5.3 Health and Safety Standards for CCDF Providers

Lead Agencies must have health and safety standards for providers serving children receiving CCDF assistance relating to the required health and safety topics as appropriate to the provider setting and age of the children served. This requirement is applicable to all child care programs receiving CCDF funds regardless of licensing status (i.e., licensed or license-exempt). The only exception to this requirement is for relative providers, as defined by CCDF. Lead Agencies have the option of exempting certain relatives from any or all CCDF health and safety requirements. Exemptions for relative providers’ standards requirements will be addressed in question 5.8.1. Describe the following health and safety standards for programs serving children receiving CCDF assistance on the following topics (note that monitoring and enforcement will be addressed in subsection 5.5): 5.3.1 Prevention and control of infectious diseases (including immunizations) health and safety standard a. Provide the standards, appropriate to the provider setting and age of children, that address the prevention and control of infectious diseases for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: All educators must be trained in infection control procedures. Educators must educate children about and promote hand washing procedures and health precautions. The licensee must ensure that educators and children wash their hands with liquid soap and running water, using friction, in accordance with Department of Public Health guidelines. Hands must be dried with individual or disposable towels or automatic hand blow- dryers. The use of common towels is prohibited. Educators and children must wash their hands at least at the following times: before and after water play; before and after eating or handling food; after toileting or diapering; after coming into contact with bodily fluids or discharges (including sneezes, coughing); and after handling animals or their equipment. In addition, educators must wash their hands before and after administration of medication, after performing cleaning tasks, and after handling trash or using cleaning products. Facilities used for hand washing after diapering or toileting must be separate from facilities and areas used for food preparation and food service. The licensee must ensure that equipment, materials, items or surfaces (including floors, walls and clothing used for dramatic play) are washed with soap and water and disinfected as needed to maintain a sanitary environment. All floors used by children must be swept and/or vacuumed daily. All eating surfaces must be washed and disinfected before and after each use. Where applicable, the following items, equipment and surfaces must be washed and disinfected after each use: toilet training chairs which have first been emptied into a toilet; sinks and faucets used for hand washing after the sink is used for rinsing a toilet training chair; diapering surfaces; mops used for cleaning body fluids; bibs (when used only for one child, good judgment should be used in deciding whether it can be reused before washing); thermometers; and water tables and water play equipment. (Toys mouthed by children must be set aside and stored after each use and may not be used by another child until they are washed and disinfected. Personal items intended for individual use by children, including but not limited to bottles, pacifiers, toothbrushes and sleeping materials, must be labeled with the name of the child for whom they are intended. The following items must be monitored for cleanliness and washed and disinfected at least daily: toilets and toilet seats; containers, including lids, used to hold soiled diapers; sinks and sink faucets; drinking fountains; play tables; and washcloths and towels. The following must be washed and disinfected at least weekly: cribs, cots, mats and other approved sleeping equipment; sheets, blankets or other coverings; machine washable fabric toys; smooth surfaced, non-porous floors; and mops used for cleaning. The disinfectant solution used to disinfect child care items, equipment and surfaces must be either a bleach solution prepared by the licensee in accordance with EEC guidelines or a commercially prepared disinfectant that has been registered as a sanitizing solution by the Environmental Protection Agency (EPA). Registration by the EPA will be indicated on the product label. Commercially prepared solutions must be used in accordance with manufacturer’s directions. All disinfectant solutions must be stored in accordance with manufacturer’s instructions and in a secure place out of the reach of children. The licensee must provide disposable non-latex gloves to be used for the clean-up of blood and bodily fluids. The affected area must be disinfected. Used gloves and any other materials containing blood or other bodily fluids must be thrown away in a lined, covered container. The licensee must ensure that educators wash their hands thoroughly with soap and water after cleaning up the contaminated area. Contaminated clothing must be sealed in a plastic container or bag, labeled with the child’s name and returned to the parent at the end of the day. The licensee must ensure that when individual towels or washcloths are used for any purpose, they are stored open to the air and not touching each other. The program must follow exclusion policies for serious illnesses, contagious diseases and reportable diseases in conformance with regulations and recommendations set by the Division of Communicable Disease Control, Department of Public Health. The licensee must notify all parents in accordance with Department of Public Health recommendations when any communicable disease or condition has been introduced into the program. Educators must follow the recommendations of the Department of Public Health regarding the use of insect repellents. ii. All CCDF-eligible licensed family child care homes. Provide the standard: All educators must be trained in infection control procedures. Educators must educate children about and promote hand washing procedures and health precautions. The licensee must ensure that educators and children wash their hands with liquid soap and running water, using friction, in accordance with Department of Public Health guidelines. Hands must be dried with individual or disposable towels or automatic hand blow-dryers. The use of common towels is prohibited. Educators and children must wash their hands at least at the following times: before and after water play; before and after eating or handling food; after toileting or diapering; after coming into contact with bodily fluids or discharges (including sneezes, coughing); and after handling animals or their equipment. In addition, educators must wash their hands before and after administration of medication, after performing cleaning tasks, and after handling trash or using cleaning products. Facilities used for hand washing after diapering or toileting must be separate from facilities and areas used for food preparation and food service. The licensee must ensure that equipment, materials, items or surfaces (including floors, walls and clothing used for dramatic play) are washed with soap and water and disinfected as needed to maintain a sanitary environment. All floors used by children must be swept and/or vacuumed daily. All eating surfaces must be washed and disinfected before and after each use. Where applicable, the following items, equipment and surfaces must be washed and disinfected after each use: toilet training chairs which have first been emptied into a toilet; sinks and faucets used for hand washing after the sink is used for rinsing a toilet training chair; diapering surfaces; mops used for cleaning body fluids; bibs (when used only for one child, good judgment should be used in deciding whether it can be reused before washing); thermometers; and water tables and water play equipment. (Toys mouthed by children must be set aside and stored after each use and may not be used by another child until they are washed and disinfected. Personal items intended for individual use by children, including but not limited to bottles, pacifiers, toothbrushes and sleeping materials, must be labeled with the name of the child for whom they are intended. The following items must be monitored for cleanliness and washed and disinfected at least daily: toilets and toilet seats; containers, including lids, used to hold soiled diapers; sinks and sink faucets; drinking fountains; play tables; and washcloths and towels. The following must be washed and disinfected at least weekly: cribs, cots, mats and other approved sleeping equipment; sheets, blankets or other coverings; machine washable fabric toys; smooth surfaced, non-porous floors; and mops used for cleaning. The disinfectant solution used to disinfect child care items, equipment and surfaces must be either a bleach solution prepared by the licensee in accordance with EEC guidelines or a commercially prepared disinfectant that has been registered as a sanitizing solution by the Environmental Protection Agency (EPA). Registration by the EPA will be indicated on the product label. Commercially prepared solutions must be used in accordance with manufacturer’s directions. All disinfectant solutions must be stored in accordance with manufacturer’s instructions and in a secure place out of the reach of children. The licensee must provide disposable non-latex gloves to be used for the clean-up of blood and bodily fluids. The affected area must be disinfected. Used gloves and any other materials containing blood or other bodily fluids must be thrown away in a lined, covered container. The licensee must ensure that educators wash their hands thoroughly with soap and water after cleaning up the contaminated area. Contaminated clothing must be sealed in a plastic container or bag, labeled with the child’s name and returned to the parent at the end of the day. The licensee must ensure that when individual towels or washcloths are used for any purpose, they are stored open to the air and not touching each other. The program must follow exclusion policies for serious illnesses, contagious diseases and reportable diseases in conformance with regulations and recommendations set by the Division of Communicable Disease Control, Department of Public Health. The licensee must notify all parents in accordance with Department of Public Health recommendations when any communicable disease or condition has been introduced into the program. Educators must follow the recommendations of the Department of Public Health regarding the use of insect repellents. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Adults and children shall wash their hands with liquid soap and running water, using friction, in accordance with Department of Public Health guidelines. Hands shall be dried with individual or disposable towels or automatic hand blow-dryers. The use of common towels is prohibited. Adults and children shall wash their hands at least at the following times: before and after water play; before eating and/or handling food; after toileting/diapering; after coming into contact with bodily fluids (including sneezes and coughs); after handling animals or their equipment; after playing in sand; after playing outside; after cleaning or handling garbage; before and after the administration of any medication (including topical ointments). All equipment, materials, items, and surfaces (including floors, walls and clothing used for dramatic play) shall be monitored for cleanliness, washed with soap and water, and disinfected or sanitized as needed to maintain a sanitary environment, in accordance with EEC policy. The solution used to sanitize or disinfect equipment, materials, items, or surfaces shall be either a bleach solution prepared in accordance with EEC guidelines or a commercially prepared solution that has been registered as either a sanitizer or a disinfectant (as appropriate) by the Environmental Protection Agency. All solutions used to sanitize or disinfect equipment, materials, items, and surfaces shall be used in a way that protects the health and safety of children, and in accordance with EEC guidelines and/or manufacturer’s directions. Cleaning, sanitizing, and disinfecting products shall not be used in close proximity to children. Adequate ventilation shall be maintained during use of all cleaning, sanitizing, and disinfecting products. All cleaning, disinfecting, and sanitizing products shall be stored in a secure place, inaccessible to children. The program shall provide sufficient space, accessible to children, for each child to store clothing, coats, bedding, and other personal items in a safe, sanitary manner. Personal items intended for individual use by children, including but not limited to bottles and cups, pacifiers, toothbrushes, and sleeping materials, shall be labeled with the name of the child for whom they are intended. Personal items shall be stored so that they do not touch. The program shall have written policies for the prevention and control of contagious illnesses and Infectious Diseases. The program shall follow exclusion policies for serious illnesses, contagious diseases, and reportable diseases in conformance with regulations and recommendations set by the Division of Communicable Disease Control, Department of Public Health. The program shall notify all parents in accordance with Department of Public Health recommendations, when any communicable disease or condition has been introduced into the program. The program shall follow the recommendations of the Department of Public Health regarding the use of insect repellants. The program shall follow infection control guidelines (per the Center for Disease Control) designed to protect individuals from exposure to diseases spread by blood, bodily fluids or excretions that may spread infectious disease. Health precautions include, but are not limited to, the use of personal protective equipment, proper disposal containers for contaminated waste, hand washing, and proper handling of bodily waste. Non- latex gloves shall be provided and used for the clean-up of blood and bodily fluids. Used gloves and any other materials containing blood or other bodily fluids shall be thrown away in a lined, covered container. Contaminated clothing shall be sealed in a plastic container or bag, labeled with the child’s name, and returned to the parent at the end of the day. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: NA vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Adults and children shall wash their hands with liquid soap and running water, using friction, in accordance with Department of Public Health guidelines. Hands shall be dried with individual or disposable towels or automatic hand blow-dryers. The use of common towels is prohibited. Sinks used for hand washing after diapering or toileting shall be separate from facilities and areas used for food preparation and food service. Equipment, materials, items, and surfaces shall be monitored for cleanliness, washed with soap and water, and disinfected or sanitized safely and as needed to maintain a sanitary environment, in accordance with EEC policy. Cleaning, sanitizing, and disinfecting products shall not be used in close proximity to children. Adequate ventilation shall be maintained during use of all cleaning, sanitizing, and disinfecting products. The solution used to sanitize or disinfect equipment, materials, items, or surfaces shall be either a bleach solution prepared in accordance with EEC guidelines or a commercially prepared solution that has been registered as either a Sanitizer or a Disinfectant (as appropriate) by the Environmental Protection Agency. The provider shall follow infection control guidelines (per the Center for Disease Control) designed to protect individuals from exposure to diseases spread by blood, bodily fluids or excretions that may spread infectious disease. Precautions include, but are not limited to, the use of personal protective equipment, proper disposal containers for contaminated waste, hand washing, and proper handling of bodily waste. Non-latex gloves shall be used for the clean-up of blood and bodily fluids. Used gloves and any other materials containing blood or other bodily fluids shall be thrown away in a lined, covered container. Contaminated clothing shall be sealed in a plastic container or bag and returned to the parent at the end of the day. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: All educators must be trained in infection control procedures. Educators must educate children about and promote hand washing procedures and health precautions. The licensee must ensure that educators and children wash their hands with liquid soap and running water, using friction, in accordance with Department of Public Health guidelines. Hands must be dried with individual or disposable towels or automatic hand blow-dryers. The use of common towels is prohibited. Educators and children must wash their hands at least at the following times: before and after water play; before and after eating or handling food; after toileting or diapering; after coming into contact with bodily fluids or discharges (including sneezes, coughing); and after handling animals or their equipment. In addition, educators must wash their hands before and after administration of medication, after performing cleaning tasks, and after handling trash or using cleaning products. Facilities used for hand washing after diapering or toileting must be separate from facilities and areas used for food preparation and food service. The licensee must ensure that equipment, materials, items or surfaces (including floors, walls and clothing used for dramatic play) are washed with soap and water and disinfected as needed to maintain a sanitary environment. All floors used by children must be swept and/or vacuumed daily. All eating surfaces must be washed and disinfected before and after each use. Where applicable, the following items, equipment and surfaces must be washed and disinfected after each use: toilet training chairs which have first been emptied into a toilet; sinks and faucets used for hand washing after the sink is used for rinsing a toilet training chair; diapering surfaces; mops used for cleaning body fluids; bibs (when used only for one child, good judgment should be used in deciding whether it can be reused before washing); thermometers; and water tables and water play equipment. (Toys mouthed by children must be set aside and stored after each use and may not be used by another child until they are washed and disinfected. Personal items intended for individual use by children, including but not limited to bottles, pacifiers, toothbrushes and sleeping materials, must be labeled with the name of the child for whom they are intended. The following items must be monitored for cleanliness and washed and disinfected at least daily: toilets and toilet seats; containers, including lids, used to hold soiled diapers; sinks and sink faucets; drinking fountains; play tables; and washcloths and towels. The following must be washed and disinfected at least weekly: cribs, cots, mats and other approved sleeping equipment; sheets, blankets or other coverings; machine washable fabric toys; smooth surfaced, non-porous floors; and mops used for cleaning. The disinfectant solution used to disinfect child care items, equipment and surfaces must be either a bleach solution prepared by the licensee in accordance with EEC guidelines or a commercially prepared disinfectant that has been registered as a sanitizing solution by the Environmental Protection Agency (EPA). Registration by the EPA will be indicated on the product label. Commercially prepared solutions must be used in accordance with manufacturer’s directions. All disinfectant solutions must be stored in accordance with manufacturer’s instructions and in a secure place out of the reach of children. The licensee must provide disposable non-latex gloves to be used for the clean-up of blood and bodily fluids. The affected area must be disinfected. Used gloves and any other materials containing blood or other bodily fluids must be thrown away in a lined, covered container. The licensee must ensure that educators wash their hands thoroughly with soap and water after cleaning up the contaminated area. Contaminated clothing must be sealed in a plastic container or bag, labeled with the child’s name and returned to the parent at the end of the day. The licensee must ensure that when individual towels or washcloths are used for any purpose, they are stored open to the air and not touching each other. The program must follow exclusion policies for serious illnesses, contagious diseases and reportable diseases in conformance with regulations and recommendations set by the Division of Communicable Disease Control, Department of Public Health. The licensee must notify all parents in accordance with Department of Public Health recommendations when any communicable disease or condition has been introduced into the program. Educators must follow the recommendations of the Department of Public Health regarding the use of insect repellents. b. Provide the standards, appropriate to the provider setting and age of children, that address that children attending child care programs under CCDF are age-appropriately immunized, according to the latest recommendation for childhood immunizations of the respective State public health agency, for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: The licensee must maintain an individual written record for each child that includes medical records, including a physician’s, nurse practitioner’s, or physician’s assistant’s certification that the child has been successfully immunized in accordance with the current Department of Public Health’s recommended schedules. The licensee must maintain ongoing records, including documentation of annual physical examinations, updated immunizations, and lead screening. ii. All CCDF-eligible licensed family child care homes. Provide the standard: The licensee must maintain an individual written record for each child that includes medical records, including a physician’s, nurse practitioner’s, or physician’s assistant’s certification that the child has been successfully immunized in accordance with the current Department of Public Health’s recommended schedules. The licensee must maintain ongoing records, including documentation of annual physical examinations, updated immunizations, and lead screening. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: The Program shall maintain a complete, accurate, and confidential file for each child documenting that the child has been successfully immunized in accordance with the current Department of Public Health’s recommended schedules. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: NA vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Program shall maintain a complete, accurate, and confidential file for each child documenting that the child has been successfully immunized in accordance with the current Department of Public Health’s recommended schedules. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: The licensee must maintain an individual written record for each child that includes medical records, including a physician’s, nurse practitioner’s, or physician’s assistant’s certification that the child has been successfully immunized in accordance with the current Department of Public Health’s recommended schedules. The licensee must maintain ongoing records, including documentation of annual physical examinations, updated immunizations, and lead screening. For school age children, the licensee may accept either a written parental statement that the required information is on file with the child’s school or copies of the child’s immunization, physical examination and lead screening records. 5.3.2 Prevention of sudden infant death syndrome and the use of safe-sleep practices health and safety standard Provide the standards, appropriate to the provider setting and age of children, that address the prevention of sudden infant death syndrome and use of safe sleeping practices for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: All staff working with infants under 12 months of age must be trained on safe sleep practices prior to caring for infants. In accordance with the EEC Essentials Policy, Infant Safe Sleep Practices and Shaken Baby Syndrome trainings must be completed prior to working with infants and toddlers in an unsupervised capacity. An educator trained in safe sleep practices must be present at all times where there is a sleeping infant. Programs serving infants must: place infants on their backs for sleeping, unless the child’s health care professional orders otherwise in writing; nap infants in an individual crib, porta crib, playpen or bassinet; ensure that cribs have firm, properly fitted mattresses with clean coverings, and do not contain any potential head entrapment areas; ensure that slats on cribs are no more than 2 3/8 inches apart; ensure that cribs, porta cribs, playpens or bassinets used for sleeping infants younger than 12 months of age do not contain pillows, comforters, stuffed animals or other soft, padded materials. The licensee must have a written health care policy that includes a plan to ensure that all children 12 months of age or younger are placed on their backs for sleeping, unless the child's health care professional orders otherwise in writing. The educator must visually observe napping children at least every 15 minutes. When children are placed in a separate room for naps, the door must remain ajar. Children younger than six months of age at the time of enrollment must be under direct visual supervision at all times, including while napping, during the first six weeks they are in care. Additional policy standards state: Infants must be placed on a firm, flat, non- inclined sleep surface. Each infant must have access to an individual crib, port-a- crib, playpen, or bassinet with a firm, properly fitted mattress and a clean fitted sheet. Only mattresses designed for the specific product should be used. Mattresses should be firm and should maintain their shape even when the fitted sheet designated for that model is used, such that there are no gaps between the mattress and the wall of the crib, bassinet, portable crib, or play yard. Pillows, cushions, and mattress toppers designed to make the sleep surface softer must not be used as substitutes for mattresses or in addition to a mattress. Car seats and other sitting devices are not allowed for sleep. Cribs and toddler beds must meet current U.S. Consumer Product Safety Commission (CPSC) and American Society for Testing and Materials (Now called ASTM International) safety standards. Each piece of equipment used for sleeping and resting infants must be checked regularly to make sure it has not been recalled, is not missing any hardware, and is in good repair. To demonstrate that the crib or other sleeping equipment meets the current CPSC crib standards, one of the following must be observed on any equipment used for sleeping children: A ￿tracking label,￿ which is a permanent, distinguishing mark on the crib that contains, at minimum, the source of the product, the date of manufacture (any date on or after June 28, 2011 will be accepted), and cohort information, such as batch or run number; a registration form including the manufacturer’s name and contact information, model name, model number, and a date of manufacture on or after June 28, 2011; and a Children’s Product Certificate (CPC) or test report from a CPSC- accepted third party lab demonstrating compliance with 16 C.F.R. part 1219 or 16 C.F.R. part 1220. Co-sleeping is prohibited. Infants must not be placed to sleep or rest on an adult bed or sofa. The use of soft objects or loose bedding in and around the crib is prohibited. Blankets, comforters, pillows, stuffed animals, wedges, positioners, bumper pads or other soft padded materials or toys must not be placed in the crib with the baby. Swaddling is prohibited for any child who can roll over or as soon as the infant begins to try to roll over. Weighted swaddles, weighted clothing, or weighted objects are prohibited. Dress infants appropriately for the environment, with no more than one layer more than an adult would wear to be comfortable in that environment. Evaluate the infant for signs of overheating, such as sweating, flushed skin, or the infant’s chest feeling hot to the touch. Avoid over-bundling and covering of the face and head. Do not place hats on infants when indoors. Room temperature should be maintained between 68- 72 degrees Fahrenheit. Bottles must never be propped, and babies should not suck on a bottle while sleeping. Propping the bottle increases the risk of choking and of ear infections. Jewelry of any kind must be removed prior to placing a child to sleep, unless the child’s parent has given the program written consent to leave jewelry on during sleep. Necklaces, earrings, bracelets, and anklets, including those used to help with teething or those worn for cultural or aesthetic purposes, are not encouraged for sleeping or resting children. Hanging objects such as mobiles, crib toys, or mirrors that can be reached by the infant are not allowed. Areas used for infant sleep must be free of hazards, such as dangling cords, electric wires, and window-covering cords, and any potential strangulation risks. Spaces used for sleeping infants must be lit enough to allow supervising staff to see each infant’s face and skin color. Home monitors or commercial devices marketed to reduce the risk of SIDS must not be relied upon for the supervision of sleeping babies. ii. All CCDF-eligible licensed family child care homes. Provide the standard: All staff working with infants under 12 months of age must be trained on safe sleep practices prior to caring for infants. In accordance with the EEC Essentials Policy, Infant Safe Sleep Practices and Shaken Baby Syndrome trainings must be completed prior to working with infants and toddlers in an unsupervised capacity. An educator trained in safe sleep practices must be present at all times where there is a sleeping infant. Programs serving infants must: place infants on their backs for sleeping, unless the child’s health care professional orders otherwise in writing; nap infants in an individual crib, porta crib, playpen or bassinet; ensure that cribs have firm, properly fitted mattresses with clean coverings, and do not contain any potential head entrapment areas; ensure that slats on cribs are no more than 2 3/8 inches apart; ensure that cribs, porta cribs, playpens or bassinets used for sleeping infants younger than 12 months of age do not contain pillows, comforters, stuffed animals or other soft, padded materials. The licensee must have a written health care policy that includes a plan to ensure that all children 12 months of age or younger are placed on their backs for sleeping, unless the child's health care professional orders otherwise in writing. The educator must visually observe napping children at least every 15 minutes. When children are placed in a separate room for naps, the door must remain ajar. Children younger than six months of age at the time of enrollment must be under direct visual supervision at all times, including while napping, during the first six weeks they are in care. Additional policy standards state: Infants must be placed on a firm, flat, non- inclined sleep surface. Each infant must have access to an individual crib, port-a- crib, playpen, or bassinet with a firm, properly fitted mattress and a clean fitted sheet. Only mattresses designed for the specific product should be used. Mattresses should be firm and should maintain their shape even when the fitted sheet designated for that model is used, such that there are no gaps between the mattress and the wall of the crib, bassinet, portable crib, or play yard. Pillows, cushions, and mattress toppers designed to make the sleep surface softer must not be used as substitutes for mattresses or in addition to a mattress. Car seats and other sitting devices are not allowed for sleep. Cribs and toddler beds must meet current U.S. Consumer Product Safety Commission (CPSC) and American Society for Testing and Materials (Now called ASTM International) safety standards. Each piece of equipment used for sleeping and resting infants must be checked regularly to make sure it has not been recalled, is not missing any hardware, and is in good repair. To demonstrate that the crib or other sleeping equipment meets the current CPSC crib standards, one of the following must be observed on any equipment used for sleeping children: A ￿tracking label,￿ which is a permanent, distinguishing mark on the crib that contains, at minimum, the source of the product, the date of manufacture (any date on or after June 28, 2011 will be accepted), and cohort information, such as batch or run number; a registration form including the manufacturer’s name and contact information, model name, model number, and a date of manufacture on or after June 28, 2011; and a Children’s Product Certificate (CPC) or test report from a CPSC- accepted third party lab demonstrating compliance with 16 C.F.R. part 1219 or 16 C.F.R. part 1220. Co-sleeping is prohibited. Infants must not be placed to sleep or rest on an adult bed or sofa. The use of soft objects or loose bedding in and around the crib is prohibited. Blankets, comforters, pillows, stuffed animals, wedges, positioners, bumper pads or other soft padded materials or toys must not be placed in the crib with the baby. Swaddling is prohibited for any child who can roll over or as soon as the infant begins to try to roll over. Weighted swaddles, weighted clothing, or weighted objects are prohibited. Dress infants appropriately for the environment, with no more than one layer more than an adult would wear to be comfortable in that environment. Evaluate the infant for signs of overheating, such as sweating, flushed skin, or the infant’s chest feeling hot to the touch. Avoid over-bundling and covering of the face and head. Do not place hats on infants when indoors. Room temperature should be maintained between 68- 72 degrees Fahrenheit. Bottles must never be propped, and babies should not suck on a bottle while sleeping. Propping the bottle increases the risk of choking and of ear infections. Jewelry of any kind must be removed prior to placing a child to sleep, unless the child’s parent has given the program written consent to leave jewelry on during sleep. Necklaces, earrings, bracelets, and anklets, including those used to help with teething or those worn for cultural or aesthetic purposes, are not encouraged for sleeping or resting children. Hanging objects such as mobiles, crib toys, or mirrors that can be reached by the infant are not allowed. Areas used for infant sleep must be free of hazards, such as dangling cords, electric wires, and window-covering cords, and any potential strangulation risks. Spaces used for sleeping infants must be lit enough to allow supervising staff to see each infant’s face and skin color. Home monitors or commercial devices marketed to reduce the risk of SIDS must not be relied upon for the supervision of sleeping babies. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: All staff working with infants under 12 months of age must be trained on safe sleep practices prior to caring for infants. In accordance with the EEC Essentials Policy, Infant Safe Sleep Practices and Shaken Baby Syndrome trainings must be completed prior to working with infants and toddlers in an unsupervised capacity. All adults caring for infants must follow safe sleep practices as recommended by the American Academy of Pediatrics and EEC Safe Sleep Policy. Infants shall be placed on their backs for sleeping, unless the child’s health care professional orders otherwise in writing. Infants who are younger than six months of age at the time of enrollment shall be under direct visual supervision at all times, including while napping, during the first six weeks they are in care. Infants shall be placed to nap in an individual crib, port-a-crib, or bassinet. All cribs, port-o-cribs, playpens, toddler beds, or bassinets used for sleeping shall meet current Consumer Product Safety Commission and American Society for Testing and Materials safety requirements. Crib slats shall be no more than 2 3/8 inches apart. Cribs shall have a firm, properly fitted mattresses with a clean fitted sheet. Cribs used for sleeping infants younger than 12 months of age shall not contain any potential head entrapment areas. Cribs, port-a-cribs, playpens or bassinets used for sleeping infants younger than 12 months of age shall not contain pillows, comforters, blankets, bumper pads, stuffed animals, or any other soft, padded materials. Car seats, swings, and other sitting devices shall not be used for infant sleep. Additional policy standards state: Infants must be placed on a firm, flat, non- inclined sleep surface. Each infant must have access to an individual crib, port-a- crib, playpen, or bassinet with a firm, properly fitted mattress and a clean fitted sheet. Only mattresses designed for the specific product should be used. Mattresses should be firm and should maintain their shape even when the fitted sheet designated for that model is used, such that there are no gaps between the mattress and the wall of the crib, bassinet, portable crib, or play yard. Pillows, cushions, and mattress toppers designed to make the sleep surface softer must not be used as substitutes for mattresses or in addition to a mattress. Car seats and other sitting devices are not allowed for sleep. Cribs and toddler beds must meet current U.S. Consumer Product Safety Commission (CPSC) and American Society for Testing and Materials (Now called ASTM International) safety standards. Each piece of equipment used for sleeping and resting infants must be checked regularly to make sure it has not been recalled, is not missing any hardware, and is in good repair. To demonstrate that the crib or other sleeping equipment meets the current CPSC crib standards, one of the following must be observed on any equipment used for sleeping children: A ￿tracking label,￿ which is a permanent, distinguishing mark on the crib that contains, at minimum, the source of the product, the date of manufacture (any date on or after June 28, 2011 will be accepted), and cohort information, such as batch or run number; a registration form including the manufacturer’s name and contact information, model name, model number, and a date of manufacture on or after June 28, 2011; and a Children’s Product Certificate (CPC) or test report from a CPSC- accepted third party lab demonstrating compliance with 16 C.F.R. part 1219 or 16 C.F.R. part 1220. Co-sleeping is prohibited. Infants must not be placed to sleep or rest on an adult bed or sofa. The use of soft objects or loose bedding in and around the crib is prohibited. Blankets, comforters, pillows, stuffed animals, wedges, positioners, bumper pads or other soft padded materials or toys must not be placed in the crib with the baby. Swaddling is prohibited for any child who can roll over or as soon as the infant begins to try to roll over. Weighted swaddles, weighted clothing, or weighted objects are prohibited. Dress infants appropriately for the environment, with no more than one layer more than an adult would wear to be comfortable in that environment. Evaluate the infant for signs of overheating, such as sweating, flushed skin, or the infant’s chest feeling hot to the touch. Avoid over-bundling and covering of the face and head. Do not place hats on infants when indoors. Room temperature should be maintained between 68- 72 degrees Fahrenheit. Bottles must never be propped, and babies should not suck on a bottle while sleeping. Propping the bottle increases the risk of choking and of ear infections. Jewelry of any kind must be removed prior to placing a child to sleep, unless the child’s parent has given the program written consent to leave jewelry on during sleep. Necklaces, earrings, bracelets, and anklets, including those used to help with teething or those worn for cultural or aesthetic purposes, are not encouraged for sleeping or resting children. Hanging objects such as mobiles, crib toys, or mirrors that can be reached by the infant are not allowed. Areas used for infant sleep must be free of hazards, such as dangling cords, electric wires, and window-covering cords, and any potential strangulation risks. Spaces used for sleeping infants must be lit enough to allow supervising staff to see each infant’s face and skin color. Home monitors or commercial devices marketed to reduce the risk of SIDS must not be relied upon for the supervision of sleeping babies. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: NA vi. All CCDF-eligible license-exempt in-home care. Provide the standard: All staff working with infants under 12 months of age must be trained on safe sleep practices prior to caring for infants. In accordance with the EEC Essentials Policy, Infant Safe Sleep Practices and Shaken Baby Syndrome trainings must be completed prior to working with infants and toddlers in an unsupervised capacity. All adults caring for infants must follow safe sleep practices as recommended by the American Academy of Pediatrics and EEC Safe Sleep Policy. Infants shall be placed on their backs for sleeping, unless the child’s health care professional orders otherwise in writing. Infants who are younger than six months of age at the time of enrollment shall be under direct visual supervision at all times, including while napping, during the first six weeks they are in care. Infants shall be placed to nap in an individual crib, port-a-crib, or bassinet. All cribs, port-o-cribs, playpens, toddler beds, or bassinets used for sleeping shall meet current Consumer Product Safety Commission and American Society for Testing and Materials safety requirements. Crib slats shall be no more than 2 3/8 inches apart. Cribs shall have a firm, properly fitted mattresses with a clean fitted sheet. Cribs used for sleeping infants younger than 12 months of age shall not contain any potential head entrapment areas. Cribs, port-a-cribs, playpens or bassinets used for sleeping infants younger than 12 months of age shall not contain pillows, comforters, blankets, bumper pads, stuffed animals, or any other soft, padded materials. Car seats, swings, and other sitting devices shall not be used for infant sleep. The provider shall have a safe sleep policy that is communicated to parents and is in accordance with EEC Safe Sleep Policy Additional policy standards state: Infants must be placed on a firm, flat, non-inclined sleep surface. Each infant must have access to an individual crib, port-a-crib, playpen, or bassinet with a firm, properly fitted mattress and a clean fitted sheet. Only mattresses designed for the specific product should be used. Mattresses should be firm and should maintain their shape even when the fitted sheet designated for that model is used, such that there are no gaps between the mattress and the wall of the crib, bassinet, portable crib, or play yard. Pillows, cushions, and mattress toppers designed to make the sleep surface softer must not be used as substitutes for mattresses or in addition to a mattress. Car seats and other sitting devices are not allowed for sleep. Cribs and toddler beds must meet current U.S. Consumer Product Safety Commission (CPSC) and American Society for Testing and Materials (Now called ASTM International) safety standards. Each piece of equipment used for sleeping and resting infants must be checked regularly to make sure it has not been recalled, is not missing any hardware, and is in good repair. To demonstrate that the crib or other sleeping equipment meets the current CPSC crib standards, one of the following must be observed on any equipment used for sleeping children: A ￿tracking label,￿ which is a permanent, distinguishing mark on the crib that contains, at minimum, the source of the product, the date of manufacture (any date on or after June 28, 2011 will be accepted), and cohort information, such as batch or run number; a registration form including the manufacturer’s name and contact information, model name, model number, and a date of manufacture on or after June 28, 2011; and a Children’s Product Certificate (CPC) or test report from a CPSC-accepted third party lab demonstrating compliance with 16 C.F.R. part 1219 or 16 C.F.R. part 1220. Co-sleeping is prohibited. Infants must not be placed to sleep or rest on an adult bed or sofa. The use of soft objects or loose bedding in and around the crib is prohibited. Blankets, comforters, pillows, stuffed animals, wedges, positioners, bumper pads or other soft padded materials or toys must not be placed in the crib with the baby. Swaddling is prohibited for any child who can roll over or as soon as the infant begins to try to roll over. Weighted swaddles, weighted clothing, or weighted objects are prohibited. Dress infants appropriately for the environment, with no more than one layer more than an adult would wear to be comfortable in that environment. Evaluate the infant for signs of overheating, such as sweating, flushed skin, or the infant’s chest feeling hot to the touch. Avoid over-bundling and covering of the face and head. Do not place hats on infants when indoors. Room temperature should be maintained between 68-72 degrees Fahrenheit. Bottles must never be propped, and babies should not suck on a bottle while sleeping. Propping the bottle increases the risk of choking and of ear infections. Jewelry of any kind must be removed prior to placing a child to sleep, unless the child’s parent has given the program written consent to leave jewelry on during sleep. Necklaces, earrings, bracelets, and anklets, including those used to help with teething or those worn for cultural or aesthetic purposes, are not encouraged for sleeping or resting children. Hanging objects such as mobiles, crib toys, or mirrors that can be reached by the infant are not allowed. Areas used for infant sleep must be free of hazards, such as dangling cords, electric wires, and window-covering cords, and any potential strangulation risks. Spaces used for sleeping infants must be lit enough to allow supervising staff to see each infant’s face and skin color. Home monitors or commercial devices marketed to reduce the risk of SIDS must not be relied upon for the supervision of sleeping babies. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: School Age Programs (OST) only serve children age 5 to 14 5.3.3 Administration of medication, consistent with standards for parental consent health and safety standard a. Provide the standards, appropriate to the provider setting and age of children, that address the administration of medication for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: The licensee must have a written plan for staff orientation, which must include health care policy, including medication administration. All educators must be trained in the program’s medication administration procedures. Each person who administers prescription or non-prescription medication to a child must be trained to verify and to document that the right child receives the proper dosage of the correct medication designated for that particular child and given at the correct time(s), and by the proper method. Each person who administers medication (other than topical medication) must demonstrate competency in the administration of medication before being authorized by the licensee to administer any medication. The licensee must ensure that at least one educator with training in medication administration is present at any and all times when children are in care. Each person who administers any medication, other than oral or topical medications and epinephrine auto-injectors, must be trained by a licensed health care practitioner and must demonstrate annually to the satisfaction of the trainer, competency in the administration of such medications. An alternative method of training approved by the Massachusetts Department of Public Health (MDPH) can be substituted with approval from MDPH. The licensee must ensure that each educator, including those educators who do not administer medication, receives training in recognizing generic medication side effects and adverse interactions among various medications, and potential side effects of specific medications administered in the program. The licensee must have a written policy regarding administration of prescription and nonprescription medication. The policy must provide for the administration of medications ordered by a child's health care practitioner. All medication administered to a child, including but not limited to oral and topical medications of any kind, either prescription or non-prescription, must be provided by the child’s parent. All prescription medications must be in the containers in which they were originally dispensed and with their original labels affixed. Over-the-counter medications must be in the original manufacturer’s packaging. The educator must not administer any medication contrary to the directions on the original container, unless so authorized in writing by the child’s licensed health care practitioner. Any medications without clear instructions on the container must be administered in accordance with a written physician or pharmacist’s descriptive order. Unless otherwise specified in a child’s individual health care plan, the educator must store all medications out of the reach of children and under proper conditions for sanitation, preservation, security and safety during the time the children are in care and during the transportation of children. Those medications found in United States Drug Enforcement Administration (DEA) Schedules II through V must be kept in a secured and locked place at all times when not being accessed by an authorized individual. Prescription medications requiring refrigeration shall be stored in a way that is inaccessible to children in a refrigerator maintained at temperatures between 38ºF and 42ºF. Emergency medications such as epinephrine auto- injectors must be immediately available for use as needed. Each licensee shall have a written policy on medication disposal. When possible, all unused, discontinued or outdated prescription medications shall be returned to the parent and such return shall be documented in the child’s record. When return to the parent is not possible or practical, such prescription medications must be destroyed and the destruction recorded by a manager or supervisor in accordance with policies of the licensee and the Department of Public Health, Drug Control Program. No educator shall administer the first dose of any medication to a child, except under extraordinary circumstances and with parental consent. Each time medication is administered, the educator must document in the child’s record the name of the medication, the dosage, the time and the method of administration, and who administered the medication, except for topical medication applied to diaper rash. The educator must inform the child's parent(s) at the end of each day whenever a topical medication is applied to a diaper rash. Any unanticipated administration of medication or unanticipated treatment for a non-life- threatening condition requires that the educator must make a reasonable attempt to contact the parent(s) prior to administering such unanticipated medication or beginning such unanticipated treatment, or, if the parent(s) cannot be reached in advance, as soon as possible after such medication or treatment is given. The educator must document all medication or treatment administration, whether scheduled or unanticipated, in the child’s medication and treatment log. The educator may administer routine, scheduled medication or treatment to the child with a chronic medical condition in accordance with written parental consent and licensed health care practitioner authorization. Educators may, with written parental consent and authorization of a licensed health care practitioner, develop and implement an individual health care plan that permits older school age children to carry their own inhalers and epinephrine auto-injectors and use them as needed, without the direct supervision of an educator. All educators must be aware of the contents and requirements of the child's individual health care plan specifying how the inhaler or epinephrine auto-injector will be kept secure from access by other children in the program. Whenever an individual health care plan provides for a child to carry his or her own medication, the licensee must maintain on-site a back-up supply of the medication for use as needed. Educators must wash their hands before and after administration of medication. The licensee must provide to families in writing, prior to enrollment of their child, the program’s policy regarding administration of medication. The licensee must maintain an individual written record for each child that includes written consent for the use of unanticipated, non-prescription and topical, non-prescription medications, if applicable. The written parental consent and the licensed health care practitioner authorization shall be valid for one year, unless withdrawn sooner. Such consent and authorization must be renewed annually for administration of medication and/or treatment to continue. The licensee must maintain ongoing records which include a record of any medications administered to the child. The licensee must inform parents immediately of any injury which requires any medical care beyond minor first aid or of any emergency administration of non-prescription medication. The licensee must immediately report to the Department any medication error which occurred while the child was in care and which required hospitalization or emergency medical treatment, or which resulted in a child receiving the wrong medication. ii. All CCDF-eligible licensed family child care homes. Provide the standard: All educators must be trained in the program’s medication administration procedures. Each person who administers prescription or non-prescription medication to a child must be trained to verify and to document that the right child receives the proper dosage of the correct medication designated for that particular child and given at the correct time(s), and by the proper method. Each person who administers medication (other than topical medication) must demonstrate competency in the administration of medication before being authorized by the licensee to administer any medication. The licensee must ensure that at least one educator with training in medication administration is present at any and all times when children are in care. Each person who administers any medication, other than oral or topical medications and epinephrine auto-injectors, must be trained by a licensed health care practitioner and must demonstrate annually to the satisfaction of the trainer, competency in the administration of such medications. An alternative method of training approved by the Massachusetts Department of Public Health (MDPH) can be substituted with approval from MDPH. The licensee must ensure that each educator, including those educators who do not administer medication, receives training in recognizing generic medication side effects and adverse interactions among various medications, and potential side effects of specific medications administered in the program. The licensee must have a written policy regarding administration of prescription and nonprescription medication. The policy must provide for the administration of medications ordered by a child's health care practitioner. All medication administered to a child, including but not limited to oral and topical medications of any kind, either prescription or non-prescription, must be provided by the child’s parent. All prescription medications must be in the containers in which they were originally dispensed and with their original labels affixed. Over-the-counter medications must be in the original manufacturer’s packaging. The educator must not administer any medication contrary to the directions on the original container, unless so authorized in writing by the child’s licensed health care practitioner. Any medications without clear instructions on the container must be administered in accordance with a written physician or pharmacist’s descriptive order. Unless otherwise specified in a child’s individual health care plan, the educator must store all medications out of the reach of children and under proper conditions for sanitation, preservation, security and safety during the time the children are in care and during the transportation of children. Those medications found in United States Drug Enforcement Administration (DEA) Schedules II through V must be kept in a secured and locked place at all times when not being accessed by an authorized individual. Prescription medications requiring refrigeration shall be stored in a way that is inaccessible to children in a refrigerator maintained at temperatures between 38ºF and 42ºF. Emergency medications such as epinephrine auto- injectors must be immediately available for use as needed. Each licensee shall have a written policy on medication disposal. When possible, all unused, discontinued or outdated prescription medications shall be returned to the parent and such return shall be documented in the child’s record. When return to the parent is not possible or practical, such prescription medications must be destroyed and the destruction recorded by a manager or supervisor in accordance with policies of the licensee and the Department of Public Health, Drug Control Program. No educator shall administer the first dose of any medication to a child, except under extraordinary circumstances and with parental consent. Each time medication is administered, the educator must document in the child’s record the name of the medication, the dosage, the time and the method of administration, and who administered the medication, except for topical medication applied to diaper rash. The educator must inform the child's parent(s) at the end of each day whenever a topical medication is applied to a diaper rash. Any unanticipated administration of medication or unanticipated treatment for a non-life- threatening condition requires that the educator must make a reasonable attempt to contact the parent(s) prior to administering such unanticipated medication or beginning such unanticipated treatment, or, if the parent(s) cannot be reached in advance, as soon as possible after such medication or treatment is given. The educator must document all medication or treatment administration, whether scheduled or unanticipated, in the child’s medication and treatment log. The educator may administer routine, scheduled medication or treatment to the child with a chronic medical condition in accordance with written parental consent and licensed health care practitioner authorization. Educators may, with written parental consent and authorization of a licensed health care practitioner, develop and implement an individual health care plan that permits older school age children to carry their own inhalers and epinephrine auto-injectors and use them as needed, without the direct supervision of an educator. All educators must be aware of the contents and requirements of the child's individual health care plan specifying how the inhaler or epinephrine auto-injector will be kept secure from access by other children in the program. Whenever an individual health care plan provides for a child to carry his or her own medication, the licensee must maintain on-site a back-up supply of the medication for use as needed. Educators must wash their hands before and after administration of medication. The licensee must provide to families in writing, prior to enrollment of their child, the program’s policy regarding administration of medication. The licensee must maintain an individual written record for each child that includes written consent for the use of unanticipated, non-prescription and topical, non-prescription medications, if applicable. The written parental consent and the licensed health care practitioner authorization shall be valid for one year, unless withdrawn sooner. Such consent and authorization must be renewed annually for administration of medication and/or treatment to continue. The licensee must maintain ongoing records which include a record of any medications administered to the child. The licensee must inform parents immediately of any injury which requires any medical care beyond minor first aid or of any emergency administration of non-prescription medication. The licensee must immediately report to the Department any medication error which occurred while the child was in care and which required hospitalization or emergency medical treatment, or which resulted in a child receiving the wrong medication. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Prescription medications shall be in the containers in which they were originally dispensed and labeled by the pharmacist, including the date the prescription was filled and clear instructions for administration. Over the counter medications shall be dated and kept in the original manufacturer’s packaging. The container should be labeled by the parent/guardian, including: the child’s first and last name; specific instructions given by the prescribing physician or pharmacist’s order for the dosage and administration, if applicable. Medications shall be stored under the proper conditions for sanitation, preservation, security, and safety at all times. All medications shall be stored out of the reach of and completely inaccessible to children, unless otherwise specified in a child’s individual health care plan. All medications that are considered controlled substances shall be kept in a secured and locked place at all times, when not being accessed by an authorized individual. All medications shall be stored at the proper temperature. Prescription medications requiring refrigeration shall be stored in a way that is inaccessible to children, in a refrigerator maintained at temperature between 38°F and 42°F. All medications shall be stored away from food. Emergency or life-saving medications, such as asthma inhalers and epinephrine auto-injectors, shall be immediately available for any children for whom they have been prescribed. The program shall have clear, written policies for the documentation, administration, handling, and disposal of all medications, in accordance with EEC requirements. All medication administered to a child, including but not limited to oral and topical medications of any kind, either prescription or non-prescription, shall be provided by the child’s parent. No medication shall be administered without written parental consent. Providers may administer routine, scheduled medication or treatment to a child with a chronic medical condition in accordance with written parental consent and licensed Health Care Practitioner authorization. Providers administering routine, scheduled medication or treatment to the child with a chronic medical condition shall have successfully completed training, given by the child's Health Care Practitioner, or, with his/her written consent, given by the child's parent or the program's Health Care Consultant that specifically addresses the child's medical condition, medication, and other treatment needs. Each time a medication is administered, providers shall document in the child’s record the name of the medication, the dosage, the time and the method of administration, and who administered the medication. Missed doses shall also be documented, along with the reason(s) why the dose was missed. The program shall ensure that at least one adult with training in medication administration is present at any and all times when children are in care. Medications shall not be used beyond their date of expiration. Unused medication shall be returned to the parent/guardian for disposal. If medication cannot be returned to the parent/guardian, the program shall have a written policy on medication disposal in accordance with the recommendations of the Department of Public Health, Drug Control Program. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: NA vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Medications administered to a child by the provider, including but not limited to oral and topical medications of any kind, either prescription or non-prescription, shall be provided by the child’s parent. No medication shall be administered without written parental consent. Prescription medications to be administered by the provider shall be in the containers in which they were originally dispensed and labeled by the pharmacist, including the date the prescription was filled and clear instructions for administration. Medications shall be stored under the proper conditions for sanitation, preservation, security, and safety at all times. All medications shall be stored at the proper temperature, away from food, and inaccessible to children at all times, unless otherwise specified in the child’s health care plan. Provider shall document all medications administered, in accordance with EEC guidelines, including the name of the medication, dosage, time and method of administration. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: The licensee must have a written plan for staff orientation, which must include health care policy, including medication administration. All educators must be trained in the program’s medication administration procedures. Each person who administers prescription or non- prescription medication to a child must be trained to verify and to document that the right child receives the proper dosage of the correct medication designated for that particular child and given at the correct time(s), and by the proper method. Each person who administers medication (other than topical medication) must demonstrate competency in the administration of medication before being authorized by the licensee to administer any medication. The licensee must ensure that at least one educator with training in medication administration is present at any and all times when children are in care. Each person who administers any medication, other than oral or topical medications and epinephrine auto-injectors, must be trained by a licensed health care practitioner and must demonstrate annually to the satisfaction of the trainer, competency in the administration of such medications. An alternative method of training approved by the Massachusetts Department of Public Health (MDPH) can be substituted with approval from MDPH. The licensee must ensure that each educator, including those educators who do not administer medication, receives training in recognizing generic medication side effects and adverse interactions among various medications, and potential side effects of specific medications administered in the program. The licensee must have a written policy regarding administration of prescription and nonprescription medication. The policy must provide for the administration of medications ordered by a child's health care practitioner. All medication administered to a child, including but not limited to oral and topical medications of any kind, either prescription or non-prescription, must be provided by the child’s parent. All prescription medications must be in the containers in which they were originally dispensed and with their original labels affixed. Over-the-counter medications must be in the original manufacturer’s packaging. The educator must not administer any medication contrary to the directions on the original container, unless so authorized in writing by the child’s licensed health care practitioner. Any medications without clear instructions on the container must be administered in accordance with a written physician or pharmacist’s descriptive order. Unless otherwise specified in a child’s individual health care plan, the educator must store all medications out of the reach of children and under proper conditions for sanitation, preservation, security and safety during the time the children are in care and during the transportation of children. Those medications found in United States Drug Enforcement Administration (DEA) Schedules II through V must be kept in a secured and locked place at all times when not being accessed by an authorized individual. Prescription medications requiring refrigeration shall be stored in a way that is inaccessible to children in a refrigerator maintained at temperatures between 38ºF and 42ºF. Emergency medications such as epinephrine auto- injectors must be immediately available for use as needed. Each licensee shall have a written policy on medication disposal. When possible, all unused, discontinued or outdated prescription medications shall be returned to the parent and such return shall be documented in the child’s record. When return to the parent is not possible or practical, such prescription medications must be destroyed and the destruction recorded by a manager or supervisor in accordance with policies of the licensee and the Department of Public Health, Drug Control Program. No educator shall administer the first dose of any medication to a child, except under extraordinary circumstances and with parental consent. Each time medication is administered, the educator must document in the child’s record the name of the medication, the dosage, the time and the method of administration, and who administered the medication, except for topical medication applied to diaper rash. The educator must inform the child's parent(s) at the end of each day whenever a topical medication is applied to a diaper rash. Any unanticipated administration of medication or unanticipated treatment for a non-life- threatening condition requires that the educator must make a reasonable attempt to contact the parent(s) prior to administering such unanticipated medication or beginning such unanticipated treatment, or, if the parent(s) cannot be reached in advance, as soon as possible after such medication or treatment is given. The educator must document all medication or treatment administration, whether scheduled or unanticipated, in the child’s medication and treatment log. The educator may administer routine, scheduled medication or treatment to the child with a chronic medical condition in accordance with written parental consent and licensed health care practitioner authorization. Educators may, with written parental consent and authorization of a licensed health care practitioner, develop and implement an individual health care plan that permits older school age children to carry their own inhalers and epinephrine auto-injectors and use them as needed, without the direct supervision of an educator. All educators must be aware of the contents and requirements of the child's individual health care plan specifying how the inhaler or epinephrine auto-injector will be kept secure from access by other children in the program. Whenever an individual health care plan provides for a child to carry his or her own medication, the licensee must maintain on-site a back-up supply of the medication for use as needed. Educators must wash their hands before and after administration of medication. The licensee must provide to families in writing, prior to enrollment of their child, the program’s policy regarding administration of medication. The licensee must maintain an individual written record for each child that includes written consent for the use of unanticipated, non-prescription and topical, non-prescription medications, if applicable. The written parental consent and the licensed health care practitioner authorization shall be valid for one year, unless withdrawn sooner. Such consent and authorization must be renewed annually for administration of medication and/or treatment to continue. The licensee must maintain ongoing records which include a record of any medications administered to the child. The licensee must inform parents immediately of any injury which requires any medical care beyond minor first aid or of any emergency administration of non-prescription medication. The licensee must immediately report to the Department any medication error which occurred while the child was in care and which required hospitalization or emergency medical treatment, or which resulted in a child receiving the wrong medication. b. Provide the standards, appropriate to the provider setting and age of children, that address obtaining permission from parents to administer medications to children for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: The licensee must maintain an individual written record for each child that includes written consent for the use of unanticipated, non-prescription and topical, non-prescription medications, if applicable. The written parental consent and the licensed health care practitioner authorization shall be valid for one year, unless withdrawn sooner. Such consent and authorization must be renewed annually for administration of medication and/or treatment to continue. No educator shall administer the first dose of any medication to a child, except under extraordinary circumstances and with parental consent. The educator may administer routine, scheduled medication or treatment to the child with a chronic medical condition in accordance with written parental consent and licensed health care practitioner authorization. Educators may, with written parental consent and authorization of a licensed health care practitioner, develop and implement an individual health care plan that permits older school age children to carry their own inhalers and epinephrine auto-injectors and use them as needed, without the direct supervision of an educator. ii. All CCDF-eligible licensed family child care homes. Provide the standard: The licensee must maintain an individual written record for each child that includes written consent for the use of unanticipated, non-prescription and topical, non- prescription medications, if applicable. The written parental consent and the licensed health care practitioner authorization shall be valid for one year, unless withdrawn sooner. Such consent and authorization must be renewed annually for administration of medication and/or treatment to continue. No educator shall administer the first dose of any medication to a child, except under extraordinary circumstances and with parental consent. The educator may administer routine, scheduled medication or treatment to the child with a chronic medical condition in accordance with written parental consent and licensed health care practitioner authorization. Educators may, with written parental consent and authorization of a licensed health care practitioner, develop and implement an individual health care plan that permits older school age children to carry their own inhalers and epinephrine auto-injectors and use them as needed, without the direct supervision of an educator. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x]Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: The Program shall maintain a complete, accurate, and confidential file for each child, which shall include written parental consent for the use of unanticipated, non- prescription and topical medications. All medication administered to a child, including but not limited to oral and topical medications of any kind, either prescription or non-prescription, shall be provided by the child’s parent. No medication shall be administered without written parental consent. Providers may administer routine, scheduled medication or treatment to a child with a chronic medical condition in accordance with written parental consent and licensed Health Care Practitioner authorization. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: NA vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Medications administered to a child by the provider, including but not limited to oral and topical medications of any kind, either prescription or non-prescription, shall be provided by the child’s parent. No medication shall be administered without written parental consent. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: The licensee must maintain an individual written record for each child that includes written consent for the use of unanticipated, non-prescription and topical, non-prescription medications, if applicable. The written parental consent and the licensed health care practitioner authorization shall be valid for one year, unless withdrawn sooner. Such consent and authorization must be renewed annually for administration of medication and/or treatment to continue. No educator shall administer the first dose of any medication to a child, except under extraordinary circumstances and with parental consent. The educator may administer routine, scheduled medication or treatment to the child with a chronic medical condition in accordance with written parental consent and licensed health care practitioner authorization. Educators may, with written parental consent and authorization of a licensed health care practitioner, develop and implement an individual health care plan that permits older school age children to carry their own inhalers and epinephrine auto- injectors and use them as needed, without the direct supervision of an educator. 5.3.4 Prevention of and response to emergencies due to food and allergic reactions health and safety standard a. Provide the standards, appropriate to the provider setting and age of children, that address the prevention of emergencies due to food and allergic reactions for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: The program must have a written health care policy that includes: a plan for meeting individual children's specific health care needs, including the procedure for identifying children with allergies and protecting children from that to which they are allergic. Educators must follow the directions of the parents and /or the child’s physician regarding any food allergies of a child. The program must maintain an individual written record for each child that includes information on allergies, special diets, chronic health conditions and/or any special limitations or concerns, including medications the child is taking at home or school and possible side effects of those medications. The licensee must post the following information in an area easily visible to parents, educators and visitors, in a manner that protects the privacy of each child: a list of all emergency or life saving medications, including but not limited to epinephrine auto-injectors, inhalers, and anti-seizure medications, that specifies to which children they belong; and a list of allergies and/or other emergency medical information provided by the parent for each child. ii. All CCDF-eligible licensed family child care homes. Provide the standard: The program must have a written health care policy that includes: a plan for meeting individual children's specific health care needs, including the procedure for identifying children with allergies and protecting children from that to which they are allergic. Educators must follow the directions of the parents and /or the child’s physician regarding any food allergies of a child. The program must maintain an individual written record for each child that includes information on allergies, special diets, chronic health conditions and/or any special limitations or concerns, including medications the child is taking at home or school and possible side effects of those medications. The licensee must post the following information in an area easily visible to parents, educators and visitors, in a manner that protects the privacy of each child: a list of all emergency or life saving medications, including but not limited to epinephrine auto-injectors, inhalers, and anti-seizure medications, that specifies to which children they belong; and a list of allergies and/or other emergency medical information provided by the parent for each child. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: The program shall have and follow a written health care policy that includes a plan for meeting individual children's specific health care needs, including, but not limited to procedures for identifying children with allergies and protecting children from that to which they are allergic, if applicable. The program shall follow the directions of the parents and /or the child’s physician regarding any allergies, food preparation, and feeding of special diets to children. The program shall ensure that information about allergies and other known medical conditions are easily and readily available at all times and accompany the children anytime they leave the facility in the care of staff. The program shall post the following information in an area easily visible to parents, providers, and visitors, in a manner that protects the privacy of each child: a list of all emergency or life-saving medications, including but not limited to epinephrine auto-injectors, inhalers, and anti-seizure medications, that specifies to which children they belong; and a list of allergies and/or other emergency medical information provided by the parent for each child. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: NA vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The provider shall have procedures for identifying children with allergies and protecting children from that to which they are allergic. The provider shall follow the directions of the parents and /or the child’s physician regarding any food allergies, preparation, and feeding of special diets to child. Information about allergies and other known medical conditions shall be easily and readily available at all times and shall accompany the child whenever leaving the home under the provider’s supervision. During child care hours, the provider shall ensure that emergency information is easily accessible, on and off the child care premises. Emergency information shall include the location of all emergency or life-saving medications, including but not limited to epinephrine auto-injectors, inhalers, and anti-seizure medications, that specifies to which child/children they belong, and a list of allergies and/or other emergency medical information provided by the parent for each child. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: The program must have a written health care policy that includes: a plan for meeting individual children's specific health care needs, including the procedure for identifying children with allergies and protecting children from that to which they are allergic. Educators must follow the directions of the parents and /or the child’s physician regarding any food allergies of a child. The program must maintain an individual written record for each child that includes information on allergies, special diets, chronic health conditions and/or any special limitations or concerns, including medications the child is taking at home or school and possible side effects of those medications. The licensee must post the following information in an area easily visible to parents, educators and visitors, in a manner that protects the privacy of each child: a list of all emergency or life saving medications, including but not limited to epinephrine auto-injectors, inhalers, and anti-seizure medications, that specifies to which children they belong; and a list of allergies and/or other emergency medical information provided by the parent for each child. Educators may, with written parental consent and authorization of a licensed health care practitioner, develop and implement an individual health care plan that permits older school age children to carry their own inhalers and epinephrine auto-injectors and use them as needed, without the direct supervision of an educator. Whenever an individual health care plan provides for a child to carry his or her own medication, the licensee must maintain on-site a back-up supply of the medication for use as needed. b. Provide the standards, appropriate to the provider setting and age of children, that address the response to emergencies due to food and allergic reactions for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: The program must post the following information in an area easily visible to parents, educators, and visitors, in a manner that protects the privacy of each child, a list of allergies and/or other emergency medical information provided by the parent for each child. The licensee must ensure that at least one educator currently certified in first aid and age-appropriate cardiopulmonary resuscitation (CPR) is present at any and all times when children are in care. The licensee must maintain an individual written record for each child that includes: permission to transport a child to a medical facility and for the child to receive emergency medical treatment, including but not limited to an epinephrine auto-injection for suspected exposure to a life threatening allergen in the event that the parent cannot be reached and when delay would be dangerous to the health of the child. The licensee must ensure that the following are easily and readily available at all times, and accompany the children anytime they leave the facility in the care of staff: information about allergies and known medical conditions; emergency or life-saving medications, such as asthma inhalers and epinephrine auto-injectors, for any children for whom they have been prescribed; telephone numbers for emergency services; authorizations for emergency care for each child. Educators may, with written parental consent and authorization of a licensed health care practitioner, develop and implement an individual health care plan that permits older school age children to carry their own inhalers and epinephrine auto- injectors and use them as needed, without the direct supervision of an educator. Whenever an individual health care plan provides for a child to carry his or her own medication, the licensee must maintain on-site a back-up supply of the medication for use as needed. ii. All CCDF-eligible licensed family child care homes. Provide the standard: The program must post the following information in an area easily visible to parents, educators, and visitors, in a manner that protects the privacy of each child, a list of allergies and/or other emergency medical information provided by the parent for each child. The licensee must ensure that at least one educator currently certified in first aid and age-appropriate cardiopulmonary resuscitation (CPR) is present at any and all times when children are in care. The licensee must maintain an individual written record for each child that includes: permission to transport a child to a medical facility and for the child to receive emergency medical treatment, including but not limited to an epinephrine auto-injection for suspected exposure to a life threatening allergen in the event that the parent cannot be reached and when delay would be dangerous to the health of the child. The licensee must ensure that the following are easily and readily available at all times, and accompany the children anytime they leave the facility in the care of staff: information about allergies and known medical conditions; emergency or life-saving medications, such as asthma inhalers and epinephrine auto-injectors, for any children for whom they have been prescribed; telephone numbers for emergency services; authorizations for emergency care for each child. Educators may, with written parental consent and authorization of a licensed health care practitioner, develop and implement an individual health care plan that permits older school age children to carry their own inhalers and epinephrine auto- injectors and use them as needed, without the direct supervision of an educator. Whenever an individual health care plan provides for a child to carry his or her own medication, the licensee must maintain on-site a back-up supply of the medication for use as needed. iii. All CCDF-eligible licensed in-home care. Provide the standard:: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: The program must post the following information in an area easily visible to parents, educators, and visitors, in a manner that protects the privacy of each child, a list of allergies and/or other emergency medical information provided by the parent for each child. At least one staff member with current age-appropriate CPR and First Aid Certification shall be present at all times while children are in care, including at least one person in each vehicle transporting children and at least one person accompanying children during activities off site. Coursework toward such certification must include basic training in food choking hazards, asthma, and anaphylaxis, and must include hands-on training, in accordance with EEC policy. The Program shall maintain a complete, accurate, and confidential file for each child, in one central location on-site, that should be immediately available to the child's caregivers/Providers (who should have Parental/guardian consent for access to records), the child's Parents/guardians, and EEC staff upon request. The individual file for each child shall include Permission to transport the child to a medical facility and for the child to receive emergency medical treatment, including but not limited to an epinephrine auto-injection for suspected exposure to a life threatening allergen in the event that the Parent cannot be reached and when delay would be dangerous to the health of the child. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: NA vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The provider must be aware of allergies and/or other emergency medical information provided by the parent for each child. Information about allergies and other known medical conditions shall be easily and readily available at all times, and shall accompany the child whenever leaving the home under the provider’s supervision. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: The program must post the following information in an area easily visible to parents, educators, and visitors, in a manner that protects the privacy of each child, a list of allergies and/or other emergency medical information provided by the parent for each child. The licensee must ensure that at least one educator currently certified in first aid and age-appropriate cardiopulmonary resuscitation (CPR) is present at any and all times when children are in care. The licensee must maintain an individual written record for each child that includes: permission to transport a child to a medical facility and for the child to receive emergency medical treatment, including but not limited to an epinephrine auto-injection for suspected exposure to a life threatening allergen in the event that the parent cannot be reached and when delay would be dangerous to the health of the child. The licensee must ensure that the following are easily and readily available at all times, and accompany the children anytime they leave the facility in the care of staff: information about allergies and known medical conditions; emergency or life-saving medications, such as asthma inhalers and epinephrine auto-injectors, for any children for whom they have been prescribed; telephone numbers for emergency services; authorizations for emergency care for each child. Educators may, with written parental consent and authorization of a licensed health care practitioner, develop and implement an individual health care plan that permits older school age children to carry their own inhalers and epinephrine auto-injectors and use them as needed, without the direct supervision of an educator. Whenever an individual health care plan provides for a child to carry his or her own medication, the licensee must maintain on-site a back-up supply of the medication for use as needed. 5.3.5 Building and physical premises safety, including the identification of and protection from hazards, bodies of water, and vehicular traffic health and safety standard a. Provide the standards, appropriate to the provider setting and age of children, that address the identification of and protection from building and physical premises hazards for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: The licensee must ensure that the physical facilities are safe, clean, in good repair and free from hazards and clutter. The licensee must monitor the environment daily to identify and remove or repair any hazards that may cause injury to children. Exits and evacuation routes must be kept clear of obstructions. Every program that is not located in a residence and every program that has a licensed capacity of more than ten children must provide a certificate of inspection from the Department of Public Safety or the local building inspector certifying that the facility complies with the applicable 780 CMR: The Sate Building Code. The licensee shall submit evidence of compliance with applicable fire codes. The licensee must submit copies of current pool and pool roof inspections as required by applicable law or statute. The licensee must maintain the interior and exterior of the program in good repair, free of chipping, flaking, or peeling paint or broken plaster. The outdoor play area must be free from hazards including but not limited to: a busy street, a parking lot, poisonous plants, water hazards, debris, broken glass, chipping, peeling or flaking paint, dangerous machinery or tools, and weather related and environmental hazards or small objects that could present a choking hazard to young children. Any such hazard must be removed or fenced by a sturdy, permanently installed barrier which is at least four feet high or otherwise protected or removed, as appropriate. If the outdoor play space is located on a roof, it must be protected by a barrier at least seven feet high, which cannot be climbed by children. The outdoor play space must not be covered with a dangerously harsh, abrasive, or toxic material. Suitable barriers, including but not limited to bulkhead doors, must be installed to prevent falls into outdoor stair or window wells. Porches and decks must be inspected and approved by the Department before use by child care children. Porches and decks that are more than three feet from grade level must be surrounded by a protective barricade in accordance with applicable building codes. Barricades must be sturdy and constructed in a way that will prevent a young child from going underneath, over, or through them. Stairs must be safely barricaded whenever the porch or deck is in use by children younger than three years old. Additional precautions may be required as deemed necessary. All windows used for ventilation must include screens in good repair. Windows and glass doors must be constructed, adapted, or adjusted through the use of window guards or other means to prevent injury to children. The interior of the child care program must be clean and maintained free from vermin. Safe and effective means of eliminating vermin must be provided. Pesticides may not be used on the child care premises during child care hours. The licensee must provide running water in sinks used by children. Water temperature must not exceed 120°F. All electrical outlets within the reach of children younger than school age must be made inaccessible by use of a safety device or covering that prevents access to the receptacle openings. If the covering is a shock stop, it must be of adequate size to prevent a choking hazard. All electrical cords must be arranged so they are not a hazard to children. Electrical cords must not be frayed or damaged. Stairways must be equipped with handrails. In programs serving children younger than three years old, barriers must be placed at the top and bottom of stairwells opening into areas used by children, unless prohibited by building or fire department regulations. Barriers must be permanently installed at the top of stairways. Pressure gates may not be used at the top of stairs. Open stairways used by children younger than school age must have railings or banisters installed along the open or unprotected side(s). The licensee must only use indoor and outdoor equipment, materials, furnishings, toys, and games that are appropriate to the ages, needs and developmental level of the children enrolled. They must be sturdy, safely constructed and installed, non-tippable, flame retardant, easily cleaned, and free from lead paint, protruding nails, rust, and other hazards that may be dangerous to children. All play equipment, fences and structures must be free of entrapment hazards. Riding toys must not be used in any room where there is access to falling hazards. Strings and cords longer than six inches that are not part of recreational or educational materials, including, but not limited to cords on window blinds, curtains or shades, must be kept out of children’s reach. All steam and hot water pipes and radiators must be protected by permanent screens, guards, insulation or another suitable device that prevents children from coming in contact with them. If a program serves any child younger than five years old, the licensee must provide evidence of a lead paint inspection from the local board of health, or the Massachusetts Department of Public Health, or a private lead paint inspection service and compliance with The Department of Public Health regulations at 105 CMR 460.000: Lead Poisoning Prevention and Control. A licensee that obtained evidence of a lead paint inspection and compliance with 105 CMR 460.000 from the local board of health or the Massachusetts Department of Public Health or a private lead paint inspection service prior to July 1, 1978, will not be required to comply with additional deleading requirements unless: a. ordered to do so by the local board of health or the Massachusetts Department of Public Health to remain in compliance with 105 CMR 460.000; or b. expanding to space not previously approved by the Department. If chipping, peeling, flaking or otherwise loose paint or plaster is discovered in a previously compliant facility built prior to 1978, the Licensee must obtain new evidence of compliance with 105 CMR 460.00. Programs must document compliance with the Integrated Pest Management program of the Department of Agricultural Resources. Pea gravel and wood chip nuggets must not be used in outdoor areas used by infants and toddlers. ii. All CCDF-eligible licensed family child care homes. Provide the standard: The licensee must ensure that the physical facilities are safe, clean, in good repair and free from hazards and clutter. The licensee must monitor the environment daily to identify and remove or repair any hazards that may cause injury to children. Exits and evacuation routes must be kept clear of obstructions. Every program that is not located in a residence and every program that has a licensed capacity of more than ten children must provide a certificate of inspection from the Department of Public Safety or the local building inspector certifying that the facility complies with the applicable 780 CMR: The Sate Building Code. The licensee shall submit evidence of compliance with applicable fire codes. The licensee must submit copies of current pool and pool roof inspections as required by applicable law or statute. The licensee must maintain the interior and exterior of the program in good repair, free of chipping, flaking, or peeling paint or broken plaster. The outdoor play area must be free from hazards including but not limited to: a busy street, a parking lot, poisonous plants, water hazards, debris, broken glass, chipping, peeling or flaking paint, dangerous machinery or tools, and weather related and environmental hazards or small objects that could present a choking hazard to young children. Any such hazard must be removed or fenced by a sturdy, permanently installed barrier which is at least four feet high or otherwise protected or removed, as appropriate. If the outdoor play space is located on a roof, it must be protected by a barrier at least seven feet high, which cannot be climbed by children. The outdoor play space must not be covered with a dangerously harsh, abrasive, or toxic material. Suitable barriers, including but not limited to bulkhead doors, must be installed to prevent falls into outdoor stair or window wells. Porches and decks must be inspected and approved by the Department before use by child care children. Porches and decks that are more than three feet from grade level must be surrounded by a protective barricade in accordance with applicable building codes. Barricades must be sturdy and constructed in a way that will prevent a young child from going underneath, over, or through them. Stairs must be safely barricaded whenever the porch or deck is in use by children younger than three years old. Additional precautions may be required as deemed necessary. All windows used for ventilation must include screens in good repair. Windows and glass doors must be constructed, adapted, or adjusted through the use of window guards or other means to prevent injury to children. The interior of the child care program must be clean and maintained free from vermin. Safe and effective means of eliminating vermin must be provided. Pesticides may not be used on the child care premises during child care hours. The licensee must provide running water in sinks used by children. Water temperature must not exceed 120°F. All electrical outlets within the reach of children younger than school age must be made inaccessible by use of a safety device or covering that prevents access to the receptacle openings. If the covering is a shock stop, it must be of adequate size to prevent a choking hazard. All electrical cords must be arranged so they are not a hazard to children. Electrical cords must not be frayed or damaged. Stairways must be equipped with handrails. In programs serving children younger than three years old, barriers must be placed at the top and bottom of stairwells opening into areas used by children, unless prohibited by building or fire department regulations. Barriers must be permanently installed at the top of stairways. Pressure gates may not be used at the top of stairs. Open stairways used by children younger than school age must have railings or banisters installed along the open or unprotected side(s). The licensee must only use indoor and outdoor equipment, materials, furnishings, toys, and games that are appropriate to the ages, needs and developmental level of the children enrolled. They must be sturdy, safely constructed and installed, non-tippable, flame retardant, easily cleaned, and free from lead paint, protruding nails, rust, and other hazards that may be dangerous to children. All play equipment, fences and structures must be free of entrapment hazards. Riding toys must not be used in any room where there is access to falling hazards. Strings and cords longer than six inches that are not part of recreational or educational materials, including, but not limited to cords on window blinds, curtains or shades, must be kept out of children’s reach. All steam and hot water pipes and radiators must be protected by permanent screens, guards, insulation or another suitable device that prevents children from coming in contact with them. If a program serves any child younger than five years old, the licensee must provide evidence of a lead paint inspection from the local board of health, or the Massachusetts Department of Public Health, or a private lead paint inspection service and compliance with The Department of Public Health regulations at 105 CMR 460.000: Lead Poisoning Prevention and Control. A licensee that obtained evidence of a lead paint inspection and compliance with 105 CMR 460.000 from the local board of health or the Massachusetts Department of Public Health or a private lead paint inspection service prior to July 1, 1978, will not be required to comply with additional deleading requirements unless: a. ordered to do so by the local board of health or the Massachusetts Department of Public Health to remain in compliance with 105 CMR 460.000; or b. expanding to space not previously approved by the Department. If chipping, peeling, flaking or otherwise loose paint or plaster is discovered in a previously compliant facility built prior to 1978, the Licensee must obtain new evidence of compliance with 105 CMR 460.00. Programs must document compliance with the Integrated Pest Management program of the Department of Agricultural Resources. Pea gravel and wood chip nuggets must not be used in outdoor areas used by infants and toddlers. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Exits and evacuation routes shall be kept clear of obstructions. The Program shall be able to provide evidence of compliance with all applicable fire code. The indoor space shall be safe, clean, in good repair, and free from hazards and clutter. Providers shall monitor the environment daily to identify and remove or repair any hazards that may cause injury to children. Strings and cords longer than six inches that are not part of recreational or educational materials, including, but not limited to cords on window blinds, curtains or shades, shall be kept out of children’s reach. All electrical outlets within the reach of children younger than school age shall be made inaccessible by use of a safety device or covering that prevents access to the receptacle openings. All electrical cords shall be arranged so they are not a hazard to children. Electrical cords shall not be frayed or damaged. All windows used for ventilation shall include screens in good repair. Windows and glass doors shall be constructed, adapted, or adjusted through the use of window guards or other means to prevent injury to children. The interior of the child care program shall be clean and maintained free from vermin. Safe and effective means of eliminating vermin shall be provided. Pesticides may not be used on the child care premises during child care hours. Stairways shall be equipped with handrails. In programs serving children younger than 2.9 years old, barriers shall be placed at the top and bottom of stairwells opening into areas used by children, unless prohibited by building or fire department regulations. Barriers shall be permanently installed at the top of stairways. Pressure gates may not be used at the top of stairs. Open stairways used by children younger than school age shall have railings or banisters installed along the open or unprotected side(s). All indoor equipment, materials, and furnishings shall be sturdy, safely constructed and installed, non-tippable and/or anchored securely, flame retardant, easily cleaned, and free from lead paint, protruding nails, rust, and other hazards that may be dangerous to children. Riding toys shall not be used in any room where there is access to falling hazards. Pea gravel and wood chip nuggets must not be used in areas used by Infants and toddlers. The outdoor play area shall be free from hazards including, but not limited to: entrapment hazards, a busy street, a parking lot, poisonous plants, water hazards, debris, broken glass, chipping, peeling or flaking paint, dangerous machinery or tools, and weather related and environmental hazards or small objects that could present a choking hazard to young children. Any such hazard shall be removed or fenced by a sturdy, permanently installed barrier which is at least four feet high or otherwise protected or removed, as appropriate. The outdoor play space shall not be covered with a dangerously harsh, abrasive, or toxic material. All outdoor play equipment, fences and structures shall be free of entrapment hazards. The program shall ensure that the outdoor space is routinely checked and cleared of all hazardous objects, including but not limited to hazardous debris, matches, lighters, toxic materials, sharp objects, plastic bags. The program shall be able to provide copies of current pool and pool roof inspections as required by applicable law or statute. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: NA vi. All CCDF-eligible license-exempt in-home care. Provide the standard: All indoor space used for child care shall be monitored daily to ensure that it is safe, adequately maintained, and free from hazards and immediate health risks. Strings and cords longer than six inches that are not part of recreational or educational materials, including, but not limited to cords on window blinds, curtains or shades, shall be kept out of children’s reach. Electrical outlets within the reach of children younger than school age shall be made inaccessible by use of a safety device or covering that prevents access to the receptacle openings. Electrical cords shall be arranged so they are not a hazard to children. Electrical cords shall not be frayed or damaged. Stairways used by child care children shall be equipped with handrails. Water temperature in sinks used by children shall not exceed 120°F. All outdoor space used for child care shall be monitored daily to ensure that it is safe, adequately maintained, and free from hazards and immediate health risks, including but not limited to a busy street, a parking lot, poisonous plants, water hazards, debris, broken glass, chipping, peeling or flaking paint, dangerous machinery or tools, and weather related and environmental hazards or small objects that could present a choking hazard to young children. The provider shall use approved barriers to restrict access to any unsafe areas, including but not limited to windows, pools, standing water, wells, wood and coal burning stoves, fireplaces, heating units, hot tubs and whirlpools, a busy street or parking lot, dangerous machinery or tools, and weather-related and environmental hazards. All windows and glass doors accessible to children shall include secure screens in good repair. Windows used for ventilation shall be securely barricaded through the use of window guards or other means to prevent injury to children, or opened from the top. Providers serving children younger than three years old, shall place approved barriers at the top and bottom of stairwells opening into areas used by children, unless prohibited by building or fire department regulations. Whenever pools are not in use, they shall be made inaccessible to children through the use of fences, self-locking gates, or other appropriate barriers to child access. All hot tubs, whether indoors or outdoors, shall be inaccessible to children. Porches and decks that are more than three feet from grade level shall be surrounded by a protective barricade. Porch and/or deck stairs shall be safely barricaded whenever the porch or deck is in use by children younger than three years old. Barricades shall be sturdy and constructed in a way that will prevent a young child from going underneath, over, or through them. At least two separate exits to the outside shall be accessible, safe, easily identified, and kept clear of obstructions at all times, in accordance with EEC policy. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: All indoor space used for child care shall be monitored daily to ensure that it is safe, adequately maintained, and free from hazards and immediate health risks. Strings and cords longer than six inches that are not part of recreational or educational materials, including, but not limited to cords on window blinds, curtains or shades, shall be kept out of children’s reach. Electrical outlets within the reach of children younger than school age shall be made inaccessible by use of a safety device or covering that prevents access to the receptacle openings. Electrical cords shall be arranged so they are not a hazard to children. Electrical cords shall not be frayed or damaged. Stairways used by child care children shall be equipped with handrails. Water temperature in sinks used by children shall not exceed 120°F. All outdoor space used for child care shall be monitored daily to ensure that it is safe, adequately maintained, and free from hazards and immediate health risks, including but not limited to a busy street, a parking lot, poisonous plants, water hazards, debris, broken glass, chipping, peeling or flaking paint, dangerous machinery or tools, and weather related and environmental hazards or small objects that could present a choking hazard to young children. The provider shall use approved barriers to restrict access to any unsafe areas, including but not limited to windows, pools, standing water, wells, wood and coal burning stoves, fireplaces, heating units, hot tubs and whirlpools, a busy street or parking lot, dangerous machinery or tools, and weather-related and environmental hazards. All windows and glass doors accessible to children shall include secure screens in good repair. Windows used for ventilation shall be securely barricaded through the use of window guards or other means to prevent injury to children, or opened from the top. Providers serving children younger than three years old, shall place approved barriers at the top and bottom of stairwells opening into areas used by children, unless prohibited by building or fire department regulations. Whenever pools are not in use, they shall be made inaccessible to children through the use of fences, self-locking gates, or other appropriate barriers to child access. All hot tubs, whether indoors or outdoors, shall be inaccessible to children. Porches and decks that are more than three feet from grade level shall be surrounded by a protective barricade. Porch and/or deck stairs shall be safely barricaded whenever the porch or deck is in use by children younger than three years old. Barricades shall be sturdy and constructed in a way that will prevent a young child from going underneath, over, or through them. At least two separate exits to the outside shall be accessible, safe, easily identified, and kept clear of obstructions at all times, in accordance with EEC policy. b. Provide the standards, appropriate to the provider setting and age of children, that address the identification of and protection from bodies of water for the following CCDF- eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: The outdoor play area must be free from hazards including but not limited to: a busy street, a parking lot, poisonous plants, water hazards, debris, broken glass, chipping, peeling or flaking paint, dangerous machinery or tools, and weather related and environmental hazards or small objects that could present a choking hazard to young children. Any such hazard must be removed or fenced by a sturdy, permanently installed barrier which is at least four feet high or otherwise protected or removed, as appropriate. For programs that offer swimming, boating, or other water activities, the program must ensure that the area is safe and children are directly supervised at all times during activities involving water, including tubs, pools, showers, or standing water. Educator/child ratios must be sufficient to maintain the safety of children in or near water. The program must ensure that all swimming and wading pools used by children are treated, cleaned, maintained and supervised according to sound health and safety practices and state and local guidelines and regulations. Whenever pools are not in use, they must be made inaccessible to children through the use of fences, self-locking gates, or other appropriate barriers to child access. Wading pools must be emptied immediately after use and sanitized between uses and whenever contaminated. All hot tubs, whether indoors or outdoors, must be inaccessible to children. Whenever children are swimming (not including the use of wading pools) a second adult must be on the premises available to assist in case of emergency. When children are swimming in a swimming pool, an adult must be present who is aware of the pump location and is able to turn the pump off in the event of an emergency. Whenever children participate in off-site water activities at least one person supervising the activity must be certified as a lifeguard and currently certified in CPR and first aid. ii. All CCDF-eligible licensed family child care homes. Provide the standard: The outdoor play area must be free from hazards including but not limited to: a busy street, a parking lot, poisonous plants, water hazards, debris, broken glass, chipping, peeling or flaking paint, dangerous machinery or tools, and weather related and environmental hazards or small objects that could present a choking hazard to young children. Any such hazard must be removed or fenced by a sturdy, permanently installed barrier which is at least four feet high or otherwise protected or removed, as appropriate. For programs that offer swimming, boating, or other water activities, the program must ensure that the area is safe and children are directly supervised at all times during activities involving water, including tubs, pools, showers, or standing water. Educator/child ratios must be sufficient to maintain the safety of children in or near water. The program must ensure that all swimming and wading pools used by children are treated, cleaned, maintained and supervised according to sound health and safety practices and state and local guidelines and regulations. Whenever pools are not in use, they must be made inaccessible to children through the use of fences, self-locking gates, or other appropriate barriers to child access. Wading pools must be emptied immediately after use and sanitized between uses and whenever contaminated. All hot tubs, whether indoors or outdoors, must be inaccessible to children. Whenever children are swimming (not including the use of wading pools) a second adult must be on the premises available to assist in case of emergency. When children are swimming in a swimming pool, an adult must be present who is aware of the pump location and is able to turn the pump off in the event of an emergency. Whenever children participate in off-site water activities at least one person supervising the activity must be certified as a lifeguard and currently certified in CPR and first aid. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: The outdoor play area shall be free from hazards including, but not limited to: entrapment hazards, a busy street, a parking lot, poisonous plants, water hazards, debris, broken glass, chipping, peeling or flaking paint, dangerous machinery or tools, and weather related and environmental hazards or small objects that could present a choking hazard to young children. Any such hazard shall be removed or fenced by a sturdy, permanently installed barrier which is at least four feet high or otherwise protected or removed, as appropriate. Whenever pools are not in use, they shall be made inaccessible to children through the use of fences, self-locking gates, or other appropriate barriers to child access. All hot tubs, whether indoors or outdoors, shall be inaccessible to children. All swimming and wading pools used by children shall be treated, cleaned, maintained, and supervised according to sound health and safety practices and state and local guidelines and regulations. Wading pools shall be emptied immediately after use and sanitized between uses and whenever contaminated. Children shall be directly and actively supervised at all times during activities involving water, including tubs, pools, showers, or standing water. Provider/child ratios shall be sufficient to maintain the safety of children in or near water. When children are swimming in a swimming pool, an adult shall be present who is aware of the pump location and is able to turn the pump off in the event of an emergency. Whenever children are swimming (not including the use of wading pools) a second adult shall be on the premises available to assist in case of emergency. Whenever children participate in on-site or off-site swimming or water activities, at least one person supervising the activity shall be currently certified as a lifeguard and currently certified in CPR and first aid. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: NA vi. All CCDF-eligible license-exempt in-home care. Provide the standard: All outdoor space used for child care shall be monitored daily to ensure that it is safe, adequately maintained, and free from hazards and immediate health risks, including but not limited to a busy street, a parking lot, poisonous plants, water hazards, debris, broken glass, chipping, peeling or flaking paint, dangerous machinery or tools, and weather related and environmental hazards or small objects that could present a choking hazard to young children. The provider shall use approved barriers to restrict access to any unsafe areas, including but not limited to windows, pools, standing water, wells, wood and coal burning stoves, fireplaces, heating units, hot tubs and whirlpools, a busy street or parking lot, dangerous machinery or tools, and weather-related and environmental hazards. Children shall be directly and actively supervised at all times during activities involving water, including tubs, pools, showers, or standing water. Whenever pools are not in use, they shall be made inaccessible to children through the use of fences, self-locking gates, or other appropriate barriers to child access. All hot tubs, whether indoors or outdoors, shall be inaccessible to children. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: The outdoor play area must be free from hazards including but not limited to: a busy street, a parking lot, poisonous plants, water hazards, debris, broken glass, chipping, peeling or flaking paint, dangerous machinery or tools, and weather related and environmental hazards or small objects that could present a choking hazard to young children. Any such hazard must be removed or fenced by a sturdy, permanently installed barrier which is at least four feet high or otherwise protected or removed, as appropriate. For programs that offer swimming, boating, or other water activities, the program must ensure that the area is safe and children are directly supervised at all times during activities involving water, including tubs, pools, showers, or standing water. Educator/child ratios must be sufficient to maintain the safety of children in or near water. The program must ensure that all swimming and wading pools used by children are treated, cleaned, maintained and supervised according to sound health and safety practices and state and local guidelines and regulations. Whenever pools are not in use, they must be made inaccessible to children through the use of fences, self-locking gates, or other appropriate barriers to child access. Wading pools must be emptied immediately after use and sanitized between uses and whenever contaminated. All hot tubs, whether indoors or outdoors, must be inaccessible to children. Whenever children are swimming (not including the use of wading pools) a second adult must be on the premises available to assist in case of emergency. When children are swimming in a swimming pool, an adult must be present who is aware of the pump location and is able to turn the pump off in the event of an emergency. Whenever children participate in off-site water activities at least one person supervising the activity must be certified as a lifeguard and currently certified in CPR and first aid. c. Provide the standards, appropriate to the provider setting and age of children, that address the identification of and protection from vehicular traffic hazards for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: The outdoor play area must be free from hazards including but not limited to: a busy street, a parking lot, poisonous plants, water hazards, debris, broken glass, chipping, peeling or flaking paint, dangerous machinery or tools, and weather related and environmental hazards or small objects that could present a choking hazard to young children. Any such hazard must be removed or fenced by a sturdy, permanently installed barrier which is at least four feet high or otherwise protected or removed, as appropriate. All licensees and educators must exercise appropriate supervision of the children in their care in order to ensure their health and safety at all times. Such supervision must include, but not be limited to, indoor and outdoor activities, mealtimes, naptime, transportation, field trips, and transitions between activities. The licensee must have a written plan for the safety and supervision of all children during transport. The plan must address the safety and supervision of children who walk and who arrive by public transportation. ii. All CCDF-eligible licensed family child care homes. Provide the standard: The outdoor play area must be free from hazards including but not limited to: a busy street, a parking lot, poisonous plants, water hazards, debris, broken glass, chipping, peeling or flaking paint, dangerous machinery or tools, and weather related and environmental hazards or small objects that could present a choking hazard to young children. Any such hazard must be removed or fenced by a sturdy, permanently installed barrier which is at least four feet high or otherwise protected or removed, as appropriate. All licensees and educators must exercise appropriate supervision of the children in their care in order to ensure their health and safety at all times. Such supervision must include, but not be limited to, indoor and outdoor activities, mealtimes, naptime, transportation, field trips, and transitions between activities. The licensee must have a written plan for the safety and supervision of all children during transport. The plan must address the safety and supervision of children who walk and who arrive by public transportation. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: The outdoor play area shall be free from hazards including, but not limited to: entrapment hazards, a busy street, a parking lot, poisonous plants, water hazards, debris, broken glass, chipping, peeling or flaking paint, dangerous machinery or tools, and weather related and environmental hazards or small objects that could present a choking hazard to young children. Any such hazard shall be removed or fenced by a sturdy, permanently installed barrier which is at least four feet high or otherwise protected or removed, as appropriate. All providers shall exercise appropriate supervision of the children in their care in order to ensure their health and safety at all times. Such supervision shall include, but not be limited to, indoor and outdoor activities, mealtimes, naptime, transportation, field trips, and transitions between activities. The program shall have a written plan for the safety and supervision of all children during transport. The plan shall address the safety and supervision of children who walk and who arrive by public transportation. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: NA vi. All CCDF-eligible license-exempt in-home care. Provide the standard: All outdoor space used for child care shall be monitored daily to ensure that it is safe, adequately maintained, and free from hazards and immediate health risks, including but not limited to a busy street, a parking lot, poisonous plants, water hazards, debris, broken glass, chipping, peeling or flaking paint, dangerous machinery or tools, and weather related and environmental hazards or small objects that could present a choking hazard to young children. The Provider shall use approved barriers to restrict access to any unsafe areas, including but not limited to windows, pools, standing water, wells, wood and coal burning stoves, fireplaces, heating units, hot tubs and whirlpools, a busy street or parking lot, dangerous machinery or tools, and weather-related and environmental hazards. The Provider shall exercise active supervision of all children, appropriate to their ages and developmental levels and in order to ensure their health and safety at all times. Such supervision shall include, but not be limited to, indoor and outdoor activities, mealtimes, naptime, and transportation. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: The outdoor play area must be free from hazards including but not limited to: a busy street, a parking lot, poisonous plants, water hazards, debris, broken glass, chipping, peeling or flaking paint, dangerous machinery or tools, and weather related and environmental hazards or small objects that could present a choking hazard to young children. Any such hazard must be removed or fenced by a sturdy, permanently installed barrier which is at least four feet high or otherwise protected or removed, as appropriate. All licensees and educators must exercise appropriate supervision of the children in their care in order to ensure their health and safety at all times. Such supervision must include, but not be limited to, indoor and outdoor activities, mealtimes, naptime, transportation, field trips, and transitions between activities. The licensee must have a written plan for the safety and supervision of all children during transport. The plan must address the safety and supervision of children who walk and who arrive by public transportation. 5.3.6 Prevention of shaken baby syndrome, abusive head trauma, and maltreatment health and safety standard a. Provide the standards, appropriate to the provider setting and age of children, that address the prevention of shaken baby syndrome and abusive head trauma and indicate the age of children it applies to for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: The following practices are strictly prohibited: subjecting children to cruel or severe punishment such as humiliation, verbal or physical abuse, neglect, or abusive treatment including any type of physical hitting inflicted in any manner upon the body, shaking, threats, or derogatory remarks. This requirement applies to all programs, infants, toddlers, preschoolers, and school age children. All educators and administrators working in EEC-licensed or funded programs are required to complete the EEC Essentials 2.0 training package, including Preventing Shaken Baby Syndrome and Protecting Children from Abuse and Neglect. ii. All CCDF-eligible licensed family child care homes. Provide the standard: The following practices are strictly prohibited: subjecting children to cruel or severe punishment such as humiliation, verbal or physical abuse, neglect, or abusive treatment including any type of physical hitting inflicted in any manner upon the body, shaking, threats, or derogatory remarks. This requirement applies to all programs, infants, toddlers, preschoolers, and school age children. All educators and administrators working in EEC-licensed or funded programs are required to complete the EEC Essentials 2.0 training package, including Preventing Shaken Baby Syndrome and Protecting Children from Abuse and Neglect. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Written information shall be provided to families regarding the prevention of shaken baby syndrome, abusive head trauma, and child maltreatment. The following practices are strictly prohibited: spanking or other corporal punishment of children and subjecting children to cruel or severe punishment such as humiliation, verbal or physical abuse, neglect, or abusive treatment including any type of physical hitting inflicted in any manner upon the body, shaking, threats, or derogatory remark. All educators and administrators working in EEC-licensed or funded programs are required to complete the EEC Essentials 2.0 training package, including Preventing Shaken Baby Syndrome and Protecting Children from Abuse and Neglect. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: NA vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The following practices are strictly prohibited: spanking or other corporal punishment of children and subjecting children to cruel or severe punishment such as humiliation, verbal or physical abuse, neglect, or abusive treatment including any type of physical hitting inflicted in any manner upon the body, shaking, threats, or derogatory remark. The Provider shall have completed all required EEC Essentials 2.0 trainings, in accordance with EEC policy, including: Preventing Shaken Baby Syndrome and Protecting Children from Abuse and Neglect. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: The following practices are strictly prohibited: subjecting children to cruel or severe punishment such as humiliation, verbal or physical abuse, neglect, or abusive treatment including any type of physical hitting inflicted in any manner upon the body, shaking, threats, or derogatory remarks. This requirement applies to all programs, infants, toddlers, preschoolers, and school age children. All applicable Afterschool and Out-of- School (ASOST) time staff will enroll in and complete the 11-course package labeled ￿EEC Essentials for ASOST programs 2.0￿ including Protecting Children from Abuse and Neglect. b. Provide the standards, appropriate to the provider setting and age of children, that address the prevention of child maltreatment and indicate the age of children it applies to for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: Any form of abuse or neglect of children while in care is strictly prohibited. The Licensee and all educators must operate the program in ways that protect children from abuse or neglect. The following practices are strictly prohibited: spanking or other corporal punishment of children; subjecting children to cruel or severe punishment such as humiliation, verbal or physical abuse, neglect, or abusive treatment including any type of physical hitting inflicted in any manner upon the body, shaking, threats, or derogatory remarks; depriving children of outdoor time, meals or snacks; force feeding children or otherwise making them eat against their will, or in any way using food as a consequence; disciplining a child for soiling, wetting, or not using the toilet; forcing a child to remain in soiled clothing or to remain on the toilet, or using any other unusual or excessive practices for toileting; confining a child to a swing, high chair, crib, playpen or any other piece of equipment for an extended period of time in lieu of supervision; and excessive time-out. All educators and administrators working in EEC-licensed or funded programs are required to complete the EEC Essentials 2.0 training package, including Protecting Children from Abuse and Neglect. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Any form of abuse or neglect of children while in care is strictly prohibited. The Licensee and all educators must operate the program in ways that protect children from abuse or neglect. The following practices are strictly prohibited: spanking or other corporal punishment of children; subjecting children to cruel or severe punishment such as humiliation, verbal or physical abuse, neglect, or abusive treatment including any type of physical hitting inflicted in any manner upon the body, shaking, threats, or derogatory remarks; depriving children of outdoor time, meals or snacks; force feeding children or otherwise making them eat against their will, or in any way using food as a consequence; disciplining a child for soiling, wetting, or not using the toilet; forcing a child to remain in soiled clothing or to remain on the toilet, or using any other unusual or excessive practices for toileting; confining a child to a swing, high chair, crib, playpen or any other piece of equipment for an extended period of time in lieu of supervision; and excessive time-out. All educators and administrators working in EEC-licensed or funded programs are required to complete the EEC Essentials 2.0 training package, including Protecting Children from Abuse and Neglect. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: The program shall be operated in ways that protect children from abuse or neglect. Any form of abuse or neglect of children while in care is strictly prohibited. The following practices are strictly prohibited: spanking or other corporal punishment of children; subjecting children to cruel or severe punishment such as humiliation, verbal or physical abuse, neglect, or abusive treatment including any type of physical hitting inflicted in any manner upon the body, shaking, threats, or derogatory remarks; depriving children of outdoor time, meals or snacks; force feeding children or otherwise making them eat against their will, or in any way using food as a consequence; disciplining a child for soiling, wetting, or not using the toilet; forcing a child to remain in soiled clothing or to remain on the toilet, or using any other unusual or excessive practices for toileting; confining a child to a swing, high chair, crib, playpen or any other piece of equipment for an extended period of time in lieu of supervision; and excessive time-out. All educators and administrators working in EEC-licensed or funded programs are required to complete the EEC Essentials 2.0 training package, including Protecting Children from Abuse and Neglect. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: NA vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Any form of abuse or neglect of children while in care is strictly prohibited. The following practices are strictly prohibited: spanking or other corporal punishment of children; subjecting children to cruel or severe punishment such as humiliation, verbal or physical abuse, neglect, or abusive treatment including any type of physical hitting inflicted in any manner upon the body, shaking, threats, or derogatory remarks; depriving children of outdoor time, meals or snacks; force feeding children or otherwise making them eat against their will, or in any way using food as a consequence; disciplining a child for soiling, wetting, or not using the toilet; forcing a child to remain in soiled clothing or to remain on the toilet, or using any other unusual or excessive practices for toileting; confining a child to a swing, high chair, crib, playpen or any other piece of equipment for an extended period of time in lieu of supervision; and excessive time-out. The provider shall have completed all required EEC Essentials 2.0 trainings, in accordance with EEC policy, including Protecting Children from Abuse and Neglect. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Any form of abuse or neglect of children while in care is strictly prohibited. The Licensee and all educators must operate the program in ways that protect children from abuse or neglect. The following practices are strictly prohibited: spanking or other corporal punishment of children; subjecting children to cruel or severe punishment such as humiliation, verbal or physical abuse, neglect, or abusive treatment including any type of physical hitting inflicted in any manner upon the body, shaking, threats, or derogatory remarks; depriving children of outdoor time, meals or snacks; force feeding children or otherwise making them eat against their will, or in any way using food as a consequence; disciplining a child for soiling, wetting, or not using the toilet; forcing a child to remain in soiled clothing or to remain on the toilet, or using any other unusual or excessive practices for toileting; confining a child to a swing, high chair, crib, playpen or any other piece of equipment for an extended period of time in lieu of supervision; and excessive time-out. All educators and administrators working in EEC-licensed or funded programs are required to complete the EEC Essentials 2.0 training package, including Protecting Children from Abuse and Neglect. 5.3.7 Emergency preparedness and response planning standard Identify by checking below that the emergency preparedness and response planning due to natural disasters and human-caused events standard includes procedures in the following areas: i. [x] Evacuation ii. [x] Relocation iii. [x] Shelter-in-place iv. [x] Lock down v. Staff emergency preparedness [x] Training [x] Practice drills vi. Volunteer emergency preparedness [x] Training [x] Practice drills vii. [x] Communication with families viii. [x] Reunification with families ix. [x] Continuity of operations x. Accommodation of [x] Infants [x] Toddlers [x] Children with disabilities [x] Children with chronic medical conditions xi. If any of the above are not checked, describe: 5.3.8 Handling and storage of hazardous materials and the appropriate disposal of biocontaminants health and safety standard a. Provide the standards, appropriate to the provider setting and age of children, that address the handling and storage of hazardous materials for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: Educators must ensure that all hazardous objects, including toxic materials, are locked or inaccessible to children. Toxic substances must be stored separately from food and medications. All toxic substances must be labeled as to the contents and antidote. The disinfectant solution used to disinfect child care items, equipment and surfaces must be either a bleach solution prepared by the licensee in accordance with EEC guidelines or a commercially prepared disinfectant that has been registered as a sanitizing solution by the Environmental Protection Agency (EPA). Registration by the EPA will be indicated on the product label. Commercially prepared solutions must be used in accordance with manufacturer’s directions. All disinfectant solutions must be stored in accordance with manufacturer’s instructions and in a secure place out of the reach of children. All sanitizing and disinfecting solutions should be used in areas with adequate ventilation and never near children. The licensee must provide disposable non- latex gloves to be used for the clean-up of blood and bodily fluids. The affected area must be disinfected. Used gloves and any other materials containing blood or other bodily fluids must be thrown away in a lined, covered container. The licensee must ensure that educators wash their hands thoroughly with soap and water after cleaning up the contaminated area. Contaminated clothing must be sealed in a plastic container or bag, labeled with the child’s name and returned to the parent at the end of the day. The outdoor play space must not be covered with a dangerously harsh, abrasive, or toxic material. Pesticides may not be used on the child care premises during child care hours. Educators must follow the recommendations of the Department of Public Health regarding the use of insect repellents. The use of any substance that may impair the educator’s alertness, judgment or ability to care for children during child care hours is prohibited. Drinking alcoholic beverages and smoking on the child care premises during child care hours are prohibited. Whenever transportation is provided or contracted by the licensee the licensee must ensure that there is no smoking in the vehicle when children are present, and that if smoking has occurred in the vehicle, it is properly ventilated prior to use by children. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Educators must ensure that all hazardous objects, including toxic materials, are locked or inaccessible to children. Toxic substances must be stored separately from food and medications. All toxic substances must be labeled as to the contents and antidote. The disinfectant solution used to disinfect child care items, equipment and surfaces must be either a bleach solution prepared by the licensee in accordance with EEC guidelines or a commercially prepared disinfectant that has been registered as a sanitizing solution by the Environmental Protection Agency (EPA). Registration by the EPA will be indicated on the product label. Commercially prepared solutions must be used in accordance with manufacturer’s directions. All disinfectant solutions must be stored in accordance with manufacturer’s instructions and in a secure place out of the reach of children. All sanitizing and disinfecting solutions should be used in areas with adequate ventilation and never near children. The licensee must provide disposable non- latex gloves to be used for the clean-up of blood and bodily fluids. The affected area must be disinfected. Used gloves and any other materials containing blood or other bodily fluids must be thrown away in a lined, covered container. The licensee must ensure that educators wash their hands thoroughly with soap and water after cleaning up the contaminated area. Contaminated clothing must be sealed in a plastic container or bag, labeled with the child’s name and returned to the parent at the end of the day. The outdoor play space must not be covered with a dangerously harsh, abrasive, or toxic material. Pesticides may not be used on the child care premises during child care hours. Educators must follow the recommendations of the Department of Public Health regarding the use of insect repellents. The use of any substance that may impair the educator’s alertness, judgment or ability to care for children during child care hours is prohibited. Drinking alcoholic beverages and smoking on the child care premises during child care hours are prohibited. Whenever transportation is provided or contracted by the licensee the licensee must ensure that there is no smoking in the vehicle when children are present, and that if smoking has occurred in the vehicle, it is properly ventilated prior to use by children. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Educators must ensure that all hazardous objects, including toxic materials, are locked or inaccessible to children. Toxic substances must be stored separately from food and medications. All toxic substances must be labeled as to the contents and antidote. The solution used to sanitize or disinfect equipment, materials, items, or surfaces shall be either a bleach solution prepared in accordance with EEC guidelines or a commercially prepared solution that has been registered as either a sanitizer or a disinfectant (as appropriate) by the Environmental Protection Agency. Cleaning, sanitizing, and disinfecting products shall not be used in close proximity to children. Adequate ventilation shall be maintained during use of all cleaning, sanitizing, and disinfecting products. All cleaning, disinfecting, and sanitizing products shall be stored in a secure place, inaccessible to children. The program shall follow infection control guidelines (per the Center for Disease Control) designed to protect individuals from exposure to diseases spread by blood, bodily fluids or excretions that may spread infectious disease. Health precautions include, but are not limited to, the use of personal protective equipment, proper disposal containers for contaminated waste, hand washing and proper handling of bodily waste. Non-latex gloves shall be provided and used for the clean-up of blood and bodily fluids. Used gloves and any other materials containing blood or other bodily fluids shall be thrown away in a lined, covered container. Contaminated clothing shall be sealed in a plastic container or bag, labeled with the child’s name, and returned to the parent at the end of the day. The outdoor play space shall not be covered with a dangerously harsh, abrasive, or toxic material. Pesticides may not be used on the child care premises during child care hours. The program shall follow the recommendations of the Department of Public Health regarding the use of insect repellants. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: NA vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Toxic substances, including but not limited to household cleaners, sanitizers, disinfectants, detergents, pesticides, rock salts, floor and furniture polish, and bleach shall be removed or stored out of sight, separately from food and medications, locked and inaccessible to children at all times. The solution used to sanitize or disinfect equipment, materials, items, or surfaces shall be either a bleach solution prepared in accordance with EEC guidelines or a commercially prepared solution that has been registered as either a sanitizer or a disinfectant (as appropriate) by the Environmental Protection Agency. Cleaning, sanitizing, and disinfecting products shall not be used in close proximity to children. Adequate ventilation shall be maintained during use of all cleaning, sanitizing, and disinfecting products. The provider shall follow infection control guidelines (per the Center for Disease Control) designed to protect individuals from exposure to diseases spread by blood, bodily fluids or excretions that may spread infectious disease. Precautions include, but are not limited to, the use of personal protective equipment, proper disposal containers for contaminated waste, hand washing and proper handling of bodily waste. Non-latex gloves shall be used for the clean- up of blood and all bodily fluids. All individuals present in the child care space and/or with child care children will not smoke, use, or be under the influence of drugs or alcohol during child care hours. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Educators must ensure that all hazardous objects, including toxic materials, are locked or inaccessible to children. Toxic substances must be stored separately from food and medications. All toxic substances must be labeled as to the contents and antidote. The disinfectant solution used to disinfect child care items, equipment and surfaces must be either a bleach solution prepared by the licensee in accordance with EEC guidelines or a commercially prepared disinfectant that has been registered as a sanitizing solution by the Environmental Protection Agency (EPA). Registration by the EPA will be indicated on the product label. Commercially prepared solutions must be used in accordance with manufacturer’s directions. All disinfectant solutions must be stored in accordance with manufacturer’s instructions and in a secure place out of the reach of children. All sanitizing and disinfecting solutions should be used in areas with adequate ventilation and never near children. The licensee must provide disposable non-latex gloves to be used for the clean-up of blood and bodily fluids. The affected area must be disinfected. Used gloves and any other materials containing blood or other bodily fluids must be thrown away in a lined, covered container. The licensee must ensure that educators wash their hands thoroughly with soap and water after cleaning up the contaminated area. Contaminated clothing must be sealed in a plastic container or bag, labeled with the child’s name and returned to the parent at the end of the day. The outdoor play space must not be covered with a dangerously harsh, abrasive, or toxic material. Pesticides may not be used on the child care premises during child care hours. Educators must follow the recommendations of the Department of Public Health regarding the use of insect repellents. The use of any substance that may impair the educator’s alertness, judgment or ability to care for children during child care hours is prohibited. Drinking alcoholic beverages and smoking on the child care premises during child care hours are prohibited. Whenever transportation is provided or contracted by the licensee the licensee must ensure that there is no smoking in the vehicle when children are present, and that if smoking has occurred in the vehicle, it is properly ventilated prior to use by children. b. Provide the standards, appropriate to the provider setting and age of children, that address the disposal of bio contaminants for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: Used gloves and any other materials containing blood or other bodily fluids must be thrown away in a lined, covered container. Contaminated clothing must be sealed in a plastic container or bag, labeled with the child’s name and returned to the parent at the end of the day. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Used gloves and any other materials containing blood or other bodily fluids must be thrown away in a lined, covered container. Contaminated clothing must be sealed in a plastic container or bag, labeled with the child’s name and returned to the parent at the end of the day. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Used gloves and any other materials containing blood or other bodily fluids must be thrown away in a lined, covered container. Contaminated clothing must be sealed in a plastic container or bag, labeled with the child’s name and returned to the parent at the end of the day. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: NA vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Used gloves and any other materials containing blood or other bodily fluids must be thrown away in a lined, covered container. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Used gloves and any other materials containing blood or other bodily fluids must be thrown away in a lined, covered container. Contaminated clothing must be sealed in a plastic container or bag, labeled with the child’s name and returned to the parent at the end of the day. 5.3.9 Precautions in transporting children health and safety standard Provide the standards, appropriate to the provider setting and age of children, that address precautions in transporting children for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: The licensee must have a written plan for the safety and supervision of all children during transport. The plan must describe how children are transported to and from the program, in an emergency, and on field trips. The plan must also address the safety and supervision of children who walk and who arrive by public transportation. The plan must include any special arrangements for children with disabilities. The licensee must have written parental consent for each child's individual transportation plan. Whenever the licensee provides or contracts for transportation for children, the licensee must establish policies and procedures that are intended to keep children safe during transport. The policies and procedures must specify: the name and telephone number of the transportation coordinator for the program; the names and telephone numbers of contact persons during transportation times; how transportation is provided, whether transportation is provided by the licensee or a sub-contractor of the licensee; if transportation is provided by a subcontractor, the identity of the subcontractor; who is responsible for the supervision of children while being transported prior to their arrival at the program; how the driver and/or monitor will respond to disruptive behavior, including children unbuckling seat belts or refusing to remain seated; how the driver and/or monitor will respond to a medical emergency; the system of communication available to the driver; the actions the driver and/or monitor must take if the child is not present at the pick-up location, or if the parent or approved adult is not present to receive the child at drop-off; the actions the driver and/or monitor must take if the vehicle becomes disabled; to whom and by whom any moving violation or accident that occurs while children are being transported must be reported. The licensee must ensure compliance with the Americans with Disabilities Act and the Rehabilitation Act of 1973, Section 504. Whenever possible, children with disabilities should be transported in the same vehicles used to transport other children. The licensee must append a copy of the current contract between the transportation provider and the licensee to the program's transportation plan, if transportation is provided by a subcontractor. The contract must include provisions for the transportation company to notify the licensee of any accidents, vehicle breakdowns, and moving violations that are cited while children are being transported. The licensee must make a copy of the transportation policies and procedures available to educators, drivers, monitors and parents on request. Whenever transportation is provided or contracted by the licensee the licensee must ensure that: any vehicle used for transportation of more than eight passengers at any one time and the driver thereof conform to Massachusetts school bus requirements as contained in the pertinent sections of M.G.L. c. 90 and 540 CMR 7.00: Minimum Standards for Construction and Equipment of School Buses; any program-owned, private or hired vehicles such as sedans, vans, or station wagons used for the transportation of eight or fewer passengers, at any one time, and the driver thereof, conform to requirements as contained in M.G.L. c. 90, § 7(D), as applicable; any and all vehicles used for transportation of children are registered and inspected in accordance with the laws of the state; the operator of any vehicle transporting children is licensed in accordance with the laws of the state; the driver and any other attendants on the vehicle have received an orientation to the transportation plan; at least one person on each vehicle is currently certified in first aid and CPR; the driver of the vehicle is alert and is not distracted by telephone, radio or other communications; one particular driver is regularly assigned to each route; there is a plan for the use of substitute drivers when the regularly assigned driver is unavailable; the driver of the vehicle takes attendance before and after each trip and conducts a complete vehicle inspection after every trip to ensure that children are not left alone in a vehicle at any time; there is no smoking in the vehicle when children are present, and that if smoking has occurred in the vehicle it is properly ventilated prior to use by children. The licensee must not allow the number of children riding in a program-owned, educator’s, or parent’s vehicle, used to transport children while they are in care, or a vehicle hired for a program- related activity to exceed the number of seats therein at any time. All children must be seated when the vehicle is in operation. Suitable car seats, safety carriers, restraints or seat belts must be provided for and used by each child, driver and attendant in all vehicles containing fewer than 16 passenger seats. All car restraints must meet the U.S. Department of Transportation Federal Motor Vehicle Safety Standards guidelines and must be crash tested and child approved. Children younger than 12 years old must not be transported in the front seat of a vehicle if the vehicle is equipped with airbags. When more than eight children are being transported, an attendant other than the driver is required. Children’s emergency contact information must be carried in the vehicle whenever children are present. Sharp, heavy or potentially dangerous objects must be placed in the trunk or cargo area and securely restrained when transporting children. The licensee must identify and communicate to the driver of the vehicle any information that may assist him/her in transporting a child, including, but not limited to, any medical or behavioral problems. The driver of the vehicle must release children only to persons known or identified to the driver and authorized by the parent(s) in writing to receive the child. Children must not be regularly transported for periods longer than 45 minutes one way between their home or school and the program. A first aid kit, seat belt cutter and emergency numbers for the children must be easily available in all vehicles. A working mechanism for making emergency telephone calls must be available on each vehicle during transport. The licensee must ensure that every accident involving a program- owned or operated vehicle providing transportation services is reported in accordance with applicable accident reporting laws and requirements. ii. All CCDF-eligible licensed family child care homes. Provide the standard: The licensee must have a written plan for the safety and supervision of all children during transport. The plan must describe how children are transported to and from the program, in an emergency, and on field trips. The plan must also address the safety and supervision of children who walk and who arrive by public transportation. The plan must include any special arrangements for children with disabilities. The licensee must have written parental consent for each child's individual transportation plan. Whenever the licensee provides or contracts for transportation for children, the licensee must establish policies and procedures that are intended to keep children safe during transport. The policies and procedures must specify: the name and telephone number of the transportation coordinator for the program; the names and telephone numbers of contact persons during transportation times; how transportation is provided, whether transportation is provided by the licensee or a sub-contractor of the licensee; if transportation is provided by a subcontractor, the identity of the subcontractor; who is responsible for the supervision of children while being transported prior to their arrival at the program; how the driver and/or monitor will respond to disruptive behavior, including children unbuckling seat belts or refusing to remain seated; how the driver and/or monitor will respond to a medical emergency; the system of communication available to the driver; the actions the driver and/or monitor must take if the child is not present at the pick-up location, or if the parent or approved adult is not present to receive the child at drop-off; the actions the driver and/or monitor must take if the vehicle becomes disabled; to whom and by whom any moving violation or accident that occurs while children are being transported must be reported. The licensee must ensure compliance with the Americans with Disabilities Act and the Rehabilitation Act of 1973, Section 504. Whenever possible, children with disabilities should be transported in the same vehicles used to transport other children. The licensee must append a copy of the current contract between the transportation provider and the licensee to the program's transportation plan, if transportation is provided by a subcontractor. The contract must include provisions for the transportation company to notify the licensee of any accidents, vehicle breakdowns, and moving violations that are cited while children are being transported. The licensee must make a copy of the transportation policies and procedures available to educators, drivers, monitors and parents on request. Whenever transportation is provided or contracted by the licensee the licensee must ensure that: any vehicle used for transportation of more than eight passengers at any one time and the driver thereof conform to Massachusetts school bus requirements as contained in the pertinent sections of M.G.L. c. 90 and 540 CMR 7.00: Minimum Standards for Construction and Equipment of School Buses; any program-owned, private or hired vehicles such as sedans, vans, or station wagons used for the transportation of eight or fewer passengers, at any one time, and the driver thereof, conform to requirements as contained in M.G.L. c. 90, § 7(D), as applicable; any and all vehicles used for transportation of children are registered and inspected in accordance with the laws of the state; the operator of any vehicle transporting children is licensed in accordance with the laws of the state; the driver and any other attendants on the vehicle have received an orientation to the transportation plan; at least one person on each vehicle is currently certified in first aid and CPR; the driver of the vehicle is alert and is not distracted by telephone, radio or other communications; one particular driver is regularly assigned to each route; there is a plan for the use of substitute drivers when the regularly assigned driver is unavailable; the driver of the vehicle takes attendance before and after each trip and conducts a complete vehicle inspection after every trip to ensure that children are not left alone in a vehicle at any time; there is no smoking in the vehicle when children are present, and that if smoking has occurred in the vehicle it is properly ventilated prior to use by children. The licensee must not allow the number of children riding in a program-owned, educator’s, or parent’s vehicle, used to transport children while they are in care, or a vehicle hired for a program- related activity to exceed the number of seats therein at any time. All children must be seated when the vehicle is in operation. Suitable car seats, safety carriers, restraints or seat belts must be provided for and used by each child, driver and attendant in all vehicles containing fewer than 16 passenger seats. All car restraints must meet the U.S. Department of Transportation Federal Motor Vehicle Safety Standards guidelines and must be crash tested and child approved. Children younger than 12 years old must not be transported in the front seat of a vehicle if the vehicle is equipped with airbags. When more than eight children are being transported, an attendant other than the driver is required. Children’s emergency contact information must be carried in the vehicle whenever children are present. Sharp, heavy or potentially dangerous objects must be placed in the trunk or cargo area and securely restrained when transporting children. The licensee must identify and communicate to the driver of the vehicle any information that may assist him/her in transporting a child, including, but not limited to, any medical or behavioral problems. The driver of the vehicle must release children only to persons known or identified to the driver and authorized by the parent(s) in writing to receive the child. Children must not be regularly transported for periods longer than 45 minutes one way between their home or school and the program. A first aid kit, seat belt cutter and emergency numbers for the children must be easily available in all vehicles. A working mechanism for making emergency telephone calls must be available on each vehicle during transport. The licensee must ensure that every accident involving a program- owned or operated vehicle providing transportation services is reported in accordance with applicable accident reporting laws and requirements. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Any and all motor vehicle used for the transportation of children shall be maintained and operated in accordance with the requirements as contained in the pertinent sections of M.G.L c. 90, in particular §§ 7A, 7B, 7C and 7D, and with all applicable regulations within 540 CMR: Registry of Motor Vehicles. Any and all vehicles used for the transportation of children shall be registered and shall have passed an annual inspection in accordance with the laws of the state. The program shall maintain documentation of vehicle registration and passed annual inspection for each motor vehicle used to transport children. The program shall have a written plan for the safety and supervision of all children during transport. The plan shall describe how children are transported to and from the program, in an emergency, and on field trips. The plan shall also address the safety and supervision of children who walk and who arrive by public transportation. The plan shall include any special arrangements for children with disabilities and the plan shall ensure compliance with the Americans with Disabilities Act and the Rehabilitation Act of 1973, Section 504. Whenever possible, children with disabilities should be transported in the same vehicles used to transport other children. The program shall have written parental consent for each child's individual transportation plan. Whenever the program provides or contracts for transportation for children, the program must establish policies and procedures that are intended to keep children safe during transport. Whenever transportation is provided or contracted by the program, the program must ensure that: the operator of any vehicle transporting children is licensed in accordance with the laws of the state; at least one person on each vehicle is currently certified in first aid and CPR; the driver of the vehicle takes attendance before and after each trip and conducts a complete vehicle inspection after every trip to ensure that children are not left alone in a vehicle at any time; children’s emergency contact information shall be carried in the vehicle whenever children are present; and the driver of the vehicle shall release children only to persons known or identified to the driver and authorized by the parent(s) in writing to receive the child. Programs are mandated to ensure that all transportation personnel are subject to a background record check pursuant to 606 CMR 14.00 et seq. The program shall ensure adequate provisions for transportation safety on each vehicle during transport, including but not limited to a first aid kit, a working mechanism to make emergency telephone calls, and a seat belt cutter. Sharp, heavy, or potentially dangerous objects shall be placed in the trunk or cargo area and securely restrained when transporting children. Suitable car seats, safety carriers, restraints or seat belts shall be provided for and used by each child, driver and attendant in all vehicles containing fewer than 16 passenger seats. All car restraints shall meet the U.S. Department of Transportation Federal Motor Vehicle Safety Requirements guidelines and shall be crash tested and child approved. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: NA vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The provider shall have written parental consent to transport any child care children. The provider shall have a current, valid driver’s license and a car registration for the vehicle used to transport child care children. The provider shall ensure adequate provisions for transportation safety on each vehicle during transport, including but not limited to a first aid kit, a working mechanism to make emergency telephone calls, and a seat belt cutter. Suitable car seats, safety carriers, restraints or seat belts shall be used by each child, driver and attendant in all vehicles. All car restraints shall meet the U.S. Department of Transportation Federal Motor Vehicle Safety Requirements guidelines and shall be crash tested and child approved. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: The licensee must have a written plan for the safety and supervision of all children during transport. The plan must describe how children are transported to and from the program, in an emergency, and on field trips. The plan must also address the safety and supervision of children who walk and who arrive by public transportation. The plan must include any special arrangements for children with disabilities. The licensee must have written parental consent for each child's individual transportation plan. Whenever the licensee provides or contracts for transportation for children, the licensee must establish policies and procedures that are intended to keep children safe during transport. The policies and procedures must specify: the name and telephone number of the transportation coordinator for the program; the names and telephone numbers of contact persons during transportation times; how transportation is provided, whether transportation is provided by the licensee or a sub-contractor of the licensee; if transportation is provided by a subcontractor, the identity of the subcontractor; who is responsible for the supervision of children while being transported prior to their arrival at the program; how the driver and/or monitor will respond to disruptive behavior, including children unbuckling seat belts or refusing to remain seated; how the driver and/or monitor will respond to a medical emergency; the system of communication available to the driver; the actions the driver and/or monitor must take if the child is not present at the pick-up location, or if the parent or approved adult is not present to receive the child at drop-off; the actions the driver and/or monitor must take if the vehicle becomes disabled; to whom and by whom any moving violation or accident that occurs while children are being transported must be reported. The licensee must ensure compliance with the Americans with Disabilities Act and the Rehabilitation Act of 1973, Section 504. Whenever possible, children with disabilities should be transported in the same vehicles used to transport other children. The licensee must append a copy of the current contract between the transportation provider and the licensee to the program's transportation plan, if transportation is provided by a subcontractor. The contract must include provisions for the transportation company to notify the licensee of any accidents, vehicle breakdowns, and moving violations that are cited while children are being transported. The licensee must make a copy of the transportation policies and procedures available to educators, drivers, monitors and parents on request. Whenever transportation is provided or contracted by the licensee the licensee must ensure that: any vehicle used for transportation of more than eight passengers at any one time and the driver thereof conform to Massachusetts school bus requirements as contained in the pertinent sections of M.G.L. c. 90 and 540 CMR 7.00: Minimum Standards for Construction and Equipment of School Buses; any program-owned, private or hired vehicles such as sedans, vans, or station wagons used for the transportation of eight or fewer passengers, at any one time, and the driver thereof, conform to requirements as contained in M.G.L. c. 90, § 7(D), as applicable; any and all vehicles used for transportation of children are registered and inspected in accordance with the laws of the state; the operator of any vehicle transporting children is licensed in accordance with the laws of the state; the driver and any other attendants on the vehicle have received an orientation to the transportation plan; at least one person on each vehicle is currently certified in first aid and CPR; the driver of the vehicle is alert and is not distracted by telephone, radio or other communications; one particular driver is regularly assigned to each route; there is a plan for the use of substitute drivers when the regularly assigned driver is unavailable; the driver of the vehicle takes attendance before and after each trip and conducts a complete vehicle inspection after every trip to ensure that children are not left alone in a vehicle at any time; there is no smoking in the vehicle when children are present, and that if smoking has occurred in the vehicle it is properly ventilated prior to use by children. The licensee must not allow the number of children riding in a program- owned, educator’s, or parent’s vehicle, used to transport children while they are in care, or a vehicle hired for a program-related activity to exceed the number of seats therein at any time. All children must be seated when the vehicle is in operation. Suitable car seats, safety carriers, restraints or seat belts must be provided for and used by each child, driver and attendant in all vehicles containing fewer than 16 passenger seats. All car restraints must meet the U.S. Department of Transportation Federal Motor Vehicle Safety Standards guidelines and must be crash tested and child approved. Children younger than 12 years old must not be transported in the front seat of a vehicle if the vehicle is equipped with airbags. When more than eight children are being transported, an attendant other than the driver is required. Children’s emergency contact information must be carried in the vehicle whenever children are present. Sharp, heavy or potentially dangerous objects must be placed in the trunk or cargo area and securely restrained when transporting children. The licensee must identify and communicate to the driver of the vehicle any information that may assist him/her in transporting a child, including, but not limited to, any medical or behavioral problems. The driver of the vehicle must release children only to persons known or identified to the driver and authorized by the parent(s) in writing to receive the child. Children must not be regularly transported for periods longer than 45 minutes one way between their home or school and the program. A first aid kit, seat belt cutter and emergency numbers for the children must be easily available in all vehicles. A working mechanism for making emergency telephone calls must be available on each vehicle during transport. The licensee must ensure that every accident involving a program-owned or operated vehicle providing transportation services is reported in accordance with applicable accident reporting laws and requirements. 5.3.10 Pediatric first aid and pediatric cardiopulmonary resuscitation (CPR) health and safety standard a. Provide the standards, appropriate to the provider setting and age of children, that address pediatric first aid for all staff for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: The licensee must ensure that at least one educator currently certified in first aid and age- appropriate cardiopulmonary resuscitation (CPR) is present at any and all times when children are in care. For center-based care, all educators must obtain within six months of employment, and must maintain thereafter, current certification of training in basic first aid appropriate to the population served. In center based funded programs, there shall be at least one staff member currently trained and certified in age-appropriate first aid at all times when children are present. ii. All CCDF-eligible licensed family child care homes. Provide the standard: The licensee must ensure that at least one educator currently certified in first aid and age-appropriate cardiopulmonary resuscitation (CPR) is present at any and all times when children are in care. For family child care, all licensees, certified assistants, and any educator who may be alone with children must maintain current certification of training in basic first aid. For center-based care, all educators must obtain within six months of employment, and must maintain thereafter, current certification of training in basic first aid appropriate to the population served. In center based funded programs, there shall be at least one staff member currently trained and certified in age-appropriate first aid at all times when children are present. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: In center based funded programs, there shall be at least one staff member currently trained and certified in age-appropriate first aid at all times when children are present. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: NA vi. All CCDF-eligible license-exempt in-home care. Provide the standard: CCDF-eligible informal child care providers (ICCs) must be trained and certified in age- appropriate first aid at all times when children are present. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: In CCDF-eligible out-of-school programs, there shall be at least one staff member currently trained and certified in age- appropriate first aid at all times when children are present. b. Provide the standards, appropriate to the provider setting and age of children, that address pediatric cardiopulmonary resuscitation for all staff for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: For group and school age programs, the licensee must ensure that at least one educator currently certified in age-appropriate cardiopulmonary resuscitation (CPR) is present at any and all times when children are in care. CPR training must be renewed prior to the expiration date listed on the CPR certificate. For center-based funded (license- exempt) programs, there must be at least one staff member currently trained and certified in age-appropriate CPR at all times when children are present. For all, CPR training must be renewed prior to the expiration date listed on the CPR certificate. Only educators who are currently certified in first aid and CPR may provide first aid and CPR. ii. All CCDF-eligible licensed family child care homes. Provide the standard: For family child care programs, all licensees, certified assistants, and any educator who may be alone with children must maintain current certification of training in age- appropriate CPR. CPR training must be renewed prior to the expiration date listed on the CPR certificate. For all, CPR training must be renewed prior to the expiration date listed on the CPR certificate. Only educators who are currently certified in first aid and CPR may provide first aid and CPR. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: For center- based funded (license-exempt) programs, there must be at least one staff member currently trained and certified in age-appropriate CPR at all times when children are present. For all, CPR training must be renewed prior to the expiration date listed on the CPR certificate. Only educators who are currently certified in first aid and CPR may provide first aid and CPR. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: NA vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The provider shall maintain current Pediatric CPR certification. For all, CPR training must be renewed prior to the expiration date listed on the CPR certificate. Only educators who are currently certified in first aid and CPR may provide first aid and CPR. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Out-of-school programs (license-exempt) programs, there must be at least one staff member currently trained and certified in age-appropriate CPR at all times when children are present. For all, CPR training must be renewed prior to the expiration date listed on the CPR certificate. Only educators who are currently certified in first aid and CPR may provide first aid and CPR. 5.3.11 Identification and reporting of child abuse and neglect health and safety standard a. Provide the standards, appropriate to the provider setting and age of children, that address the identification of child abuse and neglect for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: All educators and administrators working in EEC-licensed or funded programs are required to complete the EEC Essentials 2.0 training package, including Protecting Children from Abuse and Neglect. Every educator is a mandated reporter under M.G.L. c. 119, § 51A and must make a report to the Department of Children and Families whenever he/she has reasonable cause to believe a child in the program is suffering from serious physical or emotional injury resulting from abuse inflicted upon the child, including but not limited to sexual abuse, or from neglect, including but not limited to malnutrition, no matter where the abuse or neglect may have occurred and by whom it was inflicted. ii. All CCDF-eligible licensed family child care homes. Provide the standard: All educators and administrators working in EEC-licensed or funded programs are required to complete the EEC Essentials 2.0 training package, including Protecting Children from Abuse and Neglect. Every educator is a mandated reporter under M.G.L. c. 119, § 51A and must make a report to the Department of Children and Families whenever he/she has reasonable cause to believe a child in the program is suffering from serious physical or emotional injury resulting from abuse inflicted upon the child, including but not limited to sexual abuse, or from neglect, including but not limited to malnutrition, no matter where the abuse or neglect may have occurred and by whom it was inflicted. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: All educators and administrators working in EEC-licensed or funded programs are required to complete the EEC Essentials 2.0 training package, including Protecting Children from Abuse and Neglect. Every provider is a mandated reporter under M.G.L. c. 119, § 51A and shall make a report to the Department of Children and Families (DCF) whenever he/she has reasonable cause to believe a child in the program is suffering from serious physical or emotional injury resulting from abuse inflicted upon the child, including but not limited to sexual abuse, or from neglect, including but not limited to malnutrition, no matter where the abuse or neglect may have occurred and by whom it was inflicted. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: NA vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The provider shall have completed all required EEC Essentials 2.0 trainings, in accordance with EEC policy, including Protecting Children from Abuse and Neglect. Every child care provider is a mandated reporter under M.G.L. c. 119, § 51A and shall make a report to the Department of Children and Families whenever he/she has reasonable cause to believe a child in care is suffering from serious physical or emotional injury resulting from abuse inflicted upon the child, including but not limited to sexual abuse, or from neglect, including but not limited to malnutrition, no matter where the abuse or neglect may have occurred and by whom it was inflicted. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: All educators and administrators working in EEC-licensed or funded programs are required to complete the EEC Essentials 2.0 training package, including Protecting Children from Abuse and Neglect. Every educator is a mandated reporter under M.G.L. c. 119, § 51A and must make a report to the Department of Children and Families whenever he/she has reasonable cause to believe a child in the program is suffering from serious physical or emotional injury resulting from abuse inflicted upon the child, including but not limited to sexual abuse, or from neglect, including but not limited to malnutrition, no matter where the abuse or neglect may have occurred and by whom it was inflicted. b. Provide your standards, appropriate to the provider setting and age of children, that address the reporting of child abuse and neglect for the following CCDF-eligible providers: i. All CCDF-eligible licensed center care. Provide the standard: Every educator is a mandated reporter under M.G.L. c. 119, § 51A and must make a report to the Department of Children and Families whenever he/she has reasonable cause to believe a child in the program is suffering from serious physical or emotional injury resulting from abuse inflicted upon the child, including but not limited to sexual abuse, or from neglect, including but not limited to malnutrition, no matter where the abuse or neglect may have occurred and by whom it was inflicted. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Every educator is a mandated reporter under M.G.L. c. 119, § 51A and must make a report to the Department of Children and Families whenever he/she has reasonable cause to believe a child in the program is suffering from serious physical or emotional injury resulting from abuse inflicted upon the child, including but not limited to sexual abuse, or from neglect, including but not limited to malnutrition, no matter where the abuse or neglect may have occurred and by whom it was inflicted. iii. All CCDF-eligible licensed in-home care. Provide the standard: [x] Not applicable. iv. All CCDF-eligible license-exempt center care. Provide the standard: Every educator is a mandated reporter under M.G.L. c. 119, § 51A and must make a report to the Department of Children and Families whenever he/she has reasonable cause to believe a child in the program is suffering from serious physical or emotional injury resulting from abuse inflicted upon the child, including but not limited to sexual abuse, or from neglect, including but not limited to malnutrition, no matter where the abuse or neglect may have occurred and by whom it was inflicted. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: NA vi. All CCDF-eligible license-exempt in-home care. Provide the standard: Every child care provider is a mandated reporter under M.G.L. c. 119, § 51A and must make a report to the Department of Children and Families whenever he/she has reasonable cause to believe a child in the program is suffering from serious physical or emotional injury resulting from abuse inflicted upon the child, including but not limited to sexual abuse, or from neglect, including but not limited to malnutrition, no matter where the abuse or neglect may have occurred and by whom it was inflicted. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: Every educator is a mandated reporter under M.G.L. c. 119, § 51A and must make a report to the Department of Children and Families whenever he/she has reasonable cause to believe a child in the program is suffering from serious physical or emotional injury resulting from abuse inflicted upon the child, including but not limited to sexual abuse, or from neglect, including but not limited to malnutrition, no matter where the abuse or neglect may have occurred and by whom it was inflicted. c. Confirm if child care providers must comply with the Lead Agency’s procedures for reporting child abuse and neglect as required by the Child Abuse Prevention and Treatment Act (42 U.S.C. 5106a(b)(2)(B)(i): [x] Yes, confirmed. [ ] No. If no, describe: 5.3.12 Additional optional standards In addition to the required health and safety standards, does the Lead Agency require providers to comply with the following optional standards? [x] Yes. [ ] No. If no, skip to Section 5.4 If yes, describe the standard(s). i. Nutrition. Describe: The licensee must design and implement a nutrition program that meets the U.S.D.A. guidelines for the nutritional and dietary needs and feeding requirements of each child, including those of children with disabilities. ii. Access to physical activity. Describe: The licensee must have evidence of a plan describing how program activities support and engage children through specific learning experiences, which must provide for daily indoor and outdoor time periods, weather permitting, which include both small and large muscle activities, for at least 60 minutes in full day programs. iii. Caring for children with special needs. Describe: The licensee must maintain as part of a child’s record, an individual health care plan for each child with a chronic medical condition, which has been diagnosed by a licensed health care practitioner. The plan must describe the chronic condition, its symptoms, any medical treatment that may be necessary while the child is in care, the potential side effects of that treatment, and the potential consequences to the child’s health if the treatment is not administered. iv. Any other areas determined necessary to promote child development or to protect children’s health and safety. Describe: In addition to interacting with children as required by regulations, all programs and educators must exercise appropriate supervision of the children in their care in order to ensure their health and safety at all times. Such supervision must include, but not be limited to, indoor and outdoor activities, mealtimes, naptime, transportation, field trips, and transitions between activities.