hour Do not store
48 hours 24 hours
3-6 months Never refreeze thawed milk
6-12 months Never refreeze thawed milk
All unused, filled bottles of formula will be returned to the parent at the end of each day. Bottles to be re-used will be washed by a 3-sink method (wash, rinse, sanitize) or in the dishwasher. Powdered formula cans will be dated when opened and stored in a cool, dry place for up to one month. Medication is never added to breast milk or formula except with the written instruction of the health care provider.
Infant Food
When parents provide food from home, it will be labeled with the child's name and dated. Perishable foods will be stored below 45� F. As parents introduce foods to infants at home, they may be added to their child's feeding instructions for our program. Bottles are used for the first year, however, sippy cups may be introduced at 5-6 months of age. Sippy cups are used while the infant is sitting in a high chair and as part of the meal. No egg whites (allergy risk) or honey (bacteria risk) will be given to children under 12 months of age. Children 12-23 months will be given whole milk, unless the child's parent and health care provider have submitted a written request that the child be fed low-fat milk or a non-dairy milk substitute.
Feeding Infants
Infants will be held with heads slightly elevated while bottle feeding. Bottle propping is never allowed. When feeding an infant, staff will respond to hunger cues (e.g., fussiness, crying, opening mouth as if searching for a bottle/breast, hands to mouth, turning to caregiver or food, etc.) and signs the infant has had enough (e.g., falling asleep, decreased sucking, relaxing, pulling or pushing away).
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 49
When infants can hold their own bottles, they are held or placed in a high chair or other seat for feeding. Infants will eat from plates and utensils on appropriately sanitized surfaces, such as feeding station tables and high chair trays. A bottle provided to an infant in the crib may only contain water. (This will reduce early tooth decay and ear infections.) Chopped, safe, table foods (no larger than � inch cubes for infants and � inch cubes for toddlers) are encouraged after 10 months of age. Cups and spoons are encouraged by 9 months of age. Bottles and sippy cups are used by infants as part of the meal or snack. Bottles and sippy cups are removed at the end of the meal or snack, before the child is returned to the crib or play area. Children will eat from plates and utensils or appropriately sanitized surfaces, including high-chair trays.
Supporting Breastfeeding Mothers and Infants Our program recognizes that breast milk contains a unique mixture of nutrients that promote brain development, growth, digestion and protection from illness in the infant. We support breastfeeding throughout the first year and for as long as the infant and mother choose to continue breastfeeding. We support breastfeeding in these ways:
_____________________ (designated staff) will create a plan with the parent to allow the infant to be fed on demand by the mother or with expressed breast milk. _____________________ (designated staff) will make sure that breast milk is stored and handled appropriately. A quiet place for mothers to nurse their babies is always available. We assure that an infant receives only the breast milk intended for that infant by making sure bottles are carefully labeled with the child's first and last name. A marker with waterproof ink and moisture-resistant tape are available at the refrigerator for labeling bottles. All staff and volunteers know both the first and last name of an infant for whom they are preparing a bottle and are directed to carefully read the name on the bottle. Gloves are not worn to feed expressed breast milk to an infant. However, gloves are worn to clean up a large spill of breast milk. If an infant receives breast milk not meant for that infant, the child's parents will be notified by _____________________ (designated staff) and a recommendation to contact the infant's health care provider will be made. The health care provider may order a baseline test for HIV immediately and again up to nine months later.
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 50
The status of the infant's hepatitis B immunizations will also be checked. Parents will be reassured that the risk of transmission of HIV through this type of mix-up is very low.
_____________________ (designated staff) will contact the mother whose breast milk was fed to the wrong infant and describe the situation. This mother will be asked if she has ever had an HIV test and if she is willing to share the results with the parents of the child who received the wrong breast milk. If she does not know or has never had an HIV test, a call to her health care provider will be recommended with a suggestion that results be shared with the parents of the infant who received the wrong breast milk.
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 51
Safe Infant Sleep
When parents enroll an infant in this program, a copy of our program's Infant Sleep Policy is provided by the staff member assisting with the enrollment documentation. All new staff and volunteers receive orientation on this program's Infant Sleep Policy. All care giving staff and volunteers receive an annual update on this program's Infant Sleep Policy. Parent information literature from the American Academy of Pediatrics, First Candle, the Association of SIDS and Infant Mortality Programs, the National Institutes of Health and other recognized authorities on infant health will be readily available to parents. _____________________ (designated staff) is responsible for restocking this literature. Sleep Position
_____________________ (designated staff) will assure that infants who have not reached their first birthday are always placed on their backs for sleep. Infants who are easily able to turn from front to back and back to front, will be placed on their backs for sleep, but may then choose their own sleeping position (usually age 6 months or later). Infants will be placed in a side-lying or stomach sleeping position only when a written request from the infant's doctor has been received by the program. Care giving staff will then be directed by _____________________ (designated program administrator) in the placement of the infant for sleep. Unless specified by the infant's doctor, positioning devices that restrict the infant's movement in the crib will not be used.
Sleeping Environment In our program, all infants will sleep in a crib. Car seats, swings, and infant seats, etc. are not designed for safe sleeping.
Our cribs meet Arizona Department of Health Services, Office of Child Care Licensure Child Care Facility Rules. _____________________ (designated staff) will complete a safety check of cribs each week to assure that each crib frame: feels solid and mattress supports are secure; has no loose, missing, or broken hardware (nuts, bolts, screws); has no cracked or peeling paint;
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 52
has no splinters or rough edges; with drop-side latches is working properly and that latches securely hold the sides when raised; and has a mattress that fits snugly in the crib frame and is covered with a tightly fitted sheet.
Cribs are located away from windows, wall hangings, electrical and windowcovering cords, and other dangerous items. Cribs do not contain bumper pads, pillows, soft toys, fleece cushions or thick blankets. Our program places infants in the feet-to-foot sleeping position. Feet-to-foot means the baby's feet are at the bottom of the crib, a light blanket is placed no higher than the baby's chest, arms outside the blanket, and the blanket is tucked in around the crib mattress. No items are strung from one side of the crib to the other. Coverings are never placed over the crib or over the infant's face.
A Child Care Provider's Guide to Safe Sleep http://www.healthychildcare.org/pdf/SIDSchildcaresafesleep.pdf
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 53
Child Abuse and Neglect
Child abuse and neglect occur in families from all socioeconomic, ethnic, and educational backgrounds. Staff Training Our staff is trained to recognize the signs and symptoms of abuse and neglect and how to make reports to Child Protective Services or to local law enforcement agencies.
All staff receive this training as a part of their orientation process within 10 days of beginning work. _____________________ (designated staff) is responsible for providing this orientation. Every two years, our program arranges with Child Protective Services, the local university, community college, health department or other recognized resource to provide expert training on child abuse and neglect. The training will include an opportunity to ask questions. At this session, our program's written policies related to reporting abuse and neglect are reviewed.
Recognizing Abuse and Neglect Staff receive training on the signs and symptoms of abuse and neglect listed below. However, staff are reminded that while these signs and symptoms can be indicators of abuse, they would usually be accompanied by changes in the behavior of the child and/ or the person abusing the child. Physical abuse may be due to harsh or out-of-control punishment. Frequently physical abuse results from a violent, explosive situation. Added stress or substance abuse (including alcohol) is often present in the home. Observe for:
Bruises, particularly in soft, fleshy areas such as the upper ear or ear lobes, neck, upper arms, inner thighs, cheeks, mouth and lips, etc. Bruises that have distinctive shapes or patterns such belt marks, looped electrical cords, hand shape, etc. Burns or other injuries resulting from cigarettes, or in unusual places such as the soles of the feet, back, or buttocks A variety of bruises, cuts or burns in different stages of healing Human bite marks Hair loss or bald spots
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 54
Sexual abuse is any contact between a child and adult where the child is used for a sexual purpose such as fondling, indecent exposure, child pornography, intercourse, or exploitation. Sexual abuse is usually associated with threats of harm, thereby insuring secrecy. Observe for:
Pain or itching of the genitals Bruises or bleeding of the genitals Strange or unpleasant odors from the genitals, even after bathing Difficulty in walking or sitting An unusual or chronic fear of going home Advanced knowledge of sexual acts, words or slang terminology "Sexy" language, precocious sex play, excessive curiosity about sexual matters Sudden changes in behavior Fear of closed doors, showers, or bathrooms When a child reveals he or she has been sexually abused
Emotional abuse generally involves verbal abuse, or extended periods of silence or indifference. Lasting effects can include poor self-image and lowered self-esteem. Observe for:
Fear of adult contact Poor friendship skills Aggressive or acting out behavior Speech disorders (stuttering, etc.) Severe withdrawal Making negative comments about self Being overly anxious to please adults
Neglect occurs when a child could be harmed by what the parent or guardian does not do. This generally involves malnutrition, inappropriate clothing for age or weather, chronically-soiled clothing and/or a lack of adult supervision. Observe for:
Constant hunger Tiredness, no energy Frequent need for a bath or other personal care Need for medical or dental attention Frequent absences from school Clothes which are dirty or wrong for the weather Falling asleep in class Constantly stealing or hoarding objects or food
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 55
Endangerment through drug-exposure occurs when a child is exposed to the use or manufacture of dangerous drugs or the harmful chemicals used in manufacturing dangerous drugs, whether in a structure, such as a home, or a vehicle. There is no clear single sign of exposure to drugs or drug manufacturing. However, observe for:
Signs of physical neglect Fast or difficult breathing from exposure to toxic chemicals Fast heart beat Eye or skin irritation, or chemical burns
Immediate Interventions When a child arrives at our program with bruises, cuts or burns, etc., we document it _____________________ (where).
If staff believe an injury may have a logical explanation, the injury may be discussed with the parent to further assess the situation. If we suspect abuse, _____________________ (designated staff) will contact child protection authorities. In Arizona, call 1-888-767-2445 (1-888-SOS-CHILD) or police for instructions. If we believe a child is in immediate danger, _____________________ (designated staff) will call local law enforcement (911, police, sheriff, Department of Public Safety). If the parent or legal guardian of the child is suspected of abuse, we will follow the guidance of Child Protective Services or law enforcement agency regarding notification to the parent or legal guardian. Documentation of the event will:
Include a word-for-word account, without any editing, of what the child said and who was present when the child revealed the abuse. Additionally, record the child's emotional state, gestures, and facial expressions and what was happening at the time the child revealed the abuse. Always include the date, time, and names of everyone who heard what was said by the child. Also include a careful description of the size, shape, color, location and drainage of any obvious, physical injury and if necessary, a drawing describing the injury.
A written report to Child Protective Services and Office of Child Care Licensure will be completed within 48 hours. Office of Child Care Licensure will be notified within 24 hours that a report of abuse has been made. This will be followed with a written report within three days. A copy of this documentation should be kept for 12 months.
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 56
Accusations of Abuse Made Against Program Staff If a staff member is accused of child abuse, a report will be made immediately to local law enforcement and the child's parent will be notified by _____________________ (designated staff). During the ensuing investigation, our program will follow the advice of law enforcement and our attorney regarding suspension or reassignment of the accused staff member to tasks unrelated to the care of children. Our program prevents accusation of child abuse by:
Conducting the arrival health check each day and documenting any injuries or physical marks the child may have. Always having at least 2 staff on-site. Making sure all rooms are easily observed through windows, doors or by other means. Providing staff rest breaks _____________________ (when) for time periods of _____________________ (how long). Being sensitive to "touch" issues for both children and adult. Having clear discipline and child guidance policies. Providing staff training on child development and behavior management. Hiring staff and screening volunteers only after completing personal and professional reference checks and fingerprint clearances. Making periodic staff observations and supervision with recommendations for job improvement.
Documentation Sheet for Possible Abuse/Neglect http://www.azdhs.gov/als/forms/ccgh4.pdf
Arizona Health and Safety Policy Manual for Child Care Centers - Spring 2006
page 57
Oral Health
Our program believes that "baby teeth" are important for eating, for guiding the permanent teeth into place as children grow and for self-esteem. Children whose teeth are not healthy cannot chew vitamin-rich foods, lose b
Click tabs to swap between content that is broken into logical sections.