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: Standards for child care programs licensed by the Lead Agency that address prevention and control of infectious diseases include: Handwashing shall occur at least at the following times but not limited to: After toileting and diapering, after handling bodily fluids, prior to and after eating, prior to and after food preparation, and routine cleaning and sanitizing of tables, chairs, high chairs and toys that children place in their mouth, dishes and utensils, and the floor. Providers must require proof treatment prior to readmission of a child diagnosed with a communicable disease. Children must be appropriately immunized with limited exceptions for medical reasons or religious tenets and practices, and a grace period for children of homeless families. Children who are ill should be isolated until parents are notified and can pick them up. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with children. This training includes standards/expectations for each CCDBG health and safety topic. The expectations for prevention and control of infectious disease include but are not limited to provisions for: Immunizations as a requirement for enrollment; handwashing before food prep, before eating, after assisting children with toileting, etc.; cleaning and sanitizing eating surfaces using a two-step process and cleaning toys; procedures for diapering set-up, near a sink and away from food prep or serving areas and where supervision of other children can be maintained; routine cleaning of bedding, and separation of cribs, cots, and/or mats; handling sick children, recognizing symptoms and how to respond, how to give medications and information on isolating sick children until parents can pick them up in an area that can easily be supervised and sanitized; and time outside to experience fresh air/sunshine. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Standards for child care programs licensed by the Lead Agency that address prevention and control of infectious diseases include: Handwashing shall occur at least at the following times but not limited to: After toileting and diapering, after handling bodily fluids, prior to and after eating, prior to and after food preparation, and routine cleaning and sanitizing of tables, chairs, high chairs and toys that children place in their mouth, dishes and utensils, and the floor. Providers must require proof treatment prior to readmission of a child diagnosed with a communicable disease. Children must be appropriately immunized with limited exceptions for medical reasons or religious tenets and practices, and a grace period for children of homeless families. Children who are ill should be isolated until parents are notified and can pick them up. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with children. This training includes standards/expectations for each CCDBG health and safety topic. The expectations for prevention and control of infectious disease include but are not limited to provisions for: Immunizations as a requirement for enrollment; handwashing before food prep, before eating, after assisting children with toileting, etc.; cleaning and sanitizing eating surfaces using a two-step process and cleaning toys; procedures for diapering set-up, near a sink and away from food prep or serving areas and where supervision of other children can be maintained; routine cleaning of bedding, and separation of cribs, cots, and/or mats; handling sick children, recognizing symptoms and how to respond, how to give medications and information on isolating sick children until parents can pick them up in an area that can easily be supervised and sanitized; and time outside to experience fresh air/sunshine. 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: License- exempt child care providers regulated by the Tennessee Department of Education (TDOE) are subject to Tenn. Comp. R. & Regs 0520-12-01. Statute requires that these standards are substantially the same as those for child care providers licensed by the Lead Agency. Authority over license-exempt providers not regulated by TDOE is limited to the Lead Agency’s contract to participate in the Child Care Payment Assistance/Certificate Program. License-exempt center educators are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License- exempt center educators are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Lead Agency identifies Authorized Child Care Professionals as CCDF-eligible license-exempt family child care providers, individuals who may care for up to six (6) children (four (4) not related to the individual and up to two (2) additional related children) and who are contracted with the Lead Agency to participate in the Child Care Payment Assistance/Certificate Program as a result of parental choice. A maximum of four children approved through the Child Care Payment Assistance/Certificate Program may be enrolled to an Authorized Child Care Professional. License-exempt Authorized Child Care Professionals are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt Authorized Child Care Professionals are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. Observation of standards demonstration are documented during each monitoring inspection. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Lead Agency only permits relative care in circumstances when the child in care resides in the provider's home, i.e., a child or grandchild. The Lead Agency makes available in-home care for non-relatives in the child's home when the child requires special accommodations to meet individual needs. In such instances, these situations would be monitored using the protocols established for Authorized Professionals. Please see 5.3.1.a.v. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A. 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: Standards for child care programs licensed by the Lead Agency that address children attending child care programs are age-appropriately immunizations include: Immunizations as a requirement for enrollment as required by the Tennessee Department of Health. Exceptions to immunization record requirements may be made only if: The child’s physician or a state or local health department provides a signed and dated statement giving a medical reason why the child should not be given a specified immunization; the child’s parent provides a signed written statement that such immunizations conflict with his/her religious tenets and practices; or if care for children of homeless families and/or children in state custody is needed before documentation of immunizations can be confirmed. Care without documentation of immunizations shall not exceed sixty (60) days. Before a school-age child is accepted for care, the center shall have on file a statement from the parent or school that the child’s immunizations are current and that his or her health record is on file at the specified school which the child attends. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Standards for child care programs licensed by the Lead Agency that address children attending child care programs are age-appropriately immunizations include: Immunizations as a requirement for enrollment as required by the Tennessee Department of Health. Exceptions to immunization record requirements may be made only if: The child’s physician or a state or local health department provides a signed and dated statement giving a medical reason why the child should not be given a specified immunization; the child’s parent provides a signed written statement that such immunizations conflict with his/her religious tenets and practices; or if care for children of homeless families and/or children in state custody is needed before documentation of immunizations can be confirmed. Care without documentation of immunizations shall not exceed sixty (60) days. Before a school-age child is accepted for care, the center shall have on file a statement from the parent or school that the child’s immunizations are current and that his or her health record is on file at the specified school which the child attends. 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: License- exempt child care providers regulated by the Tennessee Department of Education (TDOE) are subject to Tenn. Comp. R. & Regs 0520-12-01. Statute requires that these standards are substantially the same as those for child care providers licensed by the Lead Agency. Authority over license-exempt providers not regulated by TDOE is limited to the Lead Agency’s contract to participate in the Child Care Payment Assistance/Certificate Program. License-exempt center educators are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License- exempt center educators are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Lead Agency identifies Authorized Child Care Professionals as CCDF-eligible license-exempt family child care providers, individuals who may care for up to six (6) children (four (4) not related to the individual and up to two (2) additional related children) and who are contracted with the Lead Agency to participate in the Child Care Payment Assistance/Certificate Program as a result of parental choice. A maximum of four children approved through the Child Care Payment Assistance/Certificate Program may be enrolled to an Authorized Child Care Professional. License-exempt Authorized Child Care Professionals are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt Authorized Child Care Professionals are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. Observation of standards demonstration are documented during each monitoring inspection. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Lead Agency only permits relative care in circumstances when the child in care resides in the provider's home, i.e., a child or grandchild. The Lead Agency makes available in-home care for non-relatives in the child's home when the child requires special accommodations to meet individual needs. In such instances, these situations would be monitored using the protocols established for Authorized Professionals. Please see 5.3.1.b.v. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A. 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: Standards for child care programs licensed by the Lead Agency that address prevention of Sudden Unexpected Infant Death (SUID), including Sudden Infant Death Syndrome (SIDS) require child care providers to follow sleeping practices, including: 1. Infants shall sleep in cribs or play yards with a firm sleep surface with a fitted sheet; 2. No infant shall be allowed to sleep on a sofa, soft mattress, adult bed, in a car seat, in a swing, or in other restraining devices; 3. Infants shall be positioned on their backs for sleeping; 4. Bibs shall be removed prior to placing infants in a crib for sleeping; 5. Soft bedding is prohibited and includes, but is not limited to, pillows, bumper pads, blankets, quilts, comforters, stuffed toys, and other soft items; 6. Mobiles and other toys that attach to any part of the crib are prohibited; 7. It is not necessary to reposition infants once they have demonstrated the ability to turn front to back and back to front independently; 8. Any cribs or other sleeping equipment prohibited by federal product safety regulations shall not be permitted; 9. Infants shall be touched by an educator every fifteen (15) minutes in order to check breathing, body temperature and position; 10. If a child appears not to be breathing, the child care agency shall immediately begin CPR and immediately call for emergency medical assistance; 11. The child care agency shall have a written policy describing safe sleep practices and provide a copy of that policy and training to all educators and volunteers assuming infant-caregiving duties; 12. All infant educators shall follow safe sleep procedures; 13. Infants that arrive asleep in car seats or fall asleep in any piece of equipment other than a crib must be immediately removed and placed on their back in a crib; 14. Avoid letting the infant overheat and ensure infants are dressed appropriately for the environment (no greater than 1 layer more than an adult would wear in the same environment); and 15. Any practice that is an exception to the these standards shall not be used without written authorization from a physician. At naptime, after the children have settled down, adult:child ratios for ages thirty- one (31) months and above may be reduced by fifty percent (50%) in each classroom as long as the children are adequately protected and all of the following requirements are met: At least one (1) adult educator shall be awake and supervising the children in each nap room/sleeping area; there are enough adults on the premises so that the adult:child ratio required for children when they are awake shall be met immediately; and ratios for children six (6) weeks through thirty (30) months shall be maintained. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with children. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Standards for child care programs licensed by the Lead Agency that address prevention of Sudden Unexpected Infant Death (SUID), including Sudden Infant Death Syndrome (SIDS) require child care providers to follow sleeping practices, including: 1. Infants shall sleep in cribs or play yards with a firm sleep surface with a fitted sheet; 2. No infant shall be allowed to sleep on a sofa, soft mattress, adult bed, in a car seat, in a swing, or in other restraining devices; 3. Infants shall be positioned on their backs for sleeping; 4. Bibs shall be removed prior to placing infants in a crib for sleeping; 5. Soft bedding is prohibited and includes, but is not limited to, pillows, bumper pads, blankets, quilts, comforters, stuffed toys, and other soft items; 6. Mobiles and other toys that attach to any part of the crib are prohibited; 7. It is not necessary to reposition infants once they have demonstrated the ability to turn front to back and back to front independently; 8. Any cribs or other sleeping equipment prohibited by federal product safety regulations shall not be permitted; 9. Infants shall be touched by an educator every fifteen (15) minutes in order to check breathing, body temperature and position; 10. If a child appears not to be breathing, the child care agency shall immediately begin CPR and immediately call for emergency medical assistance; 11. The child care agency shall have a written policy describing safe sleep practices and provide a copy of that policy and training to all educators and volunteers assuming infant-caregiving duties; 12. All infant educators shall follow safe sleep procedures; 13. Infants that arrive asleep in car seats or fall asleep in any piece of equipment other than a crib must be immediately removed and placed on their back in a crib; 14. Avoid letting the infant overheat and ensure infants are dressed appropriately for the environment (no greater than 1 layer more than an adult would wear in the same environment); and 15. Any practice that is an exception to the these standards shall not be used without written authorization from a physician. At naptime, after the children have settled down, adult:child ratios for ages thirty- one (31) months and above may be reduced by fifty percent (50%) in each classroom as long as the children are adequately protected and all of the following requirements are met: At least one (1) adult educator shall be awake and supervising the children in each nap room/sleeping area; there are enough adults on the premises so that the adult:child ratio required for children when they are awake shall be met immediately; and ratios for children six (6) weeks through thirty (30) months shall be maintained. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with 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: Not applicable based on age of children in care of license-exempt child care centers. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Lead Agency identifies Authorized Child Care Professionals as CCDF-eligible license-exempt family child care providers, individuals who may care for up to six (6) children (four (4) not related to the individual and up to two (2) additional related children) and who are contracted with the Lead Agency to participate in the Child Care Payment Assistance/Certificate Program as a result of parental choice. A maximum of four children approved through the Child Care Payment Assistance/Certificate Program may be enrolled to an Authorized Child Care Professional. License-exempt Authorized Child Care Professionals are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt Authorized Child Care Professionals are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. Observation of standards demonstration are documented during each monitoring inspection. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Lead Agency only permits relative care in circumstances when the child in care resides in the provider's home, i.e., a child or grandchild. The Lead Agency makes available in-home care for non-relatives in the child's home when the child requires special accommodations to meet individual needs. In such instances, these situations would be monitored using the protocols established for Authorized Professionals. Please see 5.3.2.v. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A. 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: Standards for child care programs licensed by the Lead Agency that address administration of medication include: (a) Receiving Medications. 1. All medications shall be received from the parent/guardian by a designated staff person. 2. The designated staff person(s) shall: (i) Obtain the parent’s/guardian’s written authorization to administer each medication; (ii) Document that the medicines or drugs are in the original container, are not expired, and are labeled with the child’s name; (iii) Document the specific dosage and times the medication is to be administered to the child; and (iv) Document that the parent/guardian has provided the child care agency with instructions on the means and method of administration. (b) Administering Medications. 1. All medications shall be administered by a staff person or persons who have received training in medication administration. Online training is available through the American Academy of Pediatrics at no cost. 2. The following documentation shall be maintained in the child’s file and a copy provided to the parent/guardian: (i) Medication was administered according to parent/guardian or health care provider instruction, including times and amounts of medications administered; (ii) Any side effects observed; (iii) Name of staff person administering medication to child; and (iv) Unused medication was returned to the parent/guardian. 3. Medication shall never be administered in bottles or infant feeders unless authorized by a physician. Educators shall ensure that medication administered in this way is not accessible to other children. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with children. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Standards for child care programs licensed by the Lead Agency that address administration of medication include: (a) Receiving Medications. 1. All medications shall be received from the parent/guardian by a designated staff person. 2. The designated staff person(s) shall: (i) Obtain the parent’s/guardian’s written authorization to administer each medication; (ii) Document that the medicines or drugs are in the original container, are not expired, and are labeled with the child’s name; (iii) Document the specific dosage and times the medication is to be administered to the child; and (iv) Document that the parent/guardian has provided the child care agency with instructions on the means and method of administration. (b) Administering Medications. 1. All medications shall be administered by a staff person or persons who have received training in medication administration. Online training is available through the American Academy of Pediatrics at no cost. 2. The following documentation shall be maintained in the child’s file and a copy provided to the parent/guardian: (i) Medication was administered according to parent/guardian or health care provider instruction, including times and amounts of medications administered; (ii) Any side effects observed; (iii) Name of staff person administering medication to child; and (iv) Unused medication was returned to the parent/guardian. 3. Medication shall never be administered in bottles or infant feeders unless authorized by a physician. Educators shall ensure that medication administered in this way is not accessible to other children. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with 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: License- exempt child care providers regulated by the Tennessee Department of Education (TDOE) are subject to Tenn. Comp. R. & Regs 0520-12-01. Statute requires that these standards are substantially the same as those for child care providers licensed by the Lead Agency. Authority over license-exempt providers not regulated by TDOE is limited to the Lead Agency’s contract to participate in the Child Care Payment Assistance/Certificate Program. License-exempt center educators are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License- exempt center educators are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Lead Agency identifies Authorized Child Care Professionals as CCDF-eligible license-exempt family child care providers, individuals who may care for up to six (6) children (four (4) not related to the individual and up to two (2) additional related children) and who are contracted with the Lead Agency to participate in the Child Care Payment Assistance/Certificate Program as a result of parental choice. A maximum of four children approved through the Child Care Payment Assistance/Certificate Program may be enrolled to an Authorized Child Care Professional. License-exempt Authorized Child Care Professionals are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt Authorized Child Care Professionals are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. Observation of standards demonstration are documented during each monitoring inspection. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Lead Agency only permits relative care in circumstances when the child in care resides in the provider's home, i.e., a child or grandchild. The Lead Agency makes available in-home care for non-relatives in the child's home when the child requires special accommodations to meet individual needs. In such instances, these situations would be monitored using the protocols established for Authorized Professionals. Please see 5.3.3.a.v. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A. 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: Standards for child care programs licensed by the Lead Agency that address obtaining permission from parents to administer medication to children include: Administration of medication must be consistent with standards for parental consent. (a) Receiving Medications. 1. All medications shall be received from the parent/guardian by a designated staff person. 2. The designated staff person(s) shall: (i) Obtain the parent’s/guardian’s written authorization to administer each medication; (ii) Document that the medicines or drugs are in the original container, are not expired, and are labeled with the child’s name; (iii) Document the specific dosage and times the medication is to be administered to the child; and (iv) Document that the parent/guardian has provided the child care agency with instructions on the means and method of administration. (b) Administering Medications. 1. All medications shall be administered by a staff person or persons who have received training in medication administration. Online training is available through the American Academy of Pediatrics at no cost. 2. The following documentation shall be maintained in the child’s file and a copy provided to the parent/guardian: (i) Medication was administered according to parent/guardian or health care provider instruction, including times and amounts of medications administered; (ii) Any side effects observed; (iii) Name of staff person administering medication to child; and (iv) Unused medication was returned to the parent/guardian. 3. Medication shall never be administered in bottles or infant feeders unless authorized by a physician. Educators shall ensure that medication administered in this way is not accessible to other children. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with children. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Standards for child care programs licensed by the Lead Agency that address obtaining permission from parents to administer medication to children include: (a) Receiving Medications. 1. All medications shall be received from the parent/guardian by a designated staff person. 2. The designated staff person(s) shall: (i) Obtain the parent’s/guardian’s written authorization to administer each medication; (ii) Document that the medicines or drugs are in the original container, are not expired, and are labeled with the child’s name; (iii) Document the specific dosage and times the medication is to be administered to the child; and (iv) Document that the parent/guardian has provided the child care agency with instructions on the means and method of administration. (b) Administering Medications. 1. All medications shall be administered by a staff person or persons who have received training in medication administration. Online training is available through the American Academy of Pediatrics at no cost. 2. The following documentation shall be maintained in the child’s file and a copy provided to the parent/guardian: (i) Medication was administered according to parent/guardian or health care provider instruction, including times and amounts of medications administered; (ii) Any side effects observed; (iii) Name of staff person administering medication to child; and (iv) Unused medication was returned to the parent/guardian. 3. Medication shall never be administered in bottles or infant feeders unless authorized by a physician. Educators shall ensure that medication administered in this way is not accessible to other children. Administration of medication must be consistent with standards for parental consent. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with 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: License- exempt child care providers regulated by the Tennessee Department of Education (TDOE) are subject to Tenn. Comp. R. & Regs 0520-12-01. Statute requires that these standards are substantially the same as those for child care providers licensed by the Lead Agency. Authority over license-exempt providers not regulated by TDOE is limited to the Lead Agency’s contract to participate in the Child Care Payment Assistance/Certificate Program. License-exempt center educators are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License- exempt center educators are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Lead Agency identifies Authorized Child Care Professionals as CCDF-eligible license-exempt family child care providers, individuals who may care for up to six (6) children (four (4) not related to the individual and up to two (2) additional related children) and who are contracted with the Lead Agency to participate in the Child Care Payment Assistance/Certificate Program as a result of parental choice. A maximum of four children approved through the Child Care Payment Assistance/Certificate Program may be enrolled to an Authorized Child Care Professional. License-exempt Authorized Child Care Professionals are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt Authorized Child Care Professionals are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. Observation of standards demonstration are documented during each monitoring inspection. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Lead Agency only permits relative care in circumstances when the child in care resides in the provider's home, i.e., a child or grandchild. The Lead Agency makes available in-home care for non-relatives in the child's home when the child requires special accommodations to meet individual needs. In such instances, these situations would be monitored using the protocols established for Authorized Professionals. Please see 5.3.3.b.v. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A. 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: Standards for child care programs licensed by the Lead Agency that address prevention of emergencies due to food and allergic reactions include: Prior to having unsupervised contact with children, each new employee shall receive orientation in, and have a working knowledge of, preventing food and allergic reactions. All child records shall include a written plan of action endorsed by the child’s pediatrician or licensed medical provider for a child with life-threatening allergies. Additionally: 1. Information about individual children’s food allergies shall be posted prominently, both where food is prepared and where food is served. 2. For a child with life-threatening allergies, a written plan of action endorsed by the child’s pediatrician or licensed medical provider shall be posted where the educator has immediate access. 3. Any child’s food allergies and the accommodations and precautions in place to address food allergies shall be prominently noted. 4. Outline child care agency procedures that reduce cross- contamination of allergenic foods and other inadvertent exposure to allergens for any child with food allergies. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with children. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Standards for child care programs licensed by the Lead Agency that address prevention of emergencies due to food and allergic reactions include: Prior to having unsupervised contact with children, each new employee shall receive orientation in, and have a working knowledge of, preventing food and allergic reactions. All child records shall include a written plan of action endorsed by the child’s pediatrician or licensed medical provider for a child with life-threatening allergies. Additionally: 1. Information about individual children’s food allergies shall be posted prominently, both where food is prepared and where food is served. 2. For a child with life-threatening allergies, a written plan of action endorsed by the child’s pediatrician or licensed medical provider shall be posted where the educator has immediate access. 3. Any child’s food allergies and the accommodations and precautions in place to address food allergies shall be prominently noted. 4. Outline child care agency procedures that reduce cross- contamination of allergenic foods and other inadvertent exposure to allergens for any child with food allergies. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with 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: CCDF-eligible license-exempt center care. Provide the standard: License-exempt child care providers regulated by the Tennessee Department of Education (TDOE) are subject to Tenn. Comp. R. & Regs 0520-12-01. Statute requires that these standards are substantially the same as those for child care providers licensed by the Lead Agency. Authority over license-exempt providers not regulated by TDOE is limited to the Lead Agency’s contract to participate in the Child Care Payment Assistance/Certificate Program. License-exempt center educators are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt center educators are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Lead Agency identifies Authorized Child Care Professionals as CCDF-eligible license-exempt family child care providers, individuals who may care for up to six (6) children (four (4) not related to the individual and up to two (2) additional related children) and who are contracted with the Lead Agency to participate in the Child Care Payment Assistance/Certificate Program as a result of parental choice. A maximum of four children approved through the Child Care Payment Assistance/Certificate Program may be enrolled to an Authorized Child Care Professional. License-exempt Authorized Child Care Professionals are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt Authorized Child Care Professionals are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. Observation of standards demonstration are documented during each monitoring inspection. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Lead Agency only permits relative care in circumstances when the child in care resides in the provider's home, i.e., a child or grandchild. The Lead Agency makes available in-home care for non-relatives in the child's home when the child requires special accommodations to meet individual needs. In such instances, these situations would be monitored using the protocols established for Authorized Professionals. Please see 5.3.4.a.v. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A. 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: Standards for child care programs licensed by the Lead Agency that address responses to emergencies due to food and allergic reactions include: Prior to having unsupervised contact with children, each new employee shall receive orientation in, and have a working knowledge of, preventing food and allergic reactions. All child records shall include a written plan of action endorsed by the child’s pediatrician or licensed medical provider for a child with life-threatening allergies. Staff shall have documentation of children’s allergies and how to deal with any allergic reaction. Additionally: 1. Information about individual children’s food allergies shall be posted prominently, both where food is prepared and where food is served. 2. For a child with life-threatening allergies, a written plan of action endorsed by the child’s pediatrician or licensed medical provider shall be posted where the educator has immediate access. 3. Any child’s food allergies and the accommodations and precautions in place to address food allergies shall be prominently noted. 4. Outline child care agency procedures that reduce cross- contamination of allergenic foods and other inadvertent exposure to allergens for any child with food allergies. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with children. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Prior to having unsupervised contact with children, each new employee shall receive orientation in, and have a working knowledge of, preventing food and allergic reactions. All child records shall include a written plan of action endorsed by the child’s pediatrician or licensed medical provider for a child with life-threatening allergies. Staff shall have documentation of children’s allergies and how to deal with any allergic reaction. Additionally: 1. Information about individual children’s food allergies shall be posted prominently, both where food is prepared and where food is served. 2. For a child with life-threatening allergies, a written plan of action endorsed by the child’s pediatrician or licensed medical provider shall be posted where the educator has immediate access. 3. Any child’s food allergies and the accommodations and precautions in place to address food allergies shall be prominently noted. 4. Outline child care agency procedures that reduce cross- contamination of allergenic foods and other inadvertent exposure to allergens for any child with food allergies. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with 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: CCDF-eligible license-exempt center care. Provide the standard: License-exempt child care providers regulated by the Tennessee Department of Education (TDOE) are subject to Tenn. Comp. R. & Regs 0520-12-01. Statute requires that these standards are substantially the same as those for child care providers licensed by the Lead Agency. Authority over license-exempt providers not regulated by TDOE is limited to the Lead Agency’s contract to participate in the Child Care Payment Assistance/Certificate Program. License-exempt center educators are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt center educators are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Lead Agency identifies Authorized Child Care Professionals as CCDF-eligible license-exempt family child care providers, individuals who may care for up to six (6) children (four (4) not related to the individual and up to two (2) additional related children) and who are contracted with the Lead Agency to participate in the Child Care Payment Assistance/Certificate Program as a result of parental choice. A maximum of four children approved through the Child Care Payment Assistance/Certificate Program may be enrolled to an Authorized Child Care Professional. License-exempt Authorized Child Care Professionals are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt Authorized Child Care Professionals are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. Observation of standards demonstration are documented during each monitoring inspection. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Lead Agency only permits relative care in circumstances when the child in care resides in the provider's home, i.e., a child or grandchild. The Lead Agency makes available in-home care for non-relatives in the child's home when the child requires special accommodations to meet individual needs. In such instances, these situations would be monitored using the protocols established for Authorized Professionals. Please see 5.3.4.b.v. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A. 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: Standards for child care programs licensed by the Lead Agency that address identification of and protection from building and physical premises hazards include: General Sanitation and Safety of Building and Grounds. Children shall not be present if an adequate water supply is not available for hand-washing and plumbing is not operating properly. Water Supply. The drinking water supply shall be from a source approved by the health authority having jurisdiction. Drinking water shall be available to all children upon request throughout the day. Sewage and Waste Disposal. Children shall not be present if the sewage is not operating. Connection to a public sewage disposal system shall be made where possible. The use of a private sewage disposal system shall have the approval of the local Tennessee Department of Environment and Conservation Division of Ground Water Protection and it shall be operating satisfactorily at all times. All garbage shall be removed from the building daily. All outdoor garbage storage receptacles shall be outside and kept closed. The area surrounding outdoor garbage receptacles shall be kept clean. Building and Grounds. The building shall be kept clean and maintained in good repair, without unsafe cracks, leaks, or plumbing that is in disrepair. All outside doors and windows of the licensed space shall be in good repair. Adequate natural and/or artificial lighting shall be provided throughout the facility. All rooms used by children shall be maintained at a temperature of between sixty-eight degrees to seventy-eight degrees Fahrenheit (68°F to 78°F) by means of heating, cooling or ventilation sources approved for use. Children shall not be present if the indoor temperature cannot be maintained between sixty-eight degrees to seventy-eight degrees Fahrenheit (68°F to 78°F). Stoves, hot radiators, steam and hot water pipes, fans, or other potentially hazardous items shall be inaccessible to children. The use of unvented fuel burning heaters is prohibited. The use of portable heaters is prohibited. The building and grounds shall be kept free of broken glass, trash and debris. Grounds, tire swings and containers shall have adequate drainage to prevent standing water that can breed mosquitoes and other insects. Animals shall be: In good health and immunized in accordance with local health authority; free of fleas, ticks and other parasites; contained in a way that does not allow unsupervised access; and kept away from all food storage and preparation or service areas. Cages, fish tanks or other containment devices shall be cleaned regularly. Reptiles and amphibians shall not be kept as pets due to the risk of Salmonella. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with children. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Standards for child care programs licensed by the Lead Agency that address identification of and protection from building and physical premises hazards include: General Sanitation and Safety of Building and Grounds. Children shall not be present if an adequate water supply is not available for hand-washing and plumbing is not operating properly. Water Supply. The drinking water supply shall be from a source approved by the health authority having jurisdiction. Drinking water shall be available to all children upon request throughout the day. Sewage and Waste Disposal. Children shall not be present if the sewage is not operating. Connection to a public sewage disposal system shall be made where possible. The use of a private sewage disposal system shall have the approval of the local Tennessee Department of Environment and Conservation Division of Ground Water Protection and it shall be operating satisfactorily at all times. All garbage shall be removed from the building daily. All outdoor garbage storage receptacles shall be outside and kept closed. The area surrounding outdoor garbage receptacles shall be kept clean. Building and Grounds. The building shall be kept clean and maintained in good repair, without unsafe cracks, leaks, or plumbing that is in disrepair. All outside doors and windows of the licensed space shall be in good repair. Adequate natural and/or artificial lighting shall be provided throughout the facility. All rooms used by children shall be maintained at a temperature of between sixty-eight degrees to seventy-eight degrees Fahrenheit (68°F to 78°F) by means of heating, cooling or ventilation sources approved for use. Children shall not be present if the indoor temperature cannot be maintained between sixty-eight degrees to seventy-eight degrees Fahrenheit (68°F to 78°F). Stoves, hot radiators, steam and hot water pipes, fans, or other potentially hazardous items shall be inaccessible to children. The use of unvented fuel burning heaters is prohibited. The use of portable heaters is prohibited. The building and grounds shall be kept free of broken glass, trash and debris. Grounds, tire swings and containers shall have adequate drainage to prevent standing water that can breed mosquitoes and other insects. Animals shall be: In good health and immunized in accordance with local health authority; free of fleas, ticks and other parasites; contained in a way that does not allow unsupervised access; and kept away from all food storage and preparation or service areas. Cages, fish tanks or other containment devices shall be cleaned regularly. Reptiles and amphibians shall not be kept as pets due to the risk of Salmonella. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with 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: CCDF-eligible license-exempt center care. Provide the standard: License-exempt child care providers regulated by the Tennessee Department of Education (TDOE) are subject to Tenn. Comp. R. & Regs 0520-12-01. Statute requires that these standards are substantially the same as those for child care providers licensed by the Lead Agency. Authority over license-exempt providers not regulated by TDOE is limited to the Lead Agency’s contract to participate in the Child Care Payment Assistance/Certificate Program. License-exempt center educators are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt center educators are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Lead Agency identifies Authorized Child Care Professionals as CCDF-eligible license-exempt family child care providers, individuals who may care for up to six (6) children (four (4) not related to the individual and up to two (2) additional related children) and who are contracted with the Lead Agency to participate in the Child Care Payment Assistance/Certificate Program as a result of parental choice. A maximum of four children approved through the Child Care Payment Assistance/Certificate Program may be enrolled to an Authorized Child Care Professional. License-exempt Authorized Child Care Professionals are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt Authorized Child Care Professionals are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. Observation of standards demonstration are documented during each monitoring inspection. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Lead Agency only permits relative care in circumstances when the child in care resides in the provider's home, i.e., a child or grandchild. The Lead Agency makes available in-home care for non-relatives in the child's home when the child requires special accommodations to meet individual needs. In such instances, these situations would be monitored using the protocols established for Authorized Professionals. Please see 5.3.5.a.v. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A. 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: Standards for child care programs licensed by the Lead Agency that address identification of and protection from identification of and protection from bodies of water include: Building, Grounds and Pools. Building and grounds shall be kept free of unprotected ponds, wells, cisterns, unused refrigerators and similar hazards. Swimming pools shall be made inaccessible to children through the use of fences and locked gates. Swimming is prohibited in Drop-In Care. Swimming pools and/or wading pools shall not be used without prior approval by the local health department. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with children. Staff of license-exempt child care providers that participate in the Child Care Payment Assistance/Certificate Program are required to complete a specified pre- service training that covers all the health and safety training topics prior to contact with children. License-exempt provider educators are also required to complete at least 6 hours of training in CCDBG health and safety topics annually and the Lead Agency recommends these educators cycle through all the CCDBG health and safety training topics every three (3) years. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Standards for child care programs licensed by the Lead Agency that address identification of and protection from identification of and protection from bodies of water: Building, Grounds and Pools. Building and grounds shall be kept free of unprotected ponds, wells, cisterns, unused refrigerators and similar hazards. Swimming pools shall be made inaccessible to children through the use of fences and locked gates. Swimming is prohibited in Drop-In Care. Swimming pools and/or wading pools shall not be used without prior approval by the local health department. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with children. Staff of license-exempt child care providers that participate in the Child Care Payment Assistance/Certificate Program are required to complete a specified pre- service training that covers all the health and safety training topics prior to contact with children. License-exempt provider educators are also required to complete at least 6 hours of training in CCDBG health and safety topics annually and the Lead Agency recommends these educators cycle through all the CCDBG health and safety training topics every three (3) years. 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: CCDF-eligible license-exempt center care. Provide the standard: License-exempt child care providers regulated by the Tennessee Department of Education (TDOE) are subject to Tenn. Comp. R. & Regs 0520-12-01. Statute requires that these standards are substantially the same as those for child care providers licensed by the Lead Agency. Authority over license-exempt providers not regulated by TDOE is limited to the Lead Agency’s contract to participate in the Child Care Payment Assistance/Certificate Program. License-exempt center educators are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt center educators are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Lead Agency identifies Authorized Child Care Professionals as CCDF-eligible license-exempt family child care providers, individuals who may care for up to six (6) children (four (4) not related to the individual and up to two (2) additional related children) and who are contracted with the Lead Agency to participate in the Child Care Payment Assistance/Certificate Program as a result of parental choice. A maximum of four children approved through the Child Care Payment Assistance/Certificate Program may be enrolled to an Authorized Child Care Professional. License-exempt Authorized Child Care Professionals are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt Authorized Child Care Professionals are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. Observation of standards demonstration are documented during each monitoring inspection. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Lead Agency only permits relative care in circumstances when the child in care resides in the provider's home, i.e., a child or grandchild. The Lead Agency makes available in-home care for non-relatives in the child's home when the child requires special accommodations to meet individual needs. In such instances, these situations would be monitored using the protocols established for Authorized Professionals. Please see 5.3.5.b.v. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A. 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: Standards for child care programs licensed by the Lead Agency that address identification of and protection from vehicular traffic hazards include requiring outdoor play areas be enclosed by a fence or barrier at least four (4) feet in height. Exception: A child care agency may request the Lead Agency, at is discretion, waive such requirement upon a clear showing that the lack of such fence or barrier poses no apparent or potential risk to children. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with children. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Standards for child care programs licensed by the Lead Agency that address identification of and protection from vehicular traffic hazards include requiring outdoor play areas be enclosed by a fence or barrier at least four (4) feet in height. Exception: A child care agency may request the Lead Agency, at is discretion, waive such requirement upon a clear showing that the lack of such fence or barrier poses no apparent or potential risk to children. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with 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: CCDF-eligible license-exempt center care. Provide the standard: License-exempt child care providers regulated by the Tennessee Department of Education (TDOE) are subject to Tenn. Comp. R. & Regs 0520-12-01. Statute requires that these standards are substantially the same as those for child care providers licensed by the Lead Agency. Authority over license-exempt providers not regulated by TDOE is limited to the Lead Agency’s contract to participate in the Child Care Payment Assistance/Certificate Program. License-exempt center educators are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt center educators are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Lead Agency identifies Authorized Child Care Professionals as CCDF-eligible license-exempt family child care providers, individuals who may care for up to six (6) children (four (4) not related to the individual and up to two (2) additional related children) and who are contracted with the Lead Agency to participate in the Child Care Payment Assistance/Certificate Program as a result of parental choice. A maximum of four children approved through the Child Care Payment Assistance/Certificate Program may be enrolled to an Authorized Child Care Professional. License-exempt Authorized Child Care Professionals are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt Authorized Child Care Professionals are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. Observation of standards demonstration are documented during each monitoring inspection. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Lead Agency only permits relative care in circumstances when the child in care resides in the provider's home, i.e., a child or grandchild. The Lead Agency makes available in-home care for non-relatives in the child's home when the child requires special accommodations to meet individual needs. In such instances, these situations would be monitored using the protocols established for Authorized Professionals. Please see 5.3.5.c.v. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A. 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: Standards for child care programs licensed by the Lead Agency that address prevention of shaken baby syndrome and abusive head trauma include: A child care provider’s policies shall include, at a minimum: Shaken baby syndrome/abusive head trauma/child maltreatment, to include: (i) recognizing potential signs and symptoms; (ii) creating strategies for coping with crying, fussing or distraught children; and (iii) understanding the development and vulnerabilities of the brain in infancy and early childhood. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice and Preventing Shaken Baby Syndrome, Abusive Head Trauma, and Child Maltreatment preservice training prior to having contact with children. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Standards for child care programs licensed by the Lead Agency that address prevention of shaken baby syndrome and abusive head trauma include: A child care provider’s policies shall include, at a minimum: Shaken baby syndrome/abusive head trauma/child maltreatment, to include: (i) recognizing potential signs and symptoms; (ii) creating strategies for coping with crying, fussing or distraught children; and (iii) understanding the development and vulnerabilities of the brain in infancy and early childhood. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice and Preventing Shaken Baby Syndrome, Abusive Head Trauma, and Child Maltreatment preservice training prior to having contact with 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: CCDF-eligible license-exempt center care. Provide the standard: License-exempt child care providers regulated by the Tennessee Department of Education (TDOE) are subject to Tenn. Comp. R. & Regs 0520-12-01. Statute requires that these standards are substantially the same as those for child care providers licensed by the Lead Agency. Authority over license-exempt providers not regulated by TDOE is limited to the Lead Agency’s contract to participate in the Child Care Payment Assistance/Certificate Program. License-exempt center educators are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt center educators are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Lead Agency identifies Authorized Child Care Professionals as CCDF-eligible license-exempt family child care providers, individuals who may care for up to six (6) children (four (4) not related to the individual and up to two (2) additional related children) and who are contracted with the Lead Agency to participate in the Child Care Payment Assistance/Certificate Program as a result of parental choice. A maximum of four children approved through the Child Care Payment Assistance/Certificate Program may be enrolled to an Authorized Child Care Professional. License-exempt Authorized Child Care Professionals are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt Authorized Child Care Professionals are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. Observation of standards demonstration are documented during each monitoring inspection. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Lead Agency only permits relative care in circumstances when the child in care resides in the provider's home, i.e., a child or grandchild. The Lead Agency makes available in-home care for non-relatives in the child's home when the child requires special accommodations to meet individual needs. In such instances, these situations would be monitored using the protocols established for Authorized Professionals. Please see 5.3.6.a.v. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A. 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: Standards for child care programs licensed by the Lead Agency that address prevention of child maltreatment include: A child care provider’s policies shall include, at a minimum: Shaken baby syndrome/abusive head trauma/child maltreatment, to include: (i) recognizing potential signs and symptoms; (ii) creating strategies for coping with crying, fussing or distraught children; and (iii) understanding the development and vulnerabilities of the brain in infancy and early childhood. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice and Preventing Shaken Baby Syndrome, Abusive Head Trauma, and Child Maltreatment preservice training prior to having contact with children. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Standards for child care programs licensed by the Lead Agency that address prevention of shaken baby syndrome and abusive head trauma include: A child care provider’s policies shall include, at a minimum: Shaken baby syndrome/abusive head trauma/child maltreatment, to include: (i) recognizing potential signs and symptoms; (ii) creating strategies for coping with crying, fussing or distraught children; and (iii) understanding the development and vulnerabilities of the brain in infancy and early childhood. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice and Preventing Shaken Baby Syndrome, Abusive Head Trauma, and Child Maltreatment preservice training prior to having contact with 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: CCDF-eligible license-exempt center care. Provide the standard: License-exempt child care providers regulated by the Tennessee Department of Education (TDOE) are subject to Tenn. Comp. R. & Regs 0520-12-01. Statute requires that these standards are substantially the same as those for child care providers licensed by the Lead Agency. Authority over license-exempt providers not regulated by TDOE is limited to the Lead Agency’s contract to participate in the Child Care Payment Assistance/Certificate Program. License-exempt center educators are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt center educators are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Lead Agency identifies Authorized Child Care Professionals as CCDF-eligible license-exempt family child care providers, individuals who may care for up to six (6) children (four (4) not related to the individual and up to two (2) additional related children) and who are contracted with the Lead Agency to participate in the Child Care Payment Assistance/Certificate Program as a result of parental choice. A maximum of four children approved through the Child Care Payment Assistance/Certificate Program may be enrolled to an Authorized Child Care Professional. License-exempt Authorized Child Care Professionals are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt Authorized Child Care Professionals are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. Observation of standards demonstration are documented during each monitoring inspection. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Lead Agency only permits relative care in circumstances when the child in care resides in the provider's home, i.e., a child or grandchild. The Lead Agency makes available in-home care for non-relatives in the child's home when the child requires special accommodations to meet individual needs. In such instances, these situations would be monitored using the protocols established for Authorized Professionals. Please see 5.3.6.b.v. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A. 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: Universal and standard precautions, as defined by the Centers for Disease Control, shall be followed when handling or cleaning bodily fluids. Firearms shall not be permitted on the premises of a child care agency, in any vehicle used to transport children for the child care agency, or in the presence of a child. In a private residence, deadly weapons and potentially hazardous items, such as power tools, are permitted on the premises, but shall be kept locked, out of sight, and inaccessible to children at all times. Firearms kept in a private residence shall be locked and unloaded with ammunition locked up separately. The physical facilities (indoor and outdoor) present no apparent hazards. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with children. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Universal and standard precautions, as defined by the Centers for Disease Control, shall be followed when handling or cleaning bodily fluids. Firearms shall not be permitted on the premises of a child care agency, in any vehicle used to transport children for the child care agency, or in the presence of a child. In a private residence, deadly weapons and potentially hazardous items, such as power tools, are permitted on the premises, but shall be kept locked, out of sight, and inaccessible to children at all times. Firearms kept in a private residence shall be locked and unloaded with ammunition locked up separately. The physical facilities (indoor and outdoor) present no apparent hazards. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with 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: CCDF-eligible license-exempt center care. Provide the standard: License-exempt child care providers regulated by the Tennessee Department of Education (TDOE) are subject to Tenn. Comp. R. & Regs 0520-12-01. Statute requires that these standards are substantially the same as those for child care providers licensed by the Lead Agency. Authority over license-exempt providers not regulated by TDOE is limited to the Lead Agency’s contract to participate in the Child Care Payment Assistance/Certificate Program. License-exempt center educators are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt center educators are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Lead Agency identifies Authorized Child Care Professionals as CCDF-eligible license-exempt family child care providers, individuals who may care for up to six (6) children (four (4) not related to the individual and up to two (2) additional related children) and who are contracted with the Lead Agency to participate in the Child Care Payment Assistance/Certificate Program as a result of parental choice. A maximum of four children approved through the Child Care Payment Assistance/Certificate Program may be enrolled to an Authorized Child Care Professional. License-exempt Authorized Child Care Professionals are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt Authorized Child Care Professionals are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. Observation of standards demonstration are documented during each monitoring inspection. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Lead Agency only permits relative care in circumstances when the child in care resides in the provider's home, i.e., a child or grandchild. The Lead Agency makes available in-home care for non-relatives in the child's home when the child requires special accommodations to meet individual needs. In such instances, these situations would be monitored using the protocols established for Authorized Professionals. Please see 5.3.8.a.v. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A. 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: Universal and standard precautions, as defined by the Centers for Disease Control, shall be followed when handling or cleaning bodily fluids. Firearms shall not be permitted on the premises of a child care agency, in any vehicle used to transport children for the child care agency, or in the presence of a child. In a private residence, deadly weapons and potentially hazardous items, such as power tools, are permitted on the premises, but shall be kept locked, out of sight, and inaccessible to children at all times. Firearms kept in a private residence shall be locked and unloaded with ammunition locked up separately. The physical facilities (indoor and outdoor) present no apparent hazards. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with children. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Universal and standard precautions, as defined by the Centers for Disease Control, shall be followed when handling or cleaning bodily fluids. Firearms shall not be permitted on the premises of a child care agency, in any vehicle used to transport children for the child care agency, or in the presence of a child. In a private residence, deadly weapons and potentially hazardous items, such as power tools, are permitted on the premises, but shall be kept locked, out of sight, and inaccessible to children at all times. Firearms kept in a private residence shall be locked and unloaded with ammunition locked up separately. The physical facilities (indoor and outdoor) present no apparent hazards. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with 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: CCDF-eligible license-exempt center care. Provide the standard: License-exempt child care providers regulated by the Tennessee Department of Education (TDOE) are subject to Tenn. Comp. R. & Regs 0520-12-01. Statute requires that these standards are substantially the same as those for child care providers licensed by the Lead Agency. Authority over license-exempt providers not regulated by TDOE is limited to the Lead Agency’s contract to participate in the Child Care Payment Assistance/Certificate Program. License-exempt center educators are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt center educators are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Lead Agency identifies Authorized Child Care Professionals as CCDF-eligible license-exempt family child care providers, individuals who may care for up to six (6) children (four (4) not related to the individual and up to two (2) additional related children) and who are contracted with the Lead Agency to participate in the Child Care Payment Assistance/Certificate Program as a result of parental choice. A maximum of four children approved through the Child Care Payment Assistance/Certificate Program may be enrolled to an Authorized Child Care Professional. License-exempt Authorized Child Care Professionals are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt Authorized Child Care Professionals are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. Observation of standards demonstration are documented during each monitoring inspection. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Lead Agency only permits relative care in circumstances when the child in care resides in the provider's home, i.e., a child or grandchild. The Lead Agency makes available in-home care for non-relatives in the child's home when the child requires special accommodations to meet individual needs. In such instances, these situations would be monitored using the protocols established for Authorized Professionals. Please see 5.3.8.b.v. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A. 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: Standards for child care programs licensed by the Lead Agency that address precautions in transporting children include: (1) Transportation shall comply with all state laws and these rules. (2) Child care agencies shall not transport children without prior written approval by the Department. (3) Prior to providing child care transportation services of any type, directly or by contract, all new and existing child care agencies shall provide a written statement to the Department that includes: (a) Scope of transportation that will be offered; (b) A list and description of the vehicles that will be used, including color, make, and model of vehicle, the license plate number, and provisions for how the child care agency will address emergency situations if the temporary use of alternate vehicles is necessary; (c) Copies of any contracts, agreements or arrangements with any third parties for transportation; and (d) Policies, procedures, and staff training plans to ensure that all transportation staff properly performs all duties related to the following requirements: 1. Child care agencies shall adhere to child-safety restraint requirements set forth in state law; 2. Child care agencies shall account for each child when loading or unloading to ensure that no child is left on a vehicle unattended; 3. Child care agencies shall conduct vehicle emergency evacuation drills quarterly; 4. Use of cell phones and texting devices is prohibited while en route; Exception: Limited use of cell phones and texting devices by vehicle monitors, who are not driving, to communicate with the child care agency or parents, is allowable, but personal calls are prohibited. 5. Child care agencies shall institute plans for emergency communication during transportation; 6. Carrying, possessing, or storing firearms or other weapons in vehicles is prohibited; 7. Routine transportation shall be limited to forty-five (45) minutes each way; (i) An individualized plan may be approved by the Department allowing the child care agency to exceed this time frame if signed by the parent/guardian and the child care agency. (ii) Field trip travel time is not limited for school-agers. 8. Child care agencies shall have current documentation of medical and liability insurance as required by law; 9. Child care agencies shall use Department-approved vehicle monitoring devices for all vehicles designed to transport six (6) passengers or more; (i) Exceptions: (I) Vehicles in which all the children being transported are five (5) years of age and in kindergarten, or older, unless any of the children are developmentally or physically disabled or non-ambulatory; (II) Vehicles used exclusively for field trips; or (III) Vehicles used by family or group child care homes. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with children. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Standards for child care programs licensed by the Lead Agency that address precautions in transporting children include: (1) Transportation shall comply with all state laws and these rules. (2) Child care agencies shall not transport children without prior written approval by the Department. (3) Prior to providing child care transportation services of any type, directly or by contract, all new and existing child care agencies shall provide a written statement to the Department that includes: (a) Scope of transportation that will be offered; (b) A list and description of the vehicles that will be used, including color, make, and model of vehicle, the license plate number, and provisions for how the child care agency will address emergency situations if the temporary use of alternate vehicles is necessary; (c) Copies of any contracts, agreements or arrangements with any third parties for transportation; and (d) Policies, procedures, and staff training plans to ensure that all transportation staff properly performs all duties related to the following requirements: 1. Child care agencies shall adhere to child-safety restraint requirements set forth in state law; 2. Child care agencies shall account for each child when loading or unloading to ensure that no child is left on a vehicle unattended; 3. Child care agencies shall conduct vehicle emergency evacuation drills quarterly; 4. Use of cell phones and texting devices is prohibited while en route; Exception: Limited use of cell phones and texting devices by vehicle monitors, who are not driving, to communicate with the child care agency or parents, is allowable, but personal calls are prohibited. 5. Child care agencies shall institute plans for emergency communication during transportation; 6. Carrying, possessing, or storing firearms or other weapons in vehicles is prohibited; 7. Routine transportation shall be limited to forty-five (45) minutes each way; (i) An individualized plan may be approved by the Department allowing the child care agency to exceed this time frame if signed by the parent/guardian and the child care agency. (ii) Field trip travel time is not limited for school-agers. 8. Child care agencies shall have current documentation of medical and liability insurance as required by law; 9. Child care agencies shall use Department-approved vehicle monitoring devices for all vehicles designed to transport six (6) passengers or more; (i) Exceptions: (I) Vehicles in which all the children being transported are five (5) years of age and in kindergarten, or older, unless any of the children are developmentally or physically disabled or non-ambulatory; (II) Vehicles used exclusively for field trips; or (III) Vehicles used by family or group child care homes. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with 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: CCDF-eligible license-exempt center care. Provide the standard: License-exempt child care providers regulated by the Tennessee Department of Education (TDOE) are subject to Tenn. Comp. R. & Regs 0520-12-01. Statute requires that these standards are substantially the same as those for child care providers licensed by the Lead Agency. Authority over license-exempt providers not regulated by TDOE is limited to the Lead Agency’s contract to participate in the Child Care Payment Assistance/Certificate Program. License-exempt center educators are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt center educators are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Lead Agency identifies Authorized Child Care Professionals as CCDF-eligible license-exempt family child care providers, individuals who may care for up to six (6) children (four (4) not related to the individual and up to two (2) additional related children) and who are contracted with the Lead Agency to participate in the Child Care Payment Assistance/Certificate Program as a result of parental choice. A maximum of four children approved through the Child Care Payment Assistance/Certificate Program may be enrolled to an Authorized Child Care Professional. License-exempt Authorized Child Care Professionals are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt Authorized Child Care Professionals are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. Observation of standards demonstration are documented during each monitoring inspection. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Lead Agency only permits relative care in circumstances when the child in care resides in the provider's home, i.e., a child or grandchild. The Lead Agency makes available in-home care for non-relatives in the child's home when the child requires special accommodations to meet individual needs. In such instances, these situations would be monitored using the protocols established for Authorized Professionals. Please see 5.3.9.v. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A. 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: Standards for child care programs licensed by the Lead Agency that address pediatric first aid for all staff include: (9) First Aid. (a) A standard first aid kit, as defined by the current National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care shall be accessible to all staff, and all staff shall be familiar with its contents and use. (b) All staff shall obtain first aid training within ninety (90) days of employment. At least one staff member who has current certification in first aid from a certifying organization recognized by the Department shall be on-site at all times. 1. The certification shall be applicable to the ages present in the classroom: (i) Infant/Child first aid; and/or (ii) Adult first aid if children over age twelve (12) are present. (c) Current and comprehensive first aid information shall be prominently posted in each area that children use. (d) Extended Care First Aid Requirements. One (1) staff person on duty at all times shall have current certification or the equivalent in first aid from a certifying organization recognized by the Department. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with children. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Standards for child care programs licensed by the Lead Agency that address pediatric first aid for all staff include: (9) First Aid. (a) A standard first aid kit, as defined by the current National Health and Safety Performance Standards: Guidelines for Out-of- Home Child Care shall be accessible to all staff, and all staff shall be familiar with its contents and use. (b) All staff shall obtain first aid training within ninety (90) days of employment. At least one staff member who has current certification in first aid from a certifying organization recognized by the Department shall be on- site at all times. 1. The certification shall be applicable to the ages present in the classroom: (i) Infant/Child first aid; and/or (ii) Adult first aid if children over age twelve (12) are present. (c) Current and comprehensive first aid information shall be prominently posted in each area that children use. (d) Extended Care First Aid Requirements. One (1) staff person on duty at all times shall have current certification or the equivalent in first aid from a certifying organization recognized by the Department. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with 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: CCDF-eligible license-exempt center care. Provide the standard: License-exempt child care providers regulated by the Tennessee Department of Education (TDOE) are subject to Tenn. Comp. R. & Regs 0520-12-01. Statute requires that these standards are substantially the same as those for child care providers licensed by the Lead Agency. Authority over license-exempt providers not regulated by TDOE is limited to the Lead Agency’s contract to participate in the Child Care Payment Assistance/Certificate Program. License-exempt center educators are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt center educators are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Lead Agency identifies Authorized Child Care Professionals as CCDF-eligible license-exempt family child care providers, individuals who may care for up to six (6) children (four (4) not related to the individual and up to two (2) additional related children) and who are contracted with the Lead Agency to participate in the Child Care Payment Assistance/Certificate Program as a result of parental choice. A maximum of four children approved through the Child Care Payment Assistance/Certificate Program may be enrolled to an Authorized Child Care Professional. License-exempt Authorized Child Care Professionals are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt Authorized Child Care Professionals are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. Observation of standards demonstration are documented during each monitoring inspection. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Lead Agency only permits relative care in circumstances when the child in care resides in the provider's home, i.e., a child or grandchild. The Lead Agency makes available in-home care for non-relatives in the child's home when the child requires special accommodations to meet individual needs. In such instances, these situations would be monitored using the protocols established for Authorized Professionals. Please see 5.3.10.a.v. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A. 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: Standards for child care programs licensed by the Lead Agency that address pediatric cardiopulmonary resuscitation (CPR) for all staff include: (10) Cardiopulmonary Resuscitation (CPR) Requirements. (a) All staff on duty shall receive training in Cardiopulmonary Resuscitation (CPR) as recognized by the Department within ninety (90) days of employment. At least one staff member who has certification in CPR from a certifying organization recognized by the Department shall be present on-site at all times. 1. The certification shall be applicable to the ages present in the classroom: (i) Infant/Child CPR; and/or (ii) Adult CPR if children over age twelve (12) are present. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with children. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Standards for child care programs licensed by the Lead Agency that address pediatric CPR for all staff include: (10) Cardiopulmonary Resuscitation (CPR) Requirements. (a) All staff on duty shall receive training in Cardiopulmonary Resuscitation (CPR) as recognized by the Department within ninety (90) days of employment. At least one staff member who has certification in CPR from a certifying organization recognized by the Department shall be present on-site at all times. 1. The certification shall be applicable to the ages present in the classroom: (i) Infant/Child CPR; and/or (ii) Adult CPR if children over age twelve (12) are present. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with 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: CCDF-eligible license-exempt center care. Provide the standard: License-exempt child care providers regulated by the Tennessee Department of Education (TDOE) are subject to Tenn. Comp. R. & Regs 0520-12-01. Statute requires that these standards are substantially the same as those for child care providers licensed by the Lead Agency. Authority over license-exempt providers not regulated by TDOE is limited to the Lead Agency’s contract to participate in the Child Care Payment Assistance/Certificate Program. License-exempt center educators are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt center educators are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Lead Agency identifies Authorized Child Care Professionals as CCDF-eligible license-exempt family child care providers, individuals who may care for up to six (6) children (four (4) not related to the individual and up to two (2) additional related children) and who are contracted with the Lead Agency to participate in the Child Care Payment Assistance/Certificate Program as a result of parental choice. A maximum of four children approved through the Child Care Payment Assistance/Certificate Program may be enrolled to an Authorized Child Care Professional. License-exempt Authorized Child Care Professionals are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt Authorized Child Care Professionals are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. Observation of standards demonstration are documented during each monitoring inspection. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Lead Agency only permits relative care in circumstances when the child in care resides in the provider's home, i.e., a child or grandchild. The Lead Agency makes available in-home care for non-relatives in the child's home when the child requires special accommodations to meet individual needs. In such instances, these situations would be monitored using the protocols established for Authorized Professionals. Please see 5.3.10.b.v. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A. 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: Prior to having contact with children, each new employee shall receive orientation in and have a working knowledge of detecting, reporting, and preventing child abuse. Child care providers are required to develop reporting policies that comply with requirements of the Tennessee Department of Children’s Services (TDCS), the state’s child welfare agency. All staff must complete training on prevention, detection, and reporting of child abuse and neglect training annually. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with children. This training includes standards/expectations for each CCDBG health and safety topic. The expectations for recognizing child abuse and neglect include but are not limited to clarifying that any person who has contact with children in a professional capacity is a mandated reporter in Tennessee. Any suspicion or knowledge of child abuse and/or neglect must be reported to the Tennessee Department of Children’s Services (TDCS), including any instance that may occur at the hand of another staff member. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Prior to having contact with children, each new employee shall receive orientation in and have a working knowledge of detecting, reporting, and preventing child abuse. Child care providers are required to develop reporting policies that comply with requirements of the Tennessee Department of Children’s Services (TDCS), the state’s child welfare agency. All staff must complete on prevention, detection, and reporting of child abuse and neglect training annually. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with children. This training includes standards/expectations for each CCDBG health and safety topic. The expectations for recognizing child abuse and neglect include but are not limited to clarifying that any person who has contact with children in a professional capacity is a mandated reporter in Tennessee. Any suspicion or knowledge of child abuse and/or neglect must be reported to the Tennessee Department of Children’s Services (TDCS), including any instance that may occur at the hand of another staff member. 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: CCDF-eligible license-exempt center care. Provide the standard: License-exempt child care providers regulated by the Tennessee Department of Education (TDOE) are subject to Tenn. Comp. R. & Regs 0520-12-01. Statute requires that these standards are substantially the same as those for child care providers licensed by the Lead Agency. Authority over license-exempt providers not regulated by TDOE is limited to the Lead Agency’s contract to participate in the Child Care Payment Assistance/Certificate Program. License-exempt center educators are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt center educators are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Lead Agency identifies Authorized Child Care Professionals as CCDF-eligible license-exempt family child care providers, individuals who may care for up to six (6) children (four (4) not related to the individual and up to two (2) additional related children) and who are contracted with the Lead Agency to participate in the Child Care Payment Assistance/Certificate Program as a result of parental choice. A maximum of four children approved through the Child Care Payment Assistance/Certificate Program may be enrolled to an Authorized Child Care Professional. License-exempt Authorized Child Care Professionals are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt Authorized Child Care Professionals are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. Observation of standards demonstration are documented during each monitoring inspection. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Lead Agency only permits relative care in circumstances when the child in care resides in the provider's home, i.e., a child or grandchild. The Lead Agency makes available in-home care for non-relatives in the child's home when the child requires special accommodations to meet individual needs. In such instances, these situations would be monitored using the protocols established for Authorized Professionals. Please see 5.3.11.a.v. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A. 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: Prior to having contact with children, each new employee shall receive orientation in and have a working knowledge of detecting, reporting, and preventing child abuse. Child care providers are required to develop reporting policies that comply with requirements of the Tennessee Department of Children’s Services (TDCS), the state’s child welfare agency. All staff must complete training on prevention, detection, and reporting of child abuse and neglect training annually. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with children. This training includes standards/expectations for each CCDBG health and safety topic. The expectations for recognizing child abuse and neglect include but are not limited to clarifying that any person who has contact with children in a professional capacity is a mandated reporter in Tennessee. Any suspicion or knowledge of child abuse and/or neglect must be reported to the Tennessee Department of Children’s Services (TDCS), including any instance that may occur at the hand of another staff member. ii. All CCDF-eligible licensed family child care homes. Provide the standard: Prior to having contact with children, each new employee shall receive orientation in and have a working knowledge of detecting, reporting, and preventing child abuse. Child care providers are required to develop reporting policies that comply with requirements of the Tennessee Department of Children’s Services (TDCS), the state’s child welfare agency. All staff must complete training on prevention, detection, and reporting of child abuse and neglect training annually. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with children. This training includes standards/expectations for each CCDBG health and safety topic. The expectations for recognizing child abuse and neglect include but are not limited to clarifying that any person who has contact with children in a professional capacity is a mandated reporter in Tennessee. Any suspicion or knowledge of child abuse and/or neglect must be reported to the Tennessee Department of Children’s Services (TDCS), including any instance that may occur at the hand of another staff member. 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: CCDF-eligible license-exempt center care. Provide the standard: License-exempt child care providers regulated by the Tennessee Department of Education (TDOE) are subject to Tenn. Comp. R. & Regs 0520-12-01. Statute requires that these standards are substantially the same as those for child care providers licensed by the Lead Agency. Authority over license-exempt providers not regulated by TDOE is limited to the Lead Agency’s contract to participate in the Child Care Payment Assistance/Certificate Program. License-exempt center educators are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt center educators are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. v. All CCDF-eligible license-exempt family child care homes. Provide the standard: The Lead Agency identifies Authorized Child Care Professionals as CCDF-eligible license-exempt family child care providers, individuals who may care for up to six (6) children (four (4) not related to the individual and up to two (2) additional related children) and who are contracted with the Lead Agency to participate in the Child Care Payment Assistance/Certificate Program as a result of parental choice. A maximum of four children approved through the Child Care Payment Assistance/Certificate Program may be enrolled to an Authorized Child Care Professional. License-exempt Authorized Child Care Professionals are required to complete a specified pre-service training that covers all the health and safety training topics prior to contact with children. License-exempt Authorized Child Care Professionals are also required to complete at least six (6) hours of training in CCDBG health and safety topics annually. The Lead Agency recommends educators cycle through all CCDBG health and safety training topics every three (3) years. Observation of standards demonstration are documented during each monitoring inspection. vi. All CCDF-eligible license-exempt in-home care. Provide the standard: The Lead Agency only permits relative care in circumstances when the child in care resides in the provider's home, i.e., a child or grandchild. The Lead Agency makes available in-home care for non-relatives in the child's home when the child requires special accommodations to meet individual needs. In such instances, these situations would be monitored using the protocols established for Authorized Professionals. Please see 5.3.11.b.v. vii. All CCDF-eligible out-of-school programs (afterschool programs, summer camps, day camps, etc.). Provide the standard: N/A. 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: Standards for child care programs licensed by the Lead Agency that address nutrition include: If a food is provided by a licensed child care provider, it must be in accordance with United States Department of Agriculture’s (USDA) Child and Adult Care Food (CACFP) program nutritional guidelines. Prior to having contact with children, each new employee shall receive orientation in and have a working knowledge of meal service and safe food preparation policies, including nutritional guidelines. During meal time and snacks, educators must engage children in developmentally appropriate conversation to include nutrition and health eating choices. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with children. This training includes standards/expectations for each CCDBG health and safety topic. The expectations for nutrition include but are not limited to other ways to promote healthy lifestyles, i.e., providing healthy meals, snacks and encouraging children to make healthy choices; including book and discussions on nutrition and health; and providing resources for families, e.g., USDA CACFP program nutritional guidelines. ii. Access to physical activity. Describe: Standards for child care programs licensed by the Lead Agency that address physical activity include: Children of all ages, including infants, who are in care more than three (3) daylight hours, must have a daily opportunity for outdoor play when the temperature range (adjusted for wind chill and heat index) is between 32° and 95° Fahrenheit, and it is not raining. Specifications for outdoor play and moderate to vigorous indoor or outdoor physical activity include: • Weather permitting, infants shall be taken outside two to three times per day. • Toddlers and preschoolers shall have 60 to 90 minutes of outdoor play per day for full-time programs. (Exception: Indoor activity can be increased if adverse weather does not permit outdoor play.) • Toddlers shall have 60 to 90 minutes of moderate to vigorous physical activity per eight (8) hour day for full-time programs. • Preschoolers shall have 90 to 120 minutes of moderate to vigorous physical activity per eight (8) hour day for full-time programs. Children shall be properly dressed, and the length of time outside adjusted according to the weather conditions and the age of the children. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with children. This training includes standards/expectations for each CCDBG health and safety topic. The expectations for physical activity include but are not limited to encouraging movement and exercise for all children through individual activities or, for older children, group games to enjoy; and time outside providing opportunities for children to enjoy fresh air, sunshine, and the change of pace outside play offers. iii. Caring for children with special needs. Describe: Standards for child care programs licensed by the Lead Agency that address caring for children with special needs include: Child care providers must consult parents/guardians when developing an individualized care plan to meet the needs of a child with diagnosed disabilities or special needs, including techniques used in the home to ensure the safety ensure health, safety, and well-being. Providers must also maintain a written activity records consisting of daily activities, behavior, and other information pertinent to the individualized care plan. All child care providers serving children receiving assistance through the Child Care Payment Assistance/Certificate program are required to complete the Before You Begin: New Educator preservice training prior to having contact with children. This training includes standards/expectations for each CCDBG health and safety topic. The expectations for caring for children with special needs include but are not limited to including children with special needs in aspects of interactions and activities (making modifications as needed); evaluating programs to meet the needs of each child (e.g., making modifications to schedules, spaces, assistive technology, etc.); and providing opportunities for inclusive interactions. iv. Any other areas determined necessary to promote child development or to protect children’s health and safety. Describe: N/A.