Minimum Health and Safety Standards Minimum Health and Safety Standards: A Guide for American Indian and Alaska Native Child Care and Development Fund Grantees CCDF Health and Safety Requirements Revised October 2018 Minimum Health and Safety Standards Minimum Health and Safety Standards: A Guide for American Indian and Alaska Native Child Care and Development Fund Grantees Contents Introduction 6 Health and Safety Requirements in the CCDF Final Rule 6 Minimum Standards for Health and Safety in AI/AN Child Care 7 I. Prevention and Control of Infectious Disease 8 CCDF Final Rule Requirements, 45 C.F.R. § 98.41(a)(1)(i) 8 Recommended Minimum Standards 9 Routine Oral Hygiene Activities 9 Diaper-Changing Procedure 10 Situations That Require Hand Hygiene 10 Routine Cleaning, Sanitizing, and Disinfecting 11 Prevention of Exposure to Blood and Body Fluids 11 Inclusion, Exclusion, and Dismissal of Children 12 Infectious Disease Outbreak Control 12 Immunization Documentation 13 Unimmunized Children 13 Immunization of Caregivers and Teachers 14 II. Prevention of Sudden Infant Death Syndrome and the Use of Safe Sleep Practices 14 CCDF Final Rule Requirements, 45 C.F.R. § 98.41(a)(1)(ii) 14 Recommended Minimum Standards 15 Safe Sleep Practices and SIDS Risk Reduction 15 III. Administration of Medication, Consistent with Standards for Parental Consent 15 CCDF Final Rule Requirements, 45 C.F.R. § 98.41(a)(1)(iii) 16 Recommended Minimum Standards 16 Medication Administration and Storage 16 Training of Caregivers and Teachers to Administer Medication 17 IV. Prevention of and Response to Emergencies due to Food and Allergic Reactions 17 CCDF Final Rule Requirements, 45 C.F.R. § 98.41(a)(1)(iv) 17 Recommended Minimum Standards 18 Care of Children with Food Allergies 18 Availability of Drinking Water 18 Preparing, Feeding, and Storing Human Milk 18 Preparing, Feeding, and Storing Infant Formula 19 October 2018 2 Minimum Health and Safety Standards Warming Bottles and Infant Foods 19 Foods That Are Choking Hazards 20 Food Preparation Area Access 20 Compliance with U.S. Food and Drug Administration (FDA) Food Code and State and Local Rules 20 V. Building and Physical Premises Safety, Including Identification of and Protection from Hazards, Bodies of Water, and Vehicular Traffic 20 CCDF Final Rule Requirements, 45 C.F.R. § 98.41(a)(1)(v) 20 Recommended Minimum Standards 21 Supervision near Water 21 Use of Tobacco, Alcohol, Marijuana, and Illegal Drugs 21 Sun Safety, Including Sunscreen 22 Strangulation Hazards 22 Inspection of Buildings 22 Compliance with Fire Prevention Code 22 Environmental Audit of Site Location 23 Guardrails and Protective Barriers 23 Safety Covers and Shock Protection Devices for Electrical Outlets 23 Location of Electrical Devices near Water 23 Integrated Pest Management 24 Carbon Monoxide Detectors 24 Safety of Equipment, Materials, and Furnishings 24 Availability and Use of a Telephone or Wireless Communication Device 25 Cribs and Play Yards 25 Firearms 26 Location of Play Areas near Bodies of Water, Enclosures for Outdoor Play Areas, and Enclosure of Bodies of Water 26 Prohibited Surfaces for Placing Climbing Equipment 27 Inspection of Indoor and Outdoor Play Areas and Equipment 27 Lifesaving Equipment 28 Water in Containers 28 Sign-In and Sign-Out System 28 Authorized Persons to Pick Up Child 28 VI. Prevention of Shaken Baby Syndrome, Abusive Head Trauma, and Child Maltreatment 28 CCDF Final Rule Requirements, 45 C.F.R. § 98.41(a)(1)(vi) 29 Recommended Minimum Standards 29 Child Abuse and Neglect Education 29 Prohibited Caregiver and Teacher Behaviors 29 Preventing and Identifying Shaken Baby Syndrome and Abusive Head Trauma 30 VII. Emergency Preparedness and Response Planning for Emergencies 30 CCDF Final Rule Requirements, 45 C.F.R. § 98.41(a)(1)(vii) 31 October 2018 3 Minimum Health and Safety Standards Recommended Minimum Standards 31 Emergency Procedures 31 First Aid and Emergency Supplies 32 Written Plan and Training for Handling Urgent Medical Care or Threatening Incidents 32 Disaster Planning, Training, and Communication, and Emergency and Evacuation Drills 33 Contents of Child Records 33 VIII. Handling and Storage of Hazardous Materials and the Appropriate Disposal of Biocontaminants 33 CCDF Final Rule Requirements, 45 C.F.R. § 98.41(a)(1)(viii) 34 Recommended Minimum Standards 34 Use and Storage of Toxic Substances 34 IX. Appropriate Precautions in Transporting Children (if applicable) 34 CCDF Final Rule Requirements, 45 C.F.R. § 98.41(a)(1)(ix) 35 Recommended Minimum Standards 35 Qualifications for Drivers 35 Child Passenger Safety 36 Interior Temperature of Vehicles 36 Passenger Vans 36 Vehicle Insurance 37 X. Pediatric First Aid and Cardiopulmonary Resuscitation 37 CCDF Final Rule Requirements, 45 C.F.R. § 98.41(a)(1)(x) 37 Recommended Minimum Standards 37 First Aid and CPR Training for Staff 37 XI. Recognition and Reporting of Child Abuse and Neglect 38 CCDF Final Rule Requirements, 45 C.F.R. § 98.41(a)(1)(xi) 38 Recommended Minimum Standards 38 Recognizing and Reporting Suspected Child Abuse, Neglect, and Exploitation 38 XII. Nutrition 39 CCDF Final Rule Requirements, 45 C.F.R. § 98.41(a)(1)(xii)(A) 39 Recommended Minimum Standards 39 Use of U.S. Department of Agriculture Child and Adult Care Food Program Guidelines 39 XIII. Physical Activity 39 CCDF Final Rule Requirements, 45 C.F.R. § 98.41(a)(1)(xii)(B) 39 Recommended Minimum Standards 40 Active Opportunities for Physical Activity 40 XIV. Caring for Children with Special Needs 40 CCDF Final Rule Requirements, 45 C.F.R. § 98.41(a)(1)(xii)(C) 40 Recommended Minimum Standards 40 Care Plan for Children with Special Health Care Needs 40 XV. Other Subject Areas to Promote Child Development or to Protect Children’s Health and Safety 41 CCDF Final Rule Requirements, 45 C.F.R. § 98.41(a)(1)(xii)(D) 41 October 2018 4 Minimum Health and Safety Standards Examples of Other Subject Areas to Promote Child Development or to Protect Children’s Health and Safety 41 XVI. Health and Safety Training 41 CCDF Final Rule Requirements, 45 C.F.R. § 98.44(b) 41 Recommended Minimum Standards 43 Preservice Training and Orientation 43 Continuing Education for Directors, Caregivers and Teachers in Centers, and Family Child Care Homes 43 Monitoring Children's Development and Obtaining Consent for Screening 44 Personal Caregiver and Teacher Relationships for Children from Birth to 5 Years 44 Preventing Expulsions, Suspensions, and Other Limitations in Services 44 XVII. Group Size and Ratios 45 CCDF Final Rule Requirements, 45 C.F.R. § 98.41(a)(1)(xii)(d) 45 Recommended Minimum Standards 45 Group Size and Ratios for Care 45 Methods of Supervision of Children 45 XVIII. Compliance with Child Abuse Reporting Requirements and Procedures 46 CCDF Final Rule Requirements, 45 C.F.R. § 98.41(a)(1)(xii)(e) 46 Recommended Minimum Standards 46 XIX. Enforcement of Licensing and Health and Safety Requirements 46 CCDF Final Rule Requirements, 45 C.F.R. § 98.42 46 Recommended Minimum Standards 47 Record of Valid License, Certificate, or Registration of Facility or Family Child Care Home 47 Frequency of Inspections for Child Care Centers and Family Child Care Homes 47 Frequency of Inspections for In-Home Care 48 XX. Criminal Background Checks 48 CCDF Final Rule Requirements, 45 C.F.R. § 98.43 48 Recommended Minimum Standards 50 Criminal Background Checks 50 Appendix A. Caring for Our Children Basics Standards by Final Rule Health and Safety Requirements 51 Appendix B. Background Check Requirement Highlights 55 Appendix C. Resource List 56 Publications and Online Resources 56 Resources from the National Center on Tribal Early Childhood Development 56 Organizations 57 American Academy of Pediatrics (AAP) 57 National Association for Regulatory Administration (NARA) 57 National Center on Early Childhood Development, Teaching, and Learning (DTL Center) 57 National Center on Early Childhood Health and Wellness (ECHW Center) 58 National Center on Early Childhood Quality Assurance (ECQA Center) 58 National Center on Tribal Early Childhood Development (NCTECD) 58 National Resource Center for Health and Safety in Child Care (NRC) 58 October 2018 5 Minimum Health and Safety Standards Introduction In November 2014, the Child Care and Development Block Grant (CCDBG) Act of 2014 was signed into law. The CCDBG Act “AI/AN CCDF grantees” refers to tribal reauthorized the Child Care and Development Fund (CCDF) nations or organizations, including Alaska program and introduced sweeping statutory changes to improve Native villages or regional or village the health, safety, and quality of child care and provide more corporations, that receive federal CCDF stable child care assistance to families. The Act continues to funding to plan and carry out programs require that the U.S. Department of Health and Human Services for the purpose of increasing the (HHS) develop minimum child care standards for American Indian availability, affordability, and quality of and Alaska Native (AI/AN) CCDF grantees.1 child care and childhood development programs. Following the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (Public Law 104-193) and after 3 years of consultation with tribes, AI/AN organizations, and AI/AN CCDF grantees, Minimum Standards for Tribal Child Care: A Health and Safety Guide was first published in 2000. The standards were updated and reissued in 2005. With the publication of the CCDF final rule on September 30, 2016, the standards have again been updated reflect the new focus on health and safety. This document contains the most current health and safety standards for AI/AN CCDF grantees and replaces previous editions of Minimum Standards of Tribal Child Care: A Health and Safety Guide. Health and Safety Requirements in the CCDF Final Rule The 2016 CCDF final rule outlines requirements based on the CCDBG Act of 2014 for administering the CCDF program, including provisions to protect the health and safety of children in care.2 The final rule strengthens health and safety requirements for programs receiving CCDF funds.