This document is a model Health Policy.

It includes both WAC items and what Snohomish Health District considers to be best practice when caring for children. To meet licensing re uirements a health policy must be indi!iduali"ed for each child care center. This document contains many sections mar#ed in red that need to be filled in with specific information rele!ant to your center. $a#e sure to ta#e out any red words in parentheses or in italics that were put in to help you complete this document. Do not hesitate to add additional points to reflect your center%s policies. $a#e sure you read through the entire policy as you wor# on it. If any items are unclear or are in conflict with what you do at your center& ma#e any necessary changes to reflect your own center%s practices. 'or e(ample& if you do not care for infants& ma#e sure to remo!e all sections from your plan that relate to infants. Call the Communicable Disease )utreach program if you ha!e uestions or need clarification on which items are re uired by WAC. The WACs can be found on the Department of *arly +earning%s website www.del.wa.go!. )nce finali"ed& your health policy should reflect e(actly what is done in your center. ,se your health policy to train all staff and to inform parents.
Note: The table of contents has been set up so that it can be easily updated. a!e all chan"es to the docu#ent. $hen you are finished% clic! once so#e&here in the #iddle of the table of contents &hich should select the entire table. Then ri"ht clic!% select 'update field( and then 'update entire table.( The table of contents &ill auto#atically update itself.

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Child Care Center-Revised 6/2010

This model health policy references !arious forms& logs& and other policies that are necessary for record#eeping. 3elow is a list of these items. The Communicable Disease )utreach program has e(amples of all of these forms and policies. Please contact the Communicable Disease )utreach program for copies or assistance with personali"ing these documents. Model Policies o o o o 3loodborne Pathogen *(posure Control Plan Pet Policy Pesticide Policy Disaster Plan

Example Forms o o o o o o o o o In4ury .eport .ecord of In4ury 5 Incidents $edication Treatment 'orm $edication Count 6erification 'orm Childhood Health History CIS 'orm Abuse17eglect .eport 'orm Diapering +og Healthy Child Care Cleaning Schedule

Individual Care Plans o Indi!idual Plan of Care 8general form9 o Asthma Plan o *mergency Plan of Se!ere Allergies Other Useful Documents o o o o o :eep $e Home If; $enu Planner Child Care 'ood Transportation Temperature +og 8for catered foods9 Child Care Classroom .efrigerator Temperature +og Playground $aintenance Chec#list

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HEALTH POLICY
Revised January 2013 Child Care 7ame= Street= City1State1@ip= Telephone= Director= 3illie%s 3usy :ids Child Care and Preschool& ++C ->?22 S. ?2 Aranite 'alls& WA ?>2B2 C2BD<B?D?B-/ 3illie Eo Fuiring

)utDofDarea Contact= Eoni $eyer G <-/DHH/DCH?B 7earest Pay Phone= Cross Street= S. ?2 and Eordan .d. 'acilities Contact 3illie Fuiring= C2BD<B?D?B-/ Emergency telephone numbers 'ire1Police1Ambulance= Poison Center= Animal Control= C.P.S.= C.P.S. 8afterDhours9= ?--D>//D222D-222 C2BD<>>D<CC/ -D>00D<0<DC20H or C2BD<<?D-></ -D>//DB02DB02C

!ospital used for life"threatening emergencies 7ame of Hospital= Address= Phone= Pro!idence $edical Center 1700 - 13th Street Everett, WA 98201

C2BD 20-DCBB-

I 'or nonDthreatening emergencies& the center will defer to parent preference as listed on the child%s registration form.

Other important telephone numbers D*+ Health Specialist= Ha"el Philp <0/DC-0DHC?2 D*+ +icensor= Unsure at this time C2BD<<?D->2/ Communicable Disease .eporting +ine= Snohomish Health District C2BD<<?DB2H> Child Care Health Consultation= Snohomish Health District C2BD<<?DB2H> Snohomish Health District Website= www.snohd.org

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#$%&E OF CO'#E'#(
I')U*+, EME*-E'C+ P*OCEDU*E(......................................................................................./ CO'#$C# O* E0PO(U*E #O %OD+ F&UID(...........................................................................1 I')U*+ P*E2E'#IO'..................................................................................................................1 MEDIC$#IO' M$'$-EME'#......................................................................................................3 PO&IC+ $'D P*OCEDU*E FO* E0C&UDI'- I&& C!I&D*E'..............................................45 COMMU'IC$%&E DI(E$(E *EPO*#I'-................................................................................46 !E$&#! *ECO*D(....................................................................................................................47 IMMU'I8$#IO'(.........................................................................................................................4/ !$'D9$(!I'-..........................................................................................................................41 #OO#!%*U(!I'-......................................................................................................................43 -E'E*$& C&E$'I'-: ($'I#I8I'-: $'D &$U'D*+.............................................................4; I'F$'# C$*E..............................................................................................................................<< DI$PE*I'-..................................................................................................................................<; FOOD (E*2ICE...........................................................................................................................5= 'U#*I#IO'..................................................................................................................................57 P!+(IC$& $C#I2I#+..................................................................................................................51 DI($(#E* P*EP$*ED'E((.....................................................................................................53 (#$FF !E$&#!...........................................................................................................................53 C!I&D $%U(E $'D 'E-&EC#..................................................................................................5; C!I&D*E' 9I#! (PECI$& 'EED( , I'C&U(IO'....................................................................6= %E!$2IO* M$'$-EME'#,-UID$'CE P*$C#ICE(.............................................................64 $'IM$&( .....................................................................................................................................64 2I(I#I'- $'IM$& PO&IC+.........................................................................................................64 #*$'(PO*#$#IO' ($FE#+.....................................................................................................6< (I-'$#U*E(..............................................................................................................................66

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INJURY/ EMER ENCY PROCE!URE"

MINOR EMER ENCIE" Staff trained in first aid will refer to the PediatricPlus CP.& A*D& and 'irst Aid for children& 'amily and Adults located with the first aid supplies. Alo!es will be used if any body fluids are present. Staff will refer to the child%s emergency form and call parents1guardians& emergency contacts& or health care pro!ider as necessary. Staff will record the incident on either the Accident .eport or the Incident .eport which are #ept in the forms folder in each classroom or in the office. These forms will include the date& time& place& and cause of the in4ury or illness& if #nown. A copy will be gi!en to the parent1guardian the same day and another copy placed in the child%s file. The incident will also be recorded on the Incident +og& which will be located in the office. Incident +ogs will be re!iewed monthly by the Program super!isor1Director The logs will be re!iewed for trends. Correcti!e action will be ta#en to pre!ent further in4ury or illness. All reports& including this log& are considered confidential. LI#E$THREATENIN EMER ENCIE" )f #ore than one staff person is present: one staff person will stay with the in4ured1ill child and send another staff person to call ?--. )f only one staff person is present: person will assess for breathing and circulation& administer CP. for one minute& if necessary& and then call ?--. Staff will pro!ide first aid as needed according to the PediatricPlus CP.& A*D& and 'irst Aid for children& 'amily and Adults located with the first aid supplies. Alo!es will be worn if any body fluids are present. A staff person will contact the parent1guardian8s9 or the child%s alternate emergency contact person. A staff person will stay with the in4ured1ill child& including transport to a hospital if necessary& until a parent& guardian& or emergency contact arri!es. The incident will be recorded on either the Accident .eport or the Incident .eport and Incident +og as described in J$inor In4uriesK section. Serious in4uries1illnesses& which re uire medical attention& will be reported to the licensor immediately. A copy of the illness or in4ury form will be sent to the licensor no later than the day after the incident. A copy will be placed in the child%s file.

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#IR"T AI! When children are in care& staff members with current training in CardioDPulmonary .esuscitation 8CP.9 and 'irst Aid are with each group or classroom. Documentation of staff training is #ept in personnel files. 'irst aid #its are inaccessible to children and located in e!ery classroom and in all !ans. The first aid #its contain= first aid guide sterile gau"e pads small scissors adhesi!e tape 3andDAids 8different si"es9 roller bandages large triangular bandage glo!es 87itrile or late(9 twee"ers for surface splinters CP. mouth barrier digital thermometer with slee!es blood cleanup #it

An une(pired bottle of Syrup of Ipecac will be stored in the office loc#ed with the medications. Syrup of Ipecac is administered only after calling Poison Control. A fully stoc#ed first aid #it will be ta#en on all field trips and playground trips and will be #ept in each !ehicle used to transport children*. These tra!el first aid #its will also contain= li uid soap and paper towels water instant hand saniti"er 8for staff use only9 chemical ice 8nonDto(ic9 change for phone calls and1or cell phone +choose one or both* an emergency dose of critical medication such as an *pipen& Er. or asthma inhaler for those children who need it All first aid #its will be chec#ed by the 8title of assigned person9 and restoc#ed 8how often9 or sooner if necessary. The e(piration date for Syrup of Ipecac will also be chec#ed at this time. +,ecause -yrup of )pecac #ay be unavailable at phar#acies-% e.pired -yrup of )pecac is not a rule violation- /er 012 letter of 3uly% 2004*

CONTACT OR E%PO"URE TO &O!Y #LUI!"

When staff reports blood contact or e(posure& the center will follow the 8name of center%s bloodborne pathogen e(posure control plan9 and the current guidelines set by the Washington State Department of +abor and Industries. The 8name of center%s bloodborne pathogen e(posure control plan9 is stored 8where9.

INJURY PRE'ENTION
The child care site will be inspected at least 8 uarterly& monthly9 for ha"ards by the 8title of assigned person9.

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Ha"ards include& but are not limited to= safety ha"ards 8bro#en toys& e uipment& drowning& cho#ing& sharp ob4ects& etc9 proper security of the center 8secure doors& proper super!ision& etc9 trip1fall ha"ards 8rugs& cords& uncontained toys& etc9 poisoning ha"ards 8plants& chemical storage& etc9 electrical ha"ards 8electrical cords& outlets& etc9 LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL Toys will be ageDappropriate& safe& in good repair& and not bro#en. $irrors will be shatterproof. Ha"ards or contamination will be reported immediately to the 8title of responsible person9. This person will ensure that the ha"ard or contamination is remo!ed& made inaccessible& or repaired immediately to pre!ent in4ury. Staff will re!iew their rooms daily and remo!e any bro#en or damaged e uipment& toys& etc. Re#ove references to loose-fill #aterial if your play"round has rubber #ats. The playground will be inspected daily before use for bro#en e uipment& en!ironmental ha"ards& garbage& animal contamination& areas of low surfacing material such as at the ends of slides and under swings& and other ha"ards by the 8title of assigned person9. +ooseDfill surfacing material will be ra#ed 8wee#ly& daily9. Playground e uipment will be free from entrapments& entanglements& and protrusions and will be chec#ed for these ha"ards 8how often= monthly or uarterly9 by the 8title of assigned person9. This safety inspection is documented on a 8name of playground maintenance chec#list9& which is #ept 8where9. Proper super!ision will be maintained during all outdoor play. Staff will position themsel!es to obser!e the entire play area. The accident and in4ury log will be monitored by the 8title of assigned person9 at least 8how often9 to identify accident trends and implement a plan of correction.

ME!ICATION MANA EMENT

Choose one state#ent and delete the other: 8Prescription medications only9 $edications are pro!ided only to those children with a health care pro!ider%s prescription. If a child has a condition where the Americans with Disabilities Act 8ADA9 applies& reasonable accommodations will be made and the child will be gi!en medication. G ). G 8Prescription or o!erDtheDcounter medications9 $edications are pro!ided to any child with a health care pro!ider%s prescription or a medication consent form from the child%s parent1guardian

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as appropriate. If a child has a condition where the Americans with Disabilities Act 8ADA9 applies& reasonable accommodations will be made and the child will be gi!en medication. ME!ICATION RULE" In order for staff to gi!e a child medication& the medication must ha!e a 8name of medication authori"ation form9 consent form filled out with the following information= the child%s first and last name the child%s parent1guardian signature the medical pro!ider%s signature 8if necessaryM see ne(t section9 the name of the medication reason for gi!ing the medication amount of medication to gi!e how to gi!e the medication or route of administration how often to gi!e the medication start and stop dates possible side effects 8use pac#age insert or pharmacist%s written information9 how to store the medicine consistent with directions on the label The consent is good for the number of days stated on the consent form. 'or acute 8shortDterm9 conditions& the number of days must be one month or less. After one month& a new consent must be obtained. 'or chronic 8longDterm9 illnesses& the consent can be used for up to si( months. 'or Jas neededK medications 8such as diaper ointments and sunscreens9& the consent can be used for up to si( months. All medications must be in the original container and labeled with the following information= child%s name instructions and dosage recommendations for the child%s weight and age duration& dosage& fre uency& and amount to be gi!en e(piration date $edication is not gi!en past the days prescribed on the medication bottle e!en if there is medication left. RE(UIRE! CON"ENT A parent1legal guardian is the sole consent to medication being gi!en& without the consent of a health care pro!ider& if and only if the medication is o!erDtheDcounter and is one of the following types= nonDaspirin fe!er reducer1pain relie!er ointment or lotion specifically intended to reduce or stop itching& treat dry s#in& or care for a wound diaper ointment or nonDtalc powder intended for the use in the diaper area sunscreen for children o!er 0 months of age
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A health care pro!ider%s consent& along with parent1guardian consent& is re uired for= prescription medications o!erDtheDcounter medications that are not one of the medications listed abo!e o!erDtheDcounter medication with a label that does not include the age or weight of the child being treated !itamins& herbal supplements& teething aids& and fluoride $any o!erDtheDcounter medications are not appro!ed for young children. The 'ood and Drug Administration recommends that cough and cold products not be gi!en to children younger than 2 years. According to the American Academy of Pediatrics& cough suppressants& antihistamines& and decongestants may not be effecti!e in children younger than 0 and can ha!e potentially serious side effects& e!en when gi!en as directed. 3ased on this information& o!erDtheDcounter cough and cold medications will not be administered to children younger than 2 years 8optional= 0 years9 unless the parent pro!ides written and signed instructions from a health care pro!ider in addition to the completed consent form. A health care pro!ider%s consent is accepted in < different ways= The health care pro!ider%s name is on the original pharmacist%s label 8along with the child%s name& name of the medication& dosage& duration& and e(piration date9. The health care pro!ider signs a note that includes the information re uired on the pharmacist%s label 8such as when medications are gi!en in the clinic9. 7ote= medications must be in the original container. The health care pro!ider signs a completed 8name of medication authori"ation form9. )A" NEE!E!* ME!ICATION" JAs neededK medications are gi!en when the abo!e re uirements are met and the signed 8name of medication authori"ation form9 also includes the= symptoms that re uire the medication the length of time the medication is to be gi!en 8e(. - wee#9 the ma(imum amount of medication that can be gi!en in a day the minimum amount of time between consecuti!e doses &UL+ ME!ICATION" )f the center does not allo& the use of bul! #edications% ta!e this section out. J3ul# medicationsK include containers of sunscreenM diaper ointments and nonDtalc powders& intended for use in the diaper areaM etc. These bul# medications are gi!en only when the abo!e re uirements are met A7D= written parental consent prior to use is obtained it is used no longer than si( months 8write the date opened on the container9 parents are notified of the name of the product used& the acti!e ingredients& and Sun Protection 'actor 8SP'9 of the sunscreen products are applied in a manner to pre!ent contaminating the bul# container

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When administering bul# medications& the method used to pre!ent contamination of the bul# container is 8describe method used G e(amples include s uee"ing medication from bottle onto a clean paper towel for each child& or only sprayDon sunscreens are used& or using clean glo!es for each child& etc.9.

A!MINI"TRATION $edications are administered by the 8title of indi!idual8s9 who will administer medications9. )nly staff persons who ha!e been oriented to 8name of center9%s medication policies and procedures can gi!e medications. Documentation of this training will be #ept 8where9.These policies are re!iewed with all staff members who administer medications 8how often9. 3efore a staff member may administer medications& parents will pro!ide instructions and demonstrate the use of speciali"ed medication administration procedures 8for e(ample= how to use the nebuli"er or *piPen& children%s preferences for swallowing pills& how to deli!er eye drops& etc9. This is documented 8where G medication administration form& indi!idual health plan& other9. To gi!e li uid medication& staff use a measuring de!ice designed specifically for oral or li uid medication. $easuring de!ices for indi!idual use are pro!ided by 8whom G parent& center9 and stored 8how9. $edications are not mi(ed in formula or food unless there are written directions to do so from a health care pro!ider with prescripti!e authority before the medication is gi!en. Staff administering medications will wash hands before preparing medications and after gi!ing the medication. $edications are prepared on a clean surface away from toileting1diapering areas. Staff will carefully read labels on medications before each administration& noting= child%s name medication name amount to be gi!en time and dates to be gi!en how long to gi!e how to gi!e 8e.g. by mouth& to diaper area& in ear& etc9 Staff will ma#e sure information on the label is consistent with information on the 8name of medication authori"ation form9. CHIL!REN TA+IN THEIR O,N ME!ICATION Children may ta#e their own medication if the abo!e re uirements are met A7D= There%s a written statement from the parent re uesting the child ta#e their own medication.
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There%s a written statement from the health care pro!ider with prescripti!e authority stating that the child is physically and mentally capable of ta#ing their own medication. All storage criteria stated in this policy are met. A staff member obser!es and documents that the child too# the medication.

!OCUMENTATION *ach time staff administer a medication& staff will document the necessary information on a 8name of medication treatment formM can be the bac# of the center%s medication authori"ation form9. This written record will include= child%s full name& date& time& name of medication& and amount gi!en 8indicate if selfD administered9 the full signature of the staff person gi!ing each dose of medication or obser!ing the child ta#ing the medication 8if staff initial after each administration& a full corresponding signature is needed on the form to !alidate the initials9 a written e(planation why a medication that should ha!e been gi!en was not gi!en any obser!ations of the child in relation to the medication ta#en 8e(ample= side effects or relief of symptoms9 when Jas neededK medications are administered& staff must document the symptoms that prompted administration Staff will report any side effects that occur to 8title of indi!idual9 and to the parent immediately. This will be documented on the 8name of medication formM for e(ample& the bac# of the medication authori"ation form9. 'or children with special health needs& detailed instructions for medications or medication deli!ery de!ices& such as nebuli"ers& insulin pumps& or *piPens& will be documented on the 8program name9 Indi!idual Plan of Care form. $edication authori"ation and documentation forms are considered confidential and will be stored 8where9. )utdated medication authori"ation1treatment forms will be #ept in the child%s file while in care and are #ept up to one year after the child lea!es care. The program implements the following system for trac#ing administration of controlled substances= 80escribe syste#: for e(ample& only - wee#%s worth of medication will be accepted from the parent at a time. Pills will be counted at each administration. This will be documented on 8name of medication count !erification form9.9 "TORA E Children%s medication will be #ept 8where9. This is a location inaccessible to childrenM away from sources of moisture& heat& and lightM away from foodM and protected from sources of contamination.

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Staff medication will be stored 8where9 inaccessible to children. Staff medications are clearly identified as such. *(ternal medications that go on the s#in will be #ept as stated abo!e but also separate from oral or in4ectable medications. All controlled substances will be #ept as stated abo!e and in a loc#ed container. $edications re uiring refrigeration will be stored in a labeled container to #eep them separated from food. *piPens will be stored in an unloc#ed location& inaccessible to children& but easily accessible to staff in an emergency. This location is 8whereM the same room as the child is recommended9. !I"PO"AL )utdated medications or medications no longer being used will promptly be returned to parents or guardians. If the parent1guardian is not a!ailable& the 8title of person9 will call -D>//DH<2D?2B< or go to www.$edicine.eturn.com for instructions on proper disposal.

POLICY AN! PROCE!URE #OR E%CLU!IN

ILL CHIL!REN

Staff will chec# all children for signs of illness when they arri!e at the center and throughout the day. If the following signs of a possibly contagious illness are present& a child will not be admitted to the center that day& or will be e(cluded. The parent will be called to pic# up their child. The child will be #ept 8where9 and the 8title of staff member9 will care for the child until the parent arri!es. 5re there conse6uences for parents &ho do not pic! up a child in a ti#ely #anner7 )f so% describe here. Staff members will follow the same e(clusion criteria as children and not come to wor#& or will lea!e if these signs de!elop. Children and staff with the following symptoms will be e(cluded= temperature of at least ?? N ' under arm 8a(illary9 or -//N ' orally A7D who also ha!e one or more of the following= o headache o earache o sore throat o rash !omiting on 2 or more occasions within the past 2C hours diarrhea 8increased fluidity and1or fre uency of bowel mo!ements relati!e to the personOs usual pattern9 occurring < or more times within 2C hoursM or any bloody stool any suspected communicable infection of the s#in or eyes such as impetigo& $.SA& pin#eye& and scabies

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open or oo"ing sores& unless properly co!ered and 2C hours ha!e passed since starting treatment& if treatment is necessary lice or nits 8for head lice& children and staff may return to child care once no nits are !isible9 fatigue& irritability& or confusion that pre!ents participation in regular acti!ities& such as sleeping or resting more than usual for that child& not wanting to eat& or multiple cold symptoms that #eep the child from regular acti!ities LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL

Temperatures are ta#en with a digital thermometer with singleDuse disposable co!ers o!er the thermometer. )ral temperatures are ta#en on preschoolD through schoolDage childrenM under arm 8a(illary9 temperatures are ta#en on all other children. 7o rectal nor ear temperatures are ta#en. Parents are notified in writing when their children ha!e been e(posed to infectious diseases or parasites1lice. The notification may consist of either a letter to parents which will be deli!ered by 8how G placing in children%s cubbies& placing by the signDin boo#& other9 and1or posting a notification for parents 8where9. 'ollowing an illness or in4ury& children will be readmitted to the program when= they no longer ha!e the abo!e symptoms they ha!e been without fe!er for 2C hours without being treated by an antipyretic such as acetaminophen 8Tylenol9 or ibuprofen 2C hours ha!e passed since starting appropriate treatment they no longer ha!e significant discomfort the center has been ad!ised by a Public Health 7urse on communicable disease guidelines for child care 'ollowing surgery or in4ury re uiring medical care& a note from the physician stating that the child may return to routine child care acti!ities and en!ironment may be re uired.

COMMUNICA&LE !I"EA"E REPORTIN

+icensed child care facilities are re uired to report communicable diseases to their local public health department 8WAC 2C0D-/-DC-B9. The following is a partial list of the official diseases that must be reported. They were selected because they represent diseases that are most li#ely to be found in child care settings. 'or a complete list of reportable diseases& call the Snohomish Health District. Children and staff who ha!e a reportable disease may not be in attendance at the center unless appro!ed by the local health department. The following communicable diseases will be reported to the Snohomish Health District at C2BD <<?DB2H>& gi!ing the caller%s name& the name of the child care program& address& telephone number& and name of child in!ol!ed=
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Animal bites Campylobacteriosis 8Campy9 Cryptosporidiosis Cyclosporiasis Diphtheria *nterohemorrhagic *. Coli& including *. Coli /-BH=HH 'ood or waterborne illness Aiardiasis Haemophilus Influen"a Type 3 8HI39 Hepatitis A 8acute infection9 Hepatitis 3 8acute and chronic infection9 Hepatitis C 8acute and chronic infection9 Influen"a 8if more than -/P of children and staff are out ill9

+isteriosis $easles 8rubeola9 $eningococcal disease $umps Pertussis 8Whooping cough9 Polio .ubella Salmonellosis Shigellosis Tetanus Tuberculosis 8T39 Qersiniosis

Should a child at the center become ill and e(pose others to any of the abo!e mentioned diseases& parents and legal guardians will be notified in the following manner 80escribe #ethod of co##unication& including time line for notification of parents& method of contact& use of health department for further uestions9. +etter written by the Snohomish Health District This will be the responsibility of the 8title of responsible person9. *!en though a disease may not re uire a report& the child care will consult with the Communicable Disease )utreach program at the Snohomish Health District at C2BD<<?DB2H> for information about common childhood illness or disease pre!ention& and to determine when a child or staff member may return to the center.

HEALTH RECOR!"
*ach child%s file will contain= identifying information about the child health& de!elopmental& nutrition& and dental histories date of last physical e(am health care pro!ider and dentist names& addresses& and phone numbers allergies Indi!iduali"ed Care Plans for special needs or considerations 8medical& physical& or beha!ioral9 list of current medications current immuni"ation record 8CIS form9 consents for emergency care preferred hospital for emergency care authori"ation to ta#e the child out of the facility to obtain emergency health care The abo!e information will be collected by the 8title of responsible person9 before a child enters the program.

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Teachers& !olunteers& coo#s& and bus dri!ers 8or others9 will be oriented to any special needs or diet restrictions before the child first enters the program. Plans for children with special needs will be documented and staff will be oriented to the Indi!iduali"ed Care Plan for that child. The abo!e information will be updated annually or sooner if changes are brought to the attention of a staff person.

IMMUNI-ATION"
To protect all children and the staff& and to meet state health re uirements& the center only accepts children fully immuni"ed for their age. The Certificate of Immuni"ation Status 8CIS9 for each child is #ept on file to show the Department of Health and the Department of *arly +earning 8D*+9 that the center is in compliance with licensing standards. A completed CIS form is collected upon enrollment in the following manner= 80escribe #ethod of initially collectin" i##uni8ation infor#ation: the parent or staff may transfer the immuni"ation dates from the health care pro!ider%s immuni"ation record onto a CIS form. The parent must sign the CIS form to !erify the information.9 3elow has been modified to address new C)* rules Children may attend child care without an immuni"ation= when the parent and .eligious organi"ation signs the e(emption form stating they ha!e .eligious $embership *(emption & ). when the parent signs the e(emption form stating they ha!e religious1personal1philosophical reasons for not obtaining specific immuni"ation8s9& A7D the health care pro!ider signs that the parent has recei!ed a consult regarding ris#s of not immuni"ing ). the parent and health care pro!ider signs that the child is medically e(empt The CIS form is #ept 8where G child%s file& immuni"ations binder& other9 and returned to parent1guardian when the child lea!es the program. A copy of indi!idual records& including the CIS& must be #ept for one year after the child lea!es. The CIS records are re!iewed and updated 8how often9 by the 8title of responsible person9. Children may attend child care without an immuni"ation= when the parent signs the e(emption form stating they ha!e personal& religious or philosophical reasons for not obtaining specific immuni"ation8s9& ). the health care pro!ider signs that the child is medically e(empted Children who ha!e been e(empt from immuni"ations will not be permitted to attend child care during an outbrea# of an immuni"ation pre!entable disease for which they are not immuni"ed. This is for the unDimmuni"ed child%s protection and to reduce the spread of the disease.
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HAN!,A"HIN
Children and center staff wash their hands using the following method= 8-9 Turn on water and ad4ust the temperature& then wet hands with warm water 829 Apply a liberal amount of soap to hands. 8<9 .ub hands in a wringing motion from wrists to fingertips for not less than 2/ seconds. 8C9 .inse hands with warm water. 8B9 Dry hands with a paper towel. 809 ,se the paper towel to turn off the water faucet8s9. Staff will wash hands= upon arri!al at the center before handling foods& coo#ing acti!ities& eating& or ser!ing food after toileting self& children& or changing a diaper after handling or coming in contact with body fluids such as mucus& blood& sali!a& urine& or feces after cleaning or ta#ing out garbage after attending to an ill child before and after gi!ing medications after handling& feeding& or cleaning up after animals after smo#ing after being outdoors or in!ol!ed in outdoor play as needed Children will be assisted or super!ised in hand washing= upon arri!al at the center before meals& snac#s& or coo#ing acti!ities after toileting or diapering 8Staff may wipe the hands of a child under the age of 0 months with a diaper wipe after diapering instead of a hand wash9 after outdoor play after coming in contact with body fluids after touching animals as needed All handwashing sin#s are stoc#ed with warm water 8>BR' D -2/R'9& li uid soap& and paper towels. Cloth towels are not used for drying hands. Handwashing reminders are posted at all handwashing sin#s. Handwashing is to be done at sin#s dedicated to this purpose only. Handwashing sin#s are located 8describe locations of handwashing sin#s9. Children are able to access the handsin#s by themsel!es 8howS where child height sin#s are pro!ided& by using a step stool& etc.9. Infants% hands are washed by being held up by the pro!ider in the infant room. 7o handwashing occurs in sin#s designated for food preparation. 7o food preparation occurs in handwashing sin#s. Handwashing sin#s are not used for drin#ing water.
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In the #itchen& hands will be washed 8where G in the separate handwashing sin#& in the designated compartment of the twoDcompartment sin#& etc.9. The use of hand saniti"ers 8is1is not9 permitted at this facility. )f hand saniti8ers are used% describe ho& and &hen they are used by staff and include the follo&in" 9 sentences. The use of hand saniti"er is 7)T a replacement for handwashing. Hand saniti"ers are not used on children. Instructions for the proper use of hand saniti"ers are posted in the classrooms.

TOOTH&RU"HIN
This section is optional. 0elete if the center does not have a toothbrushin" pro"ra#. Toothbrushing is done in the 8list the classrooms that do toothbrushing9 8how often9. Toothbrushing will be super!ised to ensure= the establishment of a routine which enhances learning that children under the age of si( use no more than a pea si"e amount of fluoride toothpaste proper toothbrushing techni ue that toothbrushes are not shared and that they are handled properly *ach child will ha!e his1her own toothbrush that will= be stored properly to decrease cross contamination o open to air with bristles up o unable to drip on one another o do not contact each other or any other thing o toothbrush caps are not used be clearly mar#ed with the child%s name on the handle with a nonDto(ic& permanent mar#er ha!e soft& rounded nylon bristles and be si"ed appropriately for the child be replaced twice each year when used less than twice a day& B days a wee#& or sooner if the bristles become splayed or the toothbrush is contaminated Teachers1child care staff will brush their own teeth to model the desired beha!ior. Staff training will be pro!ided yearly on the etiology of tooth decay& oral health promotion& and toothbrushing protocol. Choose :N1 option belo& +the sin! #ethod or the table #ethod*: Children brush teeth at the sin#& located 8where9. The toothbrushing procedure at the sin# is= A pitcher of water is obtained from a food preparation sin#. The sin# will be cleaned with the <Dstep process 8wash& rinse& saniti"e9. Teacher will hand each child their toothbrush and a small paper cup with no more than a pea si"ed portion of toothpaste on the edge. 7o more than two children will be at the sin# at one time. Children apply the toothpaste to the brush.
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Teach the children to brush in a pattern and mo!e from area to area 8leftDtoDright& inside and outside& topDtoDbottom9 around the mouth. 'inish with the top of the teeth. 3rushing should continue for at least one minute. *(posure to fluoridated toothpaste is effecti!e e!en with unsatisfactory brushing techni ue. Child spits e(cess toothpaste into the sin#. A stepping stool is pro!ided. Child returns the toothbrush to the teacher who rinses it under the faucet 8or in child%s own cup of water9 and replaces it in the toothbrush rac#. After all the children ha!e brushed& the sin# is cleaned with the <Dstep process.

G ). G Children brush teeth while sitting at the table. The toothbrushing procedure at the table is= Table area is washed& rinsed& and saniti"ed. *ach child is gi!en a paper towel and a small paper cup with no more than a pea si"ed portion of toothpaste on the edge. Children apply the toothpaste to the brush. Teach the children to brush in a pattern and mo!e from area to area 8leftDtoDright& inside and outside& topDtoDbottom9 around the mouth. 'inish with the top of the teeth. 3rushing should continue for at least one minute. *(posure to fluoridated toothpaste is effecti!e e!en with unsatisfactory brushing techni ue. Child spits the e(cess toothpaste into the empty paper cup. Clean water is poured into a new cup for rinsing the toothbrush. Child returns the toothbrush to the teacher who replaces it in the toothbrush holder. Cups are immediately discarded. After all the children ha!e brushed& the table is washed& rinsed& and saniti"ed.

ENERAL CLEANIN . "ANITI-IN . AN! LAUN!RY

The child care center is maintained in a clean and sanitary manner that helps protect the children from illness. Surfaces in the center are designed and maintained to be easily cleanable. A cleanable surface is one that is= designed to be cleaned fre uently resistant to moisture free from crac#s& chips& or tears PRO!UCT" U"E! Cleaning supplies are stored in the original containers& inaccessible to children& and separate from food and food preparation areas. Cleaning supplies for the #itchen are stored 8where9. )ther cleaning products are stored 8where9. This location is !entilated to the outside 8by mechanical !entilation or through a window9. Cleaning means the remo!al of dirt& grease& food& art material& body fluids& or other substance from the area. Cleaning is done with 8soap and water G or G name of cleaning product9. Surfaces are rinsed with water between cleaning and saniti"ing steps.
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)f usin" a saniti8er other than bleach and &ater% include this para"raph. Saniti"ing means the remo!al of germs and bacteria to a le!el that will not cause illness. Aeneral saniti"ing is done with 8name of saniti"ing solution9. The label for this product states that the product is safe for food contact surfaces. 'loors& bathrooms& and diaper changing areas are saniti"ed with 8name of saniti"ing solution9. The use of these saniti"er products was re!iewed by the 8local health department G or G Department of *arly +earning9 on 8date9. When using these products& the label directions are followed& including concentration& contact time& and rinsing. )f usin" bleach and &ater as a saniti8in" solution% include the ne.t para"raph and chart. Saniti"ing means the remo!al of germs and bacteria to a le!el that will not cause illness. Saniti"ing is done with a solution of bleach and water. The bleach used contains no scents or surfactants. A minimum contact time of the saniti"er with the surface is - minute. After this length of time& the saniti"er may be wiped off with paper towels or the surface may be allowed to air dry. The following recipes will be used when ma#ing a saniti"ing solution= A.*A F,A7TITQ Amount of 3leach Diapering area& Small - tablespoon bathroom& floors +arge T cup 'ood contact surfaces& toys& sleeping mats& dishes& utensils& pots and pans Small +arge T teaspoon - teaspoon Amount of Water - uart - gallon - uart - gallon

Whene!er possible& the saniti"er solution is made in large uantity& di!ided into spray bottles& and labeled with the preparation date. Cleaner and saniti"er spray bottles are labeled with contents. The use of sponges is not permitted in the center. CLEANIN "CHE!ULE This center%s minimum schedule for general cleaning is= Tables& highchairs& and counters used for food ser!ice will be cleaned and saniti"ed before and after each meal or snac#. 3athrooms will be cleaned and saniti"ed daily. This includes sin#s& toilets& counters& and floors. Toilet seats will be cleaned and saniti"ed throughout the day and as needed. Re#ove the follo&in" infor#ation on potty chairs if you do not use the# at the center: PottyDchairs will be immediately emptied into toilet& washed& and saniti"ed in a

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designated sin# or utility sin# separate from classrooms. This designated sin# is located 8where9. The sin# must then be cleaned and saniti"ed. Carpeting& rugs& and furniture will be !acuumed daily. This includes carpeting that may be on walls or surfaces other than the floor. Carpets will be cleaned monthly in infant areas and e!ery 8three1si(9 months in other childDoccupied rooms. Carpet cleaning will be done by 8name of carpet cleaning company or title of staff person responsibleM note= professional steam cleaning is strongly recommended9. Spot cleaning will be done as necessary. 6acuuming and mopping of the center will not occur while children are present 8carpet sweepers are o# to use9. Hard floors will be swept and mopped with 8name of floor cleaning product9 daily and saniti"ed daily. ,tility mops will be hung to dry an area with !entilation to the outside and inaccessible to children. $op heads are 8washed ho& often in the washing machineM replaced ho& oftenM other9. Toys will be washed& rinsed& saniti"ed& and airDdried or toys that are dishwasher safe can be run through a full wash and dry cycle. This is done 8how often in each room G recommend daily for high use infant1toddler toys and wee#ly for other toys9. Toys that children place in their mouth will be saniti"ed between uses by different children. The following system for ongoing rotation of mouth toys will be implemented in infant and young toddler rooms= 8describe the system9. )nly washable toys will be used. Cloth toys and dress up toys will be laundered according to the U+aundry% section of this policy. Re#ove this infor#ation if &ater tables are not used. Water tables will be emptied and saniti"ed after each use or more often as needed. Children will wash hands before and after play and be closely super!ised. 'or art acti!ities& the handwashing sin# can be used I' the counters& sin#s& and faucets are cleaned& rinsed& and saniti"ed prior to use as an art sin#. 7ap mats1cots will be cleaned and saniti"ed 8how often9& between uses by different children& after a child has been ill& and as needed. They will be stored 8describe how and where mats1cots will be stored so that sleeping surfaces don%t touch if they are not saniti"ed after each use9. Re#ove this infor#ation if the center does not care for infants. In infant areas& cribs mattresses and railings will be saniti"ed 8daily or wee#ly9& before use by a different child& after a child has been ill& and as needed. Highchairs will be washed& rinsed& and saniti"ed after each use. Aeneral cleaning of the center is done 8how often9 and more often when children or staff members are ill. Dusting is done 8how often9. Toy shel!es are cleaned and
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saniti"ed 8how often9. Door #nobs are cleaned and saniti"ed 8how often9 and more often when children or staff members are ill. Wastebas#ets will ha!e disposable liners and are emptied daily or more often if necessary. .oom deodori"ers are not used at the center due to the ris# of allergy1lung irritation. Cleaning duties are assigned to specific staff. These assignments are posted 8where9. As cleaning duties are completed& the staff person will mar# off that duty.

LAUN!RY +inens and bedding are 8sent home G ). G are washed by the center at a temperature of at least -C/o' G or G with bleach or other product in the rinse cycle9. This center%s minimum schedule for laundry is= +inens and bedding are 8washed1sent home9 wee#ly or more fre uently as needed. Re#ove this infor#ation if the center does not care for infants. Infant bedding is changed 8how often G daily is recommended9. Cloth toys and dress up clothes are laundered 8how often9. If they cannot be washed in the washing machine& they will be hand washed in warm soapy water& rinsed& then dipped into a 8bleach or other product9 solution for 8amount of time9 and allowed to air dry. 3edding will be stored 8describe how and where bedding will be stored G such as remo!ed from mats and stored separately in children%s cubbies9.

Soiled laundry is #ept inaccessible to children 8where1how9. Soiled laundry is #ept separate from clean laundry. +aundry machines are separate from #itchen and food preparation areas and are inaccessible to children. Dryers are !ented to the outside of the building. Children%s coats and other personal items will not touch during storage. A change of clothes is a!ailable for the children and is pro!ided by 8parents1center9. These clothes are stored 8where9. Staff members are encouraged to wear an apron o!er street clothes to decrease the spread of communicable disease G ). G staff members are encouraged to ha!e a change of clothing a!ailable onDsite.

IN#ANT CARE
$onthly consultation !isits in the infant room are conducted by 8name of infant nurse consultant9. The consultant is a currently licensed 8choose 1: .egistered 7urse& 7urse Practitioner& Physician Assistant& or Physician9& with training and1or e(perience in pediatrics.
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Infants will be at least 8how old G one month& si( wee#s9 of age when enrolled. INTERACTION" AN! EN'IRONMENT Infant room staff members ha!e been trained in understanding and reacting appropriately to infant cues. Staff members interact regularly with each infant throughout the day by= encouraging infants to handle and manipulate a !ariety of ob4ects pro!iding a safe en!ironment for climbing& mo!ing& e(ploring pro!iding materials and opportunities for large and small muscle de!elopment reading and tal#ing to infants pro!iding daily indoor opportunities for freedom of mo!ement outside their cribs& in an open& uncluttered space. The room has areas where all infants can be safely placed on the floor at any gi!en time. Infants are placed 8choose one: directly on the floor& on mats on the floor& on blan#ets9. +Note: ats are reco##ended because they are easy to clean and saniti8e &hen soiled*. )nclude this sentence if blan!ets are used: 'loor play blan#ets are used only for that purpose and are changed when soiled with spitDup or other body fluids. placing infants on their tummy part of the time when they are awa#e and staff are obser!ing them pro!iding outdoor opportunities 8how oftenM 2/D</ minutes per day is recommended9 LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL The infant room has been designed so that all accessible spaces are safe and secure for infant e(ploration and whole body mo!ement. Infants will either be held or placed on the floor near and obser!ant and engaged staff person. +Choose one of the follo&in" t&o options*: ,se of infant containers 8swings& infant seats& saucers& and other confining e uipment9 will be limited to short periods of time when staff feel they need to contain an infant 8such as when changing the diaper of another infant9. The infants will be placed in these containers for no more than 8how longVrecommend 2/ minutes9 collecti!ely each day& unless otherwise specified in writing by the child%s health care pro!ider. 3aby wal#ers are ne!er used. G ). G To ma(imi"e an infant%s physical& emotional& and cogniti!e de!elopment& this center has a J7o ContainerK policy. Swings& infant seats& saucers& and other confining e uipment will not be used.

This center maintains a J7oDShoesK policy in the infant room. All parents and staff are re uired to remo!e their shoes upon entering the infant room.

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IN#ANT &OTTLE #EE!IN Infants will be fed according to their need rather than an adult prescribed time schedule. Infants are held when fed a bottle. 3ottles will not be propped. Infants able to hold their own bottle will be held when possible 8if it is not possible& the teacher will sit close and interact with the child during the feeding time9. Infants will not be gi!en a bottle while lying down unless the bottle contains only water. +ying with a bottle puts a baby at ris# for baby bottle tooth decay& cho#ing and ear infections. 3ottles will be remo!ed from the infant when he1she finishes feeding. When feeding an infant& staff will watch for cues 8signs9 to #now when the infant has had enough. 'ood preparation areas in the infant room will be cleaned and saniti"ed daily. All bottles and containers of breast mil# must be labeled with the infant%s full name and the date. This is done by 8whom G classroom staff or parents9. Staff must ensure that the correct formula or breast mil# is gi!en to each infant. A refrigerator located 8where9 is used to store bottles and unser!ed& lefto!er infant food. The refrigerator temperature is chec#ed 8how often9 to ensure it is not more than C-R'. A log of these temperatures is #ept 8where9. 3ottles will be stored in the coldest part of the refrigerator& not in the door. A thermometer will be #ept in the door of the refrigerator. )f bottles are provided by the parents% include this section: 'ull bottles will be refrigerated immediately upon arri!al at the center& unless being fed to an infant right away. Any prepared formula or thawed breast mil# not used will be sent home with the family at the end of the day. 'ro"en breast mil# is stored at -/R' or less 8where9. This mil# is stored at the center for no more than 2 wee#s. )f bottles are prepared at the center% include this section: This center prepares bottles 8when G in the morning& on demand& other9. Staff uses the following steps to prepare bottles= Staff must wash hands before preparing or ser!ing bottles. All infant bottles and baby foods are prepared 8where G by the food preparation sin# in the classroom& in the #itchen9. Cold water used for mi(ing bottles or drin#ing is obtained from 8where G the designated food prep sin# in the classroom& a pitcher brought in from the #itchen9. Water from a hand washing sin# is not used for bottle preparation. )nclude this bullet if the infant roo# has a food preparation area: The food preparation area has a sin# that is separated from the diaper changing area by 8what G eight feet of space G or G a solid barrier 2C inches in height from the counter surface9. Powdered formula in cans will be dated when opened and stored in a cool& dar# place. ,nused portions will be discarded or sent home one month after opening. 'ormula will be mi(ed as directed on the can. 'ormula will not be used past the manufacturer%s e(piration date. If prepared bottles are not warmed immediately& the bottles are stored in the refrigerator. 'ormula and breast mil# bottles are warmed 8how1where G under running warm water& in a bottle warmer& or in a container of water or croc# pot that is not warmer than -2/R'9. 8If a croc# pot is
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used& include this sentence= The croc# pot will be secured to a!oid it being #noc#ed off the counter.9 3ottles are ne!er warmed in a microwa!e. A microwa!e heats une!enly and can cause Jhot spotsK& posing a burn ris#. $icrowa!ing also destroys much of the nutritional component in breast mil#. 'ro"en breast mil# is thawed 8how G in the refrigerator& under warm running water& in a container of water less than -2/R'9 then warmed as stated abo!e. Thawed breast mil# will not be refro"en. The contents of any bottle not fully consumed within an hour are thrown away. 3ottles that ha!e been used don%t go bac# into the refrigerator. 3acteria begin to multiply once bottles are ta#en from the refrigerator and warmed. 'amilies are ad!ised to send se!eral small bottles or portions& enough for one day only& to minimi"e the amount of breast mil# or formula that is discarded. 3ottle nipples are #ept co!ered when not in use to reduce cross contamination. &OTTLE CLEANIN 3ottles& bottle caps& nipples& and other e uipment used for bottle feeding are pro!ided by the 8whom G parent1guardian& child care center9. These items will not be reused without first being cleaned and saniti"ed by 8how G washing in a dishwasherM or washing& rinsing& and boiling for one minuteM or the parent1guardian G parents are as#ed to bring enough bottles to last an entire day9. CARIN #OR &REA"T#E! IN#ANT" /OPTIONAL "ECTION0 )ur child care welcomes breastfed babies and acti!ely accommodates mothers nursing their babies. Staff #nows the benefits of breastfeeding for babies and moms. The staff encourages pregnant mothers to continue breastfeeding when returning to wor# or school. The 8title of person9 will pro!ide information and resources to new moms needing assistance with pumping& safe storage and transfer of breast mil#& and other support. Staff safely store and handle breast mil# brought into the center. The infant room 8or other appropriate space9 pro!ides comfortable places for nursing and pri!ate places for pumping. Staff is trained to de!elop a trusting relationship with all parents and caregi!ers. They help assist new moms and babies with the home to child care transition. They communicate often with parents& encourage parents to dropDin any time and understand the uni ue needs of the breastfed baby 8may need to feed more often& coordinating bottle feedings with mom%s !isits& delayed introduction to solid foods9. Staff is trained to create a positi!e feeding en!ironment for all infants and recogni"e and respond appropriately to infant feeding cues. IN#ANT #OO! "A#ETY When they begin to selfDfeed& infants% hands are washed with soap and water before eating. Staff members wash hands thoroughly before preparing any infant foods. Staff ne!er touches infant food with bare hands. 3aby foods are prepared 8where G by the food preparation sin# in
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the classroom& in the #itchen9. Cold water used for preparing baby foods is obtained from 8where G the designated food prep sin# in the classroom& a pitcher brought in from the #itchen9. Water from a hand washing sin# is 7)T used to prepare baby foods. )nclude this bullet if the infant roo# has a food preparation area: The infant food preparation area has a sin# that is separated from the diaper changing area by 8what G eight feet of space G or G a solid barrier 2C inches in height from the counter surface9. 3aby food is ser!ed from a dish with a clean spoon& not from the baby food 4ar. )pened baby food 4ars are #ept co!ered and refrigerated& and are discarded or sent home with the family after 2C hours. ,nconsumed baby food portions in the ser!ing bowl will be thrown away. IN#ANT AN! TO!!LER "OLI! #OO!" The center will wor# with the infantOs parent1guardian to de!elop a plan for the infantOs feedings that is acceptable to the parent1guardian. 7ew foods are ne!er introduced at the centerM the introduction of new foods is always done by the family first +Note: The 5#erican 5cade#y of /ediatrics reco##ends &aitin" to introduce solid baby food until the child is 6 #onths of a"e.* The center uses the following guidelines= Developmental (tage,$ge of Infant ,nder 0 months of age #ype of Feeding Ser!e only formula or breast mil# unless family pro!ides a written order from the childOs health care pro!ider. Continue ser!ing formula or breast mil#. Any substitution re uires a written order from the childOs health care pro!ider. A7D 3egin iron fortified baby cereal and plain pureed fruits and !egetables upon consultation with parents. Continue ser!ing formula or breast mil#. Any substitution re uires a written order from the childOs health care pro!ider. A7D Start small amounts of water in a cup. A7D +et baby begin to feed self. A7D Start semiDsolid foods such as cottage cheese& mashed tofu& mashed soft !egetables or fruits. Continue ser!ing formula or breast mil#. Any substitution re uires a written order from the childOs health care pro!ider.
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When baby can= 8at about 0 months9 Sit with support Hold head steady Close lips o!er the spoon :eep food in mouth and swallow it

When baby can= 8at about 0D> months9 Sit without support 3egin to chew Sip from a cup with help Arasp and hold onto things

When baby can= 8at about >D-/ months9 Ta#e a bite of food Pic# up finger foods and get them

into the mouth 3egin to hold a cup while sipping from it

A7D 3egin offering small pieces of cheese& tofu& chic#en& tur#ey& fish or ground meat. 3egin offering small pieces of soft coo#ed !egetables& peeled soft fruits. 3egin offering toasted bread s uares& unsalted crac#ers or pieces of soft tortilla. 3egin offering coo#ed plain rice or noodles. A7D Ser!e only formula& breast mil#& diluted 4uice or water in the cup. Continue ser!ing formula or breast mil#. Any substitution re uires a written order from the childOs health care pro!ider. A7D 3egin offering small si"ed& coo#ed foods. 3egin offering a !ariety of whole grain cereals& bread and crac#ers& tortillas. 3egin offering coo#ed soft meats& mashed legumes 8lentils& pinto beans& #idney beans& etc.9& coo#ed egg yol#s& soft casseroles.

When a baby can= 8at about -/D-2 months9 'inger 'eed Chew and swallow soft& mashed and chopped foods Start to hold and use a spoon Drin# from a cup

When a baby can= 8about -2 months9 )ffer small amounts of formula& breast mil# *at a !ariety of foods from all food or water in the cup during meals. groups without signs of an allergic A7D reaction 3egin offering whole mil#. 3egin offering fruit pieces and coo#ed !egetables. 3egin offering yogurt and cheese slices. Crac#ed high chair trays or tableDtops are not appro!ed for food ser!ice. Infant finger food can be placed directly on an appropriate& clean& saniti"ed high chair tray. Staff members face infants and allow them to control the pace of the feeding. Toddlers will eat from plates& ha!e a paper nap#in& and de!elopmentally appropriate utensils. Staff members ser!ing or preparing food wear glo!es and use tongs or spoons to minimi"e bare hand contact. 7o egg whites 8allergy ris#9 or honey 8bacteria ris#9 will be gi!en to children less than -2 months of age. Euice will be limitedM it will only be offered in a cup and always diluted.

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NAPPIN PRACTICE" #OR IN#ANT" AN! TO!!LER" Children 2? months of age or younger will be allowed to follow their indi!idual sleep pattern. Alternati!e& uiet acti!ities 8no T6 or !ideo9 will be pro!ided for the child who is not napping. Sleeping schedules are discouraged. Howe!er& parents may re uest that an infant be wo#en up if sleeping more than < hours. This may be necessary to assist with the infant%s 2CDhour sleep1wa#e cycle. A 8what G crib& basinet& play yard& etc9 will be furnished for napping. When the child care pro!ider and parent agree& and the infant can safely do so& transitioning to a mat or cot will happen. Note: if children sleep in so#ethin" other than cribs% #a!e all necessary chan"es in this section. 3ecause infants sleeping on their stomachs are at a higher ris# of death from Sudden Infant Death Syndrome& S.I.D.S.& the following will ta#e place at this center= Infants will sleep on their bac#s unless they roll o!er themsel!es. Infants are not awa#ened to return them to their bac#s if they roll o!er themsel!es. Crib sheets will fit the mattress snugly and securely in all corners and sides. Cribs will not contain bumper pads& pillows& soft toys& fleece& cushions& or thic# blan#ets. )nly one thin blan#et will be used and #ept no higher than chest le!el. The blan#et will be tuc#ed around the foot of the mattress. Soft bedding and toys will not be allowed in cribs. Hanging mobiles will be remo!ed once the child is able to sit up and1or reach the mobile. Should a parent or legal guardian re uest an alternate sleep position it must be specified in writing by the parent1guardian and the child%s health care pro!ider. )f you use so#ethin" other than cribs% re#ove this section. Cribs will meet the following safety re uirements= constructed with !ertical slats that are no more than 2 <1> inches apart or ha!e solid barriers& such as Ple(iglas corner posts will be the same height as the side and end panel no cutout designs sturdy and in good repair 8no sharp edges& points& unsealed rough surfaces& splinters& peeling paint& crac#s& missing1bro#en parts9 mattresses will be firm& snug fitting& intact& and waterproof& and will fit snugly against the crib frame )f you use so#ethin" other than play yards% re#ove this section. Play yards will meet the following safety re uirements= ha!e no holes in the netting play yards will be sturdy and in good repair play yards will be chec#ed to ensure they ha!e not been recalled due to sides that do not properly loc#& protruding bolts& or other safety concerns

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3ecause sleeping in infant seats or swings ma#es it harder for infants to breathe fully and may inhibit gross motor de!elopment& infants will not sleep in car seats& swings& and infant seats. Children who arri!e at the center asleep in car seats will be immediately transferred to their crib. Cribs and play yards will be spaced at least </ inches apart or separated by a solid barrier& such as Ple(iglas. +ight le!els will be high enough so children can be easily obser!ed when sleeping. Cribs will not be located directly under windows unless windows are constructed of safety glass or ha!e an applied polymer safety coating. The center will ha!e at least one e!acuation crib for e!ery C infants. *!acuation cribs will ha!e= four inch or larger wheels a reinforced bottom space for a ma(imum of four infants per crib $rite here any additional policies related to infant and toddler nappin": ;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;; ;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;; ;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;; ;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;; ;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;

!IAPERIN
Diapers are changed at the changing station only. The center%s diaper changing station8s9= has a moistureDimper!ious surface has a protecti!e barrier that is at least <.B inches high has a footDoperated garbage can is on moisture imper!ious flooring is located ad4acent to a hand washing sin# is 8where in relation to food preparation areas G located > feet away from food preparation areas& has a solid barrier between the changing station and food preparation areas9 does not ha!e safety belts The diaper changing procedure is posted. The proper diaper changing procedure is as follows= Wash hands. +optional* Put on disposable glo!es. Aather necessary materials and ha!e them in reach. +optional* Co!er surface with paper. Place child on the changing table and remo!e diaper. Clean child%s bottom with diaper wipes. Wipe from front to bac#. ,se only one swipe per diaper wipe.
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.emo!e disposable glo!es and use them to wrap up dirty items. Discard all dirty items in a footDoperated step can. Pro!ider wipes own hands with a wet wipe. Diaper and dress the child. Wash the child%s hands with soap and water. 'or infants younger than 0 months& a diaper wipe can be used to wipe off the child%s hands. .eturn child to a safe area. .emo!e and discard paper. If !isible soil is present& clean with soapy water& and then rinse with water. Saniti"e the changing table and any e uipment or supplies you touched with 8what G bleach water solution& name of other disinfectant9. Allow one minute of contact time with the disinfectant. Wash hands with soap and water.

Children are not left unattended during the diaper changing procedure. 7othing but the child& changing pad 8& paper9& and diaper supplies is placed on the changing table& counter& or sin#. The changing surface is not used for other acti!ities& including writing. *ach diaper change is recorded on a 8name of diapering log9. Disposable diapers are remo!ed from the facility and the garbage liner is changed daily and more often if necessary. These diapers are disposed of with curbside garbage. Note: re#ove if reusable diapers are not used. .eusable diapers are not rinsed& are indi!idually bagged& and are 8what G gi!en to a commercial ser!ice& sent to a laundry& or returned to the parent or guardian9. Soiled clothing is not rinsed& is indi!idually bagged& and is returned to the parent or guardian.

#OO! "ER'ICE
This section should specifically reflect ho& and &here you prepare foods. <or e.a#ple% if only snac!s are served% this #ust be clearly stated and described. -upply as #uch detail as possible for this section. Contact your local health depart#ent child care health consultant if you need assistance &ith this section. #OO! PREPARATION #ACILITY This center prepares food 8whereM e(amples include the center #itchen& indi!idual classrooms& staff lounge& etc9. The following items and e uipment are present in the food preparation area8s9= 8.emo!e all items that do not apply9 W .efrigerator8s9 W 'ree"ers8s9 <Dcompartment sin# 2Dcompartment sin# separate handwashing sin#
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o!en and sto!e commercial dishwasher residentialDtype dishwasher microwa!e ade uate counter space LLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLL

#OO! "UPPLY This center purchases food from 8where9. All food meets the following criteria= All food that is past the e(piration date is discarded. Se!erely dented cans are discarded. )nly pasteuri"ed mil# and 4uice is ser!ed. Choose 1 option: Children 8may1must9 bring sac# lunches from home. Parents are e(pected to supply nutritional food for their child%s sac# lunch. G ). G Sac# lunches are not allowed at this center. *(ceptions are made for children with special dietary needs. All food ser!ed is prepared at the center%s #itchen 8or other locationS9. HomeD prepared foods 8other than sac# lunches9 are not permitted at this center. :ptional: The center uses only preDcoo#ed chic#en and ground beef. +efto!er foods are defined as pre!iously prepared food that has not been ser!ed and were stored at the proper temperature. Choose 1 option: 7o lefto!er foods are ser!ed. G ). G ,nDser!ed foods that are remo!ed from the original pac#aging are stored at the proper temperature. +efto!er foods in the refrigerator are labeled with the date that they were opened and are ser!ed or discarded within C> hours. This center does 7)T ser!e lefto!ers that re uire preparation or coo#ing. G ). G +efto!er foods that ha!e been coo#ed will be properly cooled and reheated. ,nDser!ed foods are stored at the proper temperature. +efto!er foods or opened foods in the refrigerator are labeled with the date that they were prepared or opened and are ser!ed or discarded within C> hours. )f the center receives food fro# another site% that is considered caterin" and this section #ust be included and follo&ed. This center recei!es food from a permitted catering facility. The center follows WAC -H/D2?BD<->/ regarding who can cater the center%s food. These steps are followed to assure the safety of the food= ,pon deli!ery& the food is chec#ed with a stem thermometer. Any food that does not arri!e at the proper temperature will be refused. 'ood is labeled with the date upon arri!al. Documentation on this catering facility is #ept 8where9. This documentation is #ept for the pre!ious 0 months and includes= o a copy of the catering permit o the name and temperature of the food upon arri!al o the date and time the temperature was chec#ed o the name and signature of the person who is chec#ing and recording the food temperatures
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This center has a bac#Dup system if the food does not arri!e& if the food arri!es at an improper temperature& or if for some other reason that the food cannot be ser!ed. This bac#up system is 8describe system9.

#OO! "TORA E 'ood is stored away from and ne!er below #itchen chemicals. .aw meats and unpasteuri"ed eggs are stored away from and below all other foods. All food items are stored off the floor. Dry food items are stored 8whereM in cabinets& on shel!es& in a different room& in a shed& etc9. All dry goods are stored in labeled containers with tightD fitting lids. These containers are labeled with the date when the item was opened. All refrigerated foods are #ept sealed or co!ered 8e(cept when cooling foods to C-R'9. All refrigerated foods are dated. TEMPERATURE CONTROL .efrigerators and free"ers ha!e thermometers placed in or near the door. .efrigerator temperature is maintained at C-o' or less. The refrigerator temperature is chec#ed daily and is recorded on a 8name of form9. 'ree"er temperatures are maintained at -/ o' or less. 'oods are coo#ed to the correct internal temperature as follows= poultry X -0Bo' ground beef and ground por# X -BBo' beef X -CBo' por# X -CBo' eggs X -CBo' fish 5 seafood X -CBo' coo#ed !egetables X -C/o' 'ood temperatures will be monitored using a stem thermometer. The stem thermometer is stored 8where9 and is calibrated 8how often9. Hot holding food= hot food will be held at a temperature of -C/ o' or abo!e until ser!ed. Cold holding food= food re uiring refrigeration will be held at a temperature of C- o' or less until ser!ed. )f the center uses a #icro&ave% include this para"raph. If the microwa!e is used to heat food= the food is rotated and stirred during heating the food is co!ered to retain moisture the internal temperature is monitored and coo#ed until the food reaches the proper coo#ing temperature listed abo!e the food is allowed to sit for 2 minutes prior to ser!ing to allow the temperature to spread e!enly throughout the food
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Thawing of fro"en foods is done= by placing in the refrigerator& by placing in a pan in the sin# with cool water running o!er the food& during the coo#ing process if the food is to be coo#ed immediately& or in the microwa!e )f sac! lunches are brou"ht fro# ho#e% include this para"raph. Sac# lunches from home are #ept cool to pre!ent bacteria growth. Choose one of the follo&in": Parents are e(pected to include an ice pac#& gel pac#& fro"en 4uice bo(& ice cubes in a lea#Dproof container& or other cold product to #eep the lunch at a cool temperature. G ). G Staff will chec# sac# lunches from home and refrigerate any lunches that contain any of the following items= meat products& sliced fruit or !egetables& dairy products& other perishables. HAN!LIN LE#TO'ER" )nclude this section only if the center serves coo!ed leftovers. 3efore storing coo#ed foods& the food is cooled by +choose one of the follo&in"* Placing food in shallow containers 2K deep or less. +ea!e unco!ered and immediately put the pan into the refrigerator on a top shelf. G ). G Cooling to H/o' within 2 hours and then to C-o' within C additional hours. Temperatures during the cooling process will be ta#en and recorded e!ery hour. )nce they ha!e cooled to a temperature of C- o' or less& the food is co!ered& dated& and stored in the refrigerator. Pre!iously prepared foods may be reheated one time only to an internal temperature of -0B o' within 0/ minutes. +efto!ers that were prepared more than C> hours ago are discarded. #OO! HAN!LIN All staff will wash hands with soap and water at a designated hand washing sin# prior to preparing or ser!ing food& e!en if food ser!ice glo!es are worn. Ill staff will not prepare or handle food. This center maintains a U7o 3areDHand Contact% rule when handling readyDtoDeat foods. The coo# wears glo!es or uses utensils when preparing readyDtoDeat foods. Alo!es are changed when they become contaminated. Staff in the classrooms wear glo!es or use utensils when ser!ing food to the children. )f the center serves #eals or snac!s fa#ily-style% include the follo&in" para"raph. When meals are ser!ed familyDstyle& children use utensils to ser!e themsel!es. Steps are ta#en to ensure

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children only touch their own food. Children are super!ised so that they do not touch each other%s food. Staff members sit with the children during meals and snac#s. In addition to food preparation& the coo# has the following responsibilities at the center G +ist responsibilities here. The coo# does not change diapers unless all food preparation has been completed for the day. :ptional: The coo# does not substitute in infant or toddler rooms unless all food preparation is completed for the day. +ITCHEN CLEANIN AN! "ANITI-IN All chemicals and cleaning supplies are stored away from and below food and food preparation areas. All chemicals are stored in their original containers. All spray bottles are labeled with the contents and the date. To ensure food safety& the #itchen will be #ept clean. .efrigerators will be cleaned and saniti"ed monthly& or more often as needed. Tabletops where the children eat are washed and saniti"ed before e!ery meal and snac#. :itchen counters& sin#s& and faucets will be washed& rinsed& and saniti"ed daily before any food preparation and as needed during food preparation. Sponges are not used on food contact surfaces. Cutting boards will be washed& rinsed& and saniti"ed between each use. All dishes& cups& utensils& etc. will be washed 8how G ,sing a threeDstep method whereby dishes are washed with soap and water& rinsed& and then saniti"ed with 8name of saniti"er9& or in an automatic dishwasher capable of reaching -C/ o'& or in an automatic dishwasher that saniti"es the dishes with 8name of chemical G bleach& iodine& uaternary ammonia9. #OO! ,OR+ER E!UCATION Choose one of the follo&in" three para"raphs to include in your plan. This center%s coo# has a current Washington State 'ood Wor#er Card. The coo# o!ersees the food handling at the center. +Note: )f so#eone else oversees the food handlin"% then both that person 5N0 the coo! #ust have food handler=s cards.* He1She will pro!ide orientation and onD going training as needed for all staff in!ol!ed in food handling. Documentation will be posted 8where9. D ). D The coo# and at least one staff member per classroom ha!e current Washington State 'ood Wor#er Cards. The coo# 8or other designated person9 will pro!ide orientation and onDgoing training as needed for all staff in!ol!ed in food handling. Documentation will be posted 8where9. D ). D All staff members preparing or ser!ing food ha!e a Washington State 'ood Wor#er Card. Documentation will be posted 8where9.

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NUTRITION
)f parents provide food for their children% include this para"raph. When parents pro!ide their children meals or snac#s& they must meet the nutritional re uirements as outlined by the Washington State $eal Pattern for Child Care. If the meal pro!ided does not meet nutritional re uirements& the center will supplement the meal with the missing components. The center will help the parent pro!ide more nutritionally ade uate meals in the future by 8how9 +e.a#ples: "ivin" parents a /ac!-a--ac! brochure fro# the Child Care >ealth /ro"ra#% sendin" ho#e a su##ary of &hat a sac! #eal #ust contain% etc.* )f parents are allo&ed to brin" in food for special occasions% include this para"raph. Parents are allowed to bring in snac#s for all the children that may not meet the nutritional re uirements on special occasions such as birthdays. The snac#s pro!ided by parents must be limited to store purchased uncut fruits and !egetables and foods prepac#aged in original manufacturer%s containers. 3efore bringing in the food for a special occasion& parents1guardians must discuss the food choices with staff to address any food safety and allergy concerns. )nly pasteuri"ed mil# or pasteuri"ed dairy products are ser!ed. 7ondairy mil# substitutions will only be ser!ed with written permission from the child%s 8parent G or G health care pro!ider9 for children o!er the age of twel!e months. The 8center will G or G parents must9 pro!ide an appropriate mil# substitute 8such as calciumDfortified rice mil# or soymil#. The amount of re uired mil# fat in the mil# product is determined by the childOs age= If the age of the child is ,nder -2 months #hen the fat content of the mil> must be 'ull strength formula or full strength breast mil# unless there are specific written instructions from a licensed health care pro!ider.

3etween -2 months 'ull strength whole mil# or breast mil# unless there is specific and 2C months written instruction from a licensed health care pro!ider. )!er 2C months With fat content of pro!ider%s or parent%s choiceM 2P or -P is recommended by pediatricians

The center will prepare& date& and conspicuously post menus of snac#s and meals at least one wee# in ad!ance. The center uses a 8how many G note: #ust be 2 or #ore9 wee# cycle menu& with no repeated meal1snac# combinations& to ensure !ariety. The past menus will be #ept onD site for 0 months. If needed& substitutions of comparable nutrient !alue may be made and any changes will be recorded on the menu. The menu will= consist of a wide !ariety of foods that are low in fat& sugar& and salt place emphasis on ser!ing fruits and !egetables often include a 6itaminDC rich food e!ery day include 6itaminDA rich foods three or more times each wee# :ptional: include a protein or dairy for each afternoon snac# :ptional: incorporate ethnic& cultural& and seasonal foods regularly
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$eals and snac#s will be ser!ed e!ery 2 to < Y hours. The following meals1snac#s are pro!ided by the center= Time= $eal1Snac# LLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL )f the center serves brea!fast% include the follo&in" section. +Note: )t is reco##ended to serve a brea!fast if the center opens before ?:00*. *ach brea#fast meal contains= a fruit or !egetable 8the center ser!es fruit instead of 4uice most often9 a dairy product 8such as mil#& cheese& yogurt& or cottage cheese9 a grain product 8such as bread& cereal& rice ca#e& or bagel9 *ach lunch and dinner meal contains= a dairy product 8such as mil#& cheese& yogurt& or cottage cheese9 meat or meat alternati!e 8such as beef& fish& poultry& legumes& tofu& or beans9 a grain product 8such as bread& cereal& rice ca#e& or bagel9 fruits or !egetables 8two fruits& two !egetables& or one fruit and one !egetable to e ual the total portion si"e re uired9 *ach snac# contains two of the four components= a dairy product 8such as mil#& cheese& yogurt& or cottage cheese9 meat or meat alternati!e 8such as meat& legumes& beans& egg9 a grain product 8such as bread& cereal& rice ca#e& or bagel9 fruit or !egetable *ach snac# or meal includes a li uid to drin#. The drin# could be water or one of the re uired components such as mil# or fruit1!egetable 4uice. When 4uice is ser!ed in place of a fruit or !egetable it must be one hundred percent fruit or !egetable 4uice. If a child has a food allergy or special dietary need& the parent and the child%s health care pro!ider will identify a protocol for managing the child%s special dietary need. The center will de!elop an allergy management plan or an indi!idual care plan with parent input for the child. This plan will include 8describe: information on alternati!e foods with comparable nutriti!e !alue& a re uirement that the parents must supply food for the special diet& etc.9 $ealtime and snac# time will support children%s de!elopment of healthy eating habits. 'or safety and roleDmodeling& staff members sit& eat& and ha!e casual con!ersations with children during mealtimes. Staff members are trained in helping ser!e food familyDstyle. Coffee& tea and other hot be!erages will not be consumed by staff while children are in their care& in order to pre!ent scalding in4uries. Staff will not consume pop or other nonDnutritional
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be!erages while children are in their care. During meal and snac# times& staff will eat only those foods that are ser!ed to the children.

PHY"ICAL ACTI'ITY
All children birth to age fi!e should engage in daily physical acti!ity that promotes fitness for health and mo!ement s#ills. Promoting and fostering en4oyment of mo!ement and motor s#ill competence and confidence at an early age helps to ensure that children de!elop acti!e& healthy habits. Current research also shows that regular physical acti!ity of infants and young children is an important component of early brain de!elopment and learning. )ur center follows the 7ASP* guidelines for physical acti!ity for children age birth to fi!e 8Acti!e Start& 7ASP*& 2//29= IN#ANT" +Re#ove this section if center does not care for infants* Positi!e early mo!ement e(periences increase the infant%s chances of achie!ing full de!elopmental potential throughout life. Infants will= be placed in a safe setting 8name areas= carpeted floor& mats& sectionedDoff areas etc9 that encourages e(ploration and does not restrict mo!ement for prolonged periods of timeM Container use will be limited to 8name time frame9 G ). G This center does not use any containers e(cept for highDchairs when solid foods are introduced. ha!e help from staff to facilitate mo!ement by= o recei!ing regular& attenti!e interaction 8using facial& !erbal and nonD!erbal e(pressions9 that encourages playful acti!ity o ha!ing an open en!ironment suitable for the e(ploration and de!elopment of rolling o!er& reaching& sitting& crawling& creeping and standing o ha!ing daily Jtummy timeK G placing infant on his1her tummy to promote wiggling and scooting which contributes to large motor s#ill de!elopment TO!!LER" With ample opportunity for e(ploration and learning& basic mo!ement s#ills li#e running& 4umping& throwing& and #ic#ing will de!elop. Toddlers will= not be sedentary for more than 0/ minutes at a time e(cept when sleeping get at least </ minutes of staff guided& playful acti!ity that contributes to the de!elopment of mo!ement s#ills 8wal#ing& 4umping& hopping& sideDstepping etc9 ha!e opportunities throughout the day 8se!eral hours9 for unstructured physical acti!ities and play in a safe area both indoors and outdoors that promotes e(ploration and playful practice of mo!ement s#ills P*E(C!OO&E*( $'D P*E"?I'DE*-$*#E' Instruction and positi!e reinforcement is critical during this time in order to ensure that children de!elop gross motor and mo!ement s#ills before entering school. Children < G B will= not be sedentary for more than 0/ minutes at a time e(cept when sleeping accumulate at least 0/ minutes of guided& structured acti!ities that encourage playful practice of mo!ement s#ills in a !ariety of acti!ities and settings
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engage in at least an hour and up to se!eral hours of unstructured physical acti!ities in a safe area both indoors and outdoors suitable for large muscle acti!ities 8gross motor mo!ement9

!I"A"TER PREPARE!NE""
This center has de!eloped a disaster preparedness policy. See the 8title of center%s comprehensi!e disaster plan9. This plan is located 8where9 and a copy is #ept in the disaster #it. Parents should read& re!iew& sign& and date the plan upon enrollment and annually thereafter. Annually& staff and parents1guardians will be oriented to this disaster policy and documentation of staff orientation will be #ept in the disaster plan manual. The 8title of person9 will be responsible for orienting new staff or substitutes to these plans. Procedures for medical& dental& poison& earth ua#e& fire& and other emergency situations will be posted in each classroom. These plans include= which staff is responsible for each part of the plan procedure for accounting for all children during and after an emergency e!acuation routes and meeting location Indi!iduali"ed Care Plans for children with special needs how children will be cared for until parents are able to pic# them up how contact will be made with parents1guardians when normal lines of communication are not a!ailable transportation arrangements& if necessary 'ire drills are conducted monthly& as per the state fire marshal in WAC 2-2D-2. Documentation& including date and time of the drill and a debriefing1e!aluation of the drill& is #ept 8where9. Disaster and earth ua#e preparation and pre!ention training are documented. Staff members recei!e training on how to use the fire e(tinguisher 8how often9 by 8whom9. Fuarterly& the center conducts and documents a disaster drill. )ne type of disaster will be chosen for staff and children to practice& such as earth ua#e or intruder alert. Parents will be notified of the drill. 'ood& water& medication& and supplies for H2 hours of sur!i!al are a!ailable for each staff and child. These supplies are stored 8where9 and are chec#ed 8how often9.

"TA## HEALTH
TU&ERCULO"I" /T&0 7ew employees must ha!e the results of a one step $antou( Tuberculin 8T39 s#in test prior to starting wor#. The new employee doesn%t need the test if=
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they ha!e had a documented negati!e T3 s#in test within one year prior to employment they ha!e had a positi!e T3 s#in test in the pastM they will always ha!e a positi!e s#in test& despite ha!ing undergone treatment. These employees do not need documentation of a s#in test. Instead& documentation must be on record that the employee has had a negati!e 8normal9 chest (Dray& or documented proof of treatment.

Staff must be reDtested for T3 when the center is notified that any staff has been e(posed to T3. The center will comply with the public health department for followDup. OTHER ILLNE"" Staff members who ha!e a communicable disease are e(pected to remain at home until the period of communicability has passed. Staff will also follow the same procedures listed under J*(clusion of Ill ChildrenK in this policy. The 8title of person9 will re!iew the 8name of center%s 3loodborne Pathogen *(posure Control Plan9 with each staff person within -/ days of hire. Staff are offered the Hepatitis 3 !accine series 8whenM upon employment G or G within 2C hours of a bloodborne pathogen e(posure e!ent9. Staff immuni"ations will be recorded upon employment. .ecommendations of immuni"ations for child care pro!iders will be a!ailable to staff. OTHER HEALTH I""UE" Adult si"ed bathrooms will be onDsite. Staff recei!e training on topics li#e stress management and body mechanics. Separate space will be pro!ided for staff to wor# or ta#e brea#s. This space is a!ailable 8where9. :ptional: Step stools will be pro!ided for children to reach the sin# and diaper changing table 8with super!ision9 to help protect employees% bac#s. Staff members who are pregnant or considering pregnancy should inform their health care pro!ider that they wor# with young children and discuss possible ris#s. 'or staff who become stressed or frustrated& the following will be pro!ided 8describe what is a!ailable9.

CHIL! A&U"E AN! NE LECT

Any instance when staff ha!e reason to suspect the occurrence of any physical& se(ual& or emotional child abuse or neglect& child endangerment& or child e(ploitation as re uired under .CW chapter 20.CC& a report is filed by the staff directly in!ol!ed with the child. The child%s file is on hand when placing the call. Call -D>00D*7DHA.$& 8-D>00D<0<DC20H9 or the local C.P.S. office at C2BD<<?D-></. The witnessing staff person will ma#e the call& with the assistance of the
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8title of responsible person9 if needed. The 8title of responsible person9 will contact the licensor immediately after a report of abuse is made. If there is an immediate danger to a child& a report is made to local law enforcement. Signs of child abuse or neglect are recorded on the 8name of report form9& which are located 8where9. Documentation of staff orientation or training on the indicators of child abuse and neglect are #ept in staff files. .egular trainings occur e!ery 8how fre uently9.

CHIL!REN ,ITH "PECIAL NEE!" / INCLU"ION

Children with special needs are accepted into the program under the guidelines of the Americans with Disabilities Act 8ADA9. Confidentiality is assured with all families and staff in the program. All families are treated with dignity and with respect for their indi!idual needs and1or differences. A written 8name of formM e(amples include Indi!idual Care Plan& Plan of Care& Children with Special 7eeds 'orm& etc9 is de!eloped by the director& parent1guardian& and teacher for each child with special needs. It includes instructions from the parent and health care pro!ider regarding medications& specific food or feeding re uirements& lifeDthreatening allergies& treatments& and special e uipment or health needs. The parent pro!ides training to staff on any procedures that will be done to the child while in care. This written plan of care is updated 8how often9 or sooner if needed. The director see#s further information or training if necessary for center staff from local resources. Snohomish Health District 7utritionist will be contacted for consultation and instructions on handling food allergies or special menu re uirements This plan includes how the child%s special need would be met in the case of a disaster. At a minimum the center will plan for the child to stay at the center for H2 hours without being able to contact the child%s parents. Children with special needs are gi!en the opportunity to participate in the program to the fullest e(tent possible. This is accomplished by consulting with outside agencies1organi"ations as needed. The center cooperates with other agencies that can pro!ide ser!ices to the child onD site. The center has a policy as to how they try to accommodate an undiagnosed special need in which a parent refuses to see# medical and1or de!elopmental assessment and inter!ention for their child. All staff members recei!e general training on wor#ing with children with special needs and updated trainings on specific special needs that are encountered in their classrooms. Describe how staff training is trac#ed and documented.

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&EHA'IOR MANA EMENT/ UI!ANCE PRACTICE"

Teaching staff follow the center%s beha!ior management and guidance practices& which are based on 8what principles G describe9. 7oise le!els in the center are #ept low& so that teachers can be heard without the need to raise their !oices. Staff members get to #now each indi!idual child%s needs and stage of de!elopment and guide each child accordingly. Staff point out positi!e social interactions rather than only focusing on negati!e beha!ior. Staff help children problem sol!e when conflicts arise. Staff members e(hibit a range of techni ues such as ignoring& conse uences& coolDoff& and reDdirecting when beha!ior issues occur. Describe other beha!ior management practices briefly or refer to parent handboo#. 3eha!ior plans are implemented in coordination with the parent1guardian when necessary. Community resources are consulted when needed. Teaching staff recei!e the following training on beha!ior management= Describe the beha!ior training that teaching staff recei!e. Include information on the fre uency of this training and who pro!ides the training 8such as Child Care .esource 5 .eferral& Snohomish Health District Distance +earning& Compass Health& local hospitals& independent STA.S trainers9.

ANIMAL"
)nclude this section only if the child care has ani#als on-site. Animals in this center will be carefully chosen in regards to care& temperament& health ris#s& and appropriateness for young children. The following animals are onDsite at the child care= 8+ist what animals and where they are and potential health ris#s associated with these animals9 LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL )ccasionally an animal may !isit the child care. Prior to any animals !isiting the child care& parents will be informed of the date and time of the animal%s !isit and any potential health ris#s by 8how9. 'or additional child care animal information& including cleaning and handwashing policies& please refer to this center%s 8Title of pet policy& such as JCare and Handling of PetsK9 which is #ept 8where9.

'I"ITIN

ANIMAL POLICY
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)nclude this section only if the child care has n1 ani#als on-site. :ther&ise delete.

This child care program does not ha!e any pets onDsite. Parents1families are discouraged from bringing their pets onDsite. In the rare e!ent that an animal is !isiting the site& or if the children ha!e contact with animals while on a field trip& the following policies will be implemented= Parents will be notified& in writing& of the type of animal that will be !isiting and any potential health ris#s associated with that animal by 8how9. The site director will ensure that no children are allergic to the animal. The site director will ha!e primary responsibility of super!ising all acti!ities associated with the animal%s !isit as related to safety and hygiene. This includes ma#ing sure that the animal has an acceptable temperament for interactions with children and that the animal is current on all !accinations 8if appropriate9. Any animal that has a history of biting or other aggressi!e beha!iors will not be allowed onDsite. The animal will be properly cared for while onDsite. This is the responsibility of the !isiting animal%s owner. The animal will not be allowed in any food preparation areas. Items associated with the animal& including cages& food& water& etc.& will not be placed on foodDcontact surfaces. Children will be closely super!ised while handling the animal. Children will be in small groups of < or fewer while handling the animal. Children will immediately wash hands after handling or feeding the animal. Handwashing will be closely super!ised by staff. After the animal lea!es the site& staff will clean and saniti"e the area. Sin#s that are used for food preparation or cleaning dishes are not used to clean animal supplies or cages. If necessary& animal supplies will be cleaned 8in which sin# G preferably a 4anitorial or utility sin#9. Staff will wash hands after cleaning and saniti"ing the area.

TRAN"PORTATION "A#ETY
)nclude this section if the child care transports children. :ther&ise delete. All !ehicles will be maintained in good operating condition. A safety chec# will be done 8how often9 by the dri!er. All !ehicle maintenance is conducted by 8who9. 6ehicles will be properly licensed and insured. ChildDadult ratios will be maintained in !ehicles. All adults and children riding in the !ehicle will use ageDappropriate safety restraints 8seatbelts& car seats& booster seats9. .estraints for children with special needs will be appropriate for the child. Car seats and booster seats are pro!ided by 8the center G or G parents1guardians9. To ensure car seats and booster seats are properly installed& 8describe steps ta#en G e(amples include ta#ing !ehicle with seats installed to a car seat safety chec# location& insisting parents pro!ide car seat installation information from the manufacturer& etc.9. All !ehicles will contain a first aid #it& 8type of communication G cell phone& two way radio9 as a means of communication& emergency supplies for children with special needs 8e(ample= *piPen or inhaler9& and all children%s emergency information. Dri!ers will not use cell phones while operating the !ehicle.
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Signed field trip permission slips are #ept onDsite at the center. Dri!ers will ha!e a current dri!er%s license& bac#ground chec#& and CP.1 'irst Aid training. Dri!ers recei!e training on safe !ehicle operation from 8who9. This training consists of 8describe training9.

-ee ne.t pa"e for si"nature pa"e

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'ame of Center
Health Policy .e!iew $onth& 2/-/

"I NATURE"
This program%s health policies ha!e been re!iewed as complete. The signing of the document does not imply obser!ation of procedures in practice& nor the uality of the program. I ha!e re!iewed these health policies and they appear to meet minimum licensing re uirements de!eloped by the Washington State Department of *arly +earning for child care facilities certified by them.

.e!iew Date=

L$)7TH and dayLLL2/-/ .e!iewed by=LLLLLLLLLLLLLLLLL Alba SuZre"& .7& 3S7 .egistered 7urse

.e!iewed by=LLLLLLLLLLLLLLLLLLL $icha Horn&*HS *n!ironmental Health Specialist

LLLLLLLLLLLLLLLLLLLLLLL Director%s 7ame Director& 7ame of Center

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