Last Update October 30, 2008
PURPOSE AND USE OF HEALTH POLICY
This health policy is a description of our health and safety practices.
Our policy was prepared by Kelly Hittle.
Staff will be oriented to our health policy by Kelly Hittle, annually in November.
Our policy is accessible to staff and parents and is located in each building and online on our website, bbecare.com.
Please note: Changes to health policy must be approved by a health professional (as per WAC).
This health policy does not replace these additional policies required by WAC: These policies are found in our Parent Handbook online.
1. Pesticide Policy
2. Bloodborne Pathogen Policy
3. Behavior Policy
4. Disaster Policy
5. Animal Policy and/or Fish Policy
PROCEDURES FOR INJURIES AND MEDICAL EMERGENCIES
1. Child is assessed and appropriate supplies are obtained.
2. If further information is needed, staff trained in first aid refer to the First Aid Guidebooks located in the main First Aid bin in each building.
3. First aid is administered. Non-porous gloves (nitrile, vinyl or latex*) are used if blood is present. If injury/medical emergency is life-threatening, one staff person stays with the injured/ill child and administers appropriate first aid, while another staff person calls 911. If only one staff member is present, person assesses for breathing and circulation, administers CPR for one minute if necessary, and then calls 911.
4. Staff call parent/guardian or designated emergency contact if necessary. For major injuries/medical emergencies, a staff person stays with the injured/ill child until a parent/guardian or emergency contact arrives, including during transport to a hospital.
5. Staff record the injury/medical emergency on accident/incident report which is/are kept on a clipboard in each building.
The report includes:
? date, time, place and cause of the injury/medical emergency (if known),
? treatment provided,
? name(s) of staff providing treatment, and
? persons contacted.
A copy is given to the parent/guardian the same day and a copy is placed in the child?s file. For major injuries/medical emergencies, parent/guardian signs for receipt of the report and a copy is sent to the licensor no later than the day after the incident.
6. An injury is also recorded on the Injury Log, which is located in the registration notembook. The entry will include the child?s name, staff involved, and a brief description of incident. We maintain confidentiality of this document.
7. The child care licensor is called immediately for serious injuries/incidents which require medical attention.
*Please note: Use of latex gloves over time may lead to latex allergy. Latex-free gloves are preferred. If using latex gloves, consider selecting reduced-powder or powder-free low-protein/hypo-allergenic gloves. Hands should always be washed after gloves are removed.
Please see Appendix I: INJURY LOG TEMPLATE.
FIRST AID
At least one staff person with current training in Cardio-Pulmonary Resuscitation (CPR) and First Aid is present with each group or classroom at all times. Training includes: instruction, demonstration of skills, and test or assessment. Documentation of staff training is kept in personnel files.
Our first aid kits are inaccessible to children and located in the white closet in the upper building and on top of the refrigerator in the lower building. Each class has their own mini first aid kit.
First aid kits are identified by a label and medical cross symbol.
Each of our first aid kits contain all of the following:
|
? First aid guide ? Sterile gauze pads (different sizes) ? Small scissors ? Adhesive tape |
? Band-Aids (different sizes) ? Roller bandages (gauze) ? Large triangular bandage ? Gloves (nitrile, vinyl, or latex) |
? Tweezers for surface splinters ? Syrup of Ipecac * (unexpired) ? CPR mouth barrier |
*Syrup of Ipecac is administered only after calling Poison Control 1-800-222-1222.
Our first aid kits do not contain medications, medicated wipes, or medical treatments/equipment which would require written permission from parent/guardian or special training to administer.
Travel First Aid Kit(s)
A fully stocked first aid kit is taken on all field trips and playground trips and is kept in each vehicle used to transport children. These travel first aid kits also contain:
|
? Liquid soap and paper towels |
? Water |
? Chemical ice (non-toxic) for injuries |
? Cell phone, walkie-talkies, and/or change for phone calls. |
? Copies of completed ?consent for emergency treatment? & ?emergency contact? forms |
All first aid kits are checked by the director and assistant director and restocked monthly or sooner if necessary. The expiration date for syrup of ipecac is also checked at this time.
Please see Appendix II: FIRST AID KIT CHECKLIST.
BLOOD/BODY FLUID CONTACT OR EXPOSURE
Even healthy people can spread infection through direct contact with body fluids. Body fluids include blood, urine, stool (feces), drool (saliva), vomit, drainage from sores/rashes (pus), etc. All body fluids may be infected with contagious disease. Non-porous gloves are always used when blood or wound drainage is present. To limit risk associated with potentially infectious blood/body fluids, the following precautions are always taken:
1. Any open cuts or sores on children or staff are kept covered.
2. Whenever a child or staff comes into contact with any body fluids, the exposed area is washed immediately with soap and warm water, rinsed, and dried with paper towels.
3. All surfaces in contact with body fluids are cleaned immediately with detergent and water, rinsed, and disinfected with an agent such as bleach in the concentration used for disinfecting body fluids (1/4 cup bleach per gallon of water or 1 tablespoon/quart).
4. Gloves and paper towels or other material used to wipe up body fluids are put in a plastic bag, tied closed, and placed in a covered waste container. Any brushes, brooms, dustpans, mops, etc. used to clean-up body fluids are washed with detergent, rinsed, and soaked in a disinfecting solution for at least 2 minutes and air dried. Machine washable items, such as mop heads, are washed with hot water and detergent in the washing machine. All items are hung off the floor or ground to dry. Equipment used for cleaning is stored safely out of children?s reach in an area ventilated to the outside.
5. A child?s clothes soiled with body fluids are put into a closed plastic bag and sent home with the child?s parent/guardian. A change of clothing is available for children in care, as well as for staff.
6. Hands are always washed after handling soiled laundry or equipment, and after removing gloves.
Blood Contact or Exposure
When a staff person or child comes into contact with blood (e.g. staff provides first aid for a child who is bleeding) or is exposed to blood (e.g. blood from one person enters the cut or mucous membrane of another person), the staff person informs the director immediately.
When staff report blood contact or exposure, we follow current guidelines set by Washington Industrial Safety and Health Act (WISHA), as outlined in our Bloodborne Pathogen Exposure Control Plan (separate document). We review the BBP Exposure Control Plan annually with our staff annually and document this review.
INJURY PREVENTION
1. Proper supervision is maintained at all times, both indoors and outdoors. Staff position themselves to observe the entire play area.
2. The site is inspected constantly) for safety hazards by staff and management. Staff review their rooms daily and remove any broken or damaged equipment.
Hazards include, but are not limited to:
? Security issues (unsecured doors, inadequate supervision, etc.)
? General safety hazards (broken toys & equipment, standing water, chokable & sharp objects, etc.)
? Strangulation hazards
? Trip/fall hazards (rugs, cords, etc.)
? Poisoning hazards (plants, chemicals, etc.)
? Burn hazards (hot coffee in child-accessible areas, unanchored or too-hot crock pots, etc.)
3. The playground is inspected daily for broken equipment, environmental hazards, garbage, animal contamination, and required depth of cushion material under and around equipment by staff and management. It is free from entrapments, entanglements, and protrusions.
4. Toys are age appropriate, safe, and in good repair. Broken toys are discarded. Mirrors are shatterproof.
5. Rooms with children under 3 years old are free of push pins, thumbtacks, and staples.
6. Cords from window blinds/treatments are inaccessible to children and have been replaced with curtains.
7. Hazards are reported immediately to management. The assigned person will insure that they are removed, made inaccessible or repaired immediately to prevent injury.
8. The Injury Log is monitored by the director quarterly to identify accident trends and implement a plan of correction.
We routinely get updates on recalled items and other safety hazards on the Consumer Products Safety Commission website: http://www.cpsc.gov
POLICY AND PROCEDURE FOR EXCLUDING ILL CHILDREN
Children with any of the following symptoms are not permitted to remain in care:
1. Fever of at least 100 ? F as read under arm (axillary temp.) accompanied by one or more of the following:
? diarrhea or vomiting
? earache
? headache
? signs of irritability or confusion
? sore throat
? rash
? fatigue that limits participation in daily activities
? general fussiness
Children must be fever free without fever reducing medication for 24 hours before returning to school.
No rectal or ear temperatures are taken. Digital thermometers are used.
(Oral temperatures may be taken for preschool through school age children if single use covers are used over the thermometer. Glass thermometers contain mercury, a toxic substance, and are therefore should not be used. Temperature strips should not be used because they are frequently inaccurate.)
2. Vomiting: 2 or more occasions within the past 24 hours.
3. Diarrhea: 3 or more watery stools within the past 24 hours or any bloody stool.
4. Rash, especially with fever or itching.
5. Eye discharge or conjunctivitis (pinkeye) until clear or until 24 hours of antibiotic treatment.
6. Sick appearance, not feeling well, and/or not able to keep up with program activities.
7. Open or oozing sores, unless properly covered and 24 hours has passed since starting antibiotic treatment, if antibiotic treatment is necessary.
8. Lice or scabies:
Head lice: until no nits are present.
Scabies: until after treatment is begun.
Following exclusion, children are readmitted to the program when they no longer have any of the above symptoms and/or Public Health exclusion guidelines for child care are met.
Children with any of the above symptoms/conditions are separated from the group and cared for away from other children. Parent/guardian or emergency contact is notified to pick up child.
We notify parents and guardians when their children may have been exposed to a communicable disease or condition (other than the common cold) and provide them with information about that disease or condition. We notify parents and guardians of possible exposure by letter posted on sign in/out clipboards. Individual child confidentiality is maintained.
In order to keep track of contagious illnesses (other than the common cold), an Illness Log is kept. Each entry includes the child?s name, classroom, and type of illness. This is located attendance clipboard. We maintain confidentiality of this log.
Please see
Appendix III: ILLNESS LOG
TEMPLATE.
Fact sheets and sample letters are available from your public health nurse consultant and are also online at www.metrokc.gov/health/childcare (listed in ?Model Policies and Forms?).
Staff members follow the same exclusion criteria as children.
COMMUNICABLE DISEASE REPORTING
Communicable diseases can spread quickly in childcare settings. Because some of these diseases can be very serious in children, licensed childcare providers in Washington are required to notify Public Health when they learn that a child has been diagnosed with one of the communicable diseases listed below (WAC 246-101-415[1]). In addition, providers should also notify their Public Health Nurse when an unusual number of children and/or staff are ill (for example, >10% of children in a center, or most of the children in the toddler room), even if the disease is not on this list or has not yet been identified.
IMMUNIZATIONS
To protect all children and staff, each child in our center has a completed and signed Certificate of Immunization Status (CIS) on site. The official CIS form or a copy of both sides of that form is used. Other forms/printouts are not accepted in place of the CIS form. The CIS form is returned to parent/guardian when the child leaves the program.
Immunization records are reviewed quarterly by the director.
Children are required to be immunized for the following:
DTaP (Diphtheria, Tetanus, Pertussis)
IPV (Polio)
MMR (Measles, Mumps, Rubella)
Hepatitis B
HIB (Hemophilus Influenza Type B)
Varicella (Chicken Pox)
Children may attend child care without an immunization:
? when the parent signs the back of the CIS form stating they have personal, religious or philosophical reasons for not obtaining the immunization(s)
OR
? the health care provider signs that the child is medically exempted.
A current list of exempted children is maintained at all times.
Children who are not immunized may not be accepted for care during an outbreak of a vaccine-preventable disease. This is for the protection of the unimmunized child and to reduce the spread of the disease. This determination will be made by Public Health?s Communicable Disease and Epidemiology division.
Current immunization information and schedules are available at http://www.doh.wa.gov/cfh/Immunize/schools/
MEDICATION POLICY
?span style="font:7.0pt "Times New Roman""> Medication is accepted only in its original container, labeled with child?s name.
?span style="font:7.0pt "Times New Roman""> Medication is not accepted if it is expired.
?span style="font:7.0pt "Times New Roman""> Medication is given only with prior written consent of a child?s parent/legal guardian. This consent on the medication authorization form includes all of the following (completed by parent/guardian):
? child?s name,
? name of the medication,
? reason for the medication,
? dosage,
? method of administration,
? frequency (cannot be given ?as needed?; consent must specify time at which and/or symptoms for which medication should be given),
? duration (start and stop dates),
? special storage requirements,
? any possible side effects (from package insert or pharmacist's written information), and
? any special instructions.
Parent /Guardian Consent*
1. A parent/legal guardian may provide the sole consent for a medication, (without the consent of a health care provider), if and only if the medication meets all of the following criteria:
a. The medication is over-the-counter and is one of the following:
? Antihistamine
? Non-aspirin fever reducer/pain reliever
? Non-narcotic cough suppressant
? Decongestant
? Ointment or lotion intended specifically to relieve itching or dry skin
? Diaper ointment or non-talc powder intended for use in diaper area
? Sunscreen for children over 6 months of age; and
b. The medication has instructions and dosage recommendations for the child?s age and weight; and
c. The medication duration, dosage, amount, and frequency specified on consent do not exceed label recommendations.
2. Written consent for medications covers only the course of illness or specific episode (of teething, etc.).
3. Written consent for sunscreen is valid up to 6 months.
4. Written consent for diaper ointment is valid up to 6 months.
Please note: As with all medications, label directions must be followed. Most diaper ointment labels indicate that rashes that are not resolved, or reoccur, within 5-7 days should be evaluated by a health care provider.
*Medication Authorization forms are available at www.metrokc.gov/health/childcare
Health Care Provider Consent
The written consent of a health care provider with prescriptive authority is required for prescription medications and all over-the-counter medications that do not meet the above criteria (including vitamins, iron, supplements, oral re-hydration solutions, fluoride, herbal remedies, and teething gels and tablets).
Medication is added to a child?s food or liquid only with the written consent of health care provider.
A licensed health care provider?s consent is accepted in one of 3 ways:
?span style="font:7.0pt "Times New Roman""> The provider?s name is on the original pharmacist?s label (along with the child?s name, name of the medication, dosage, frequency [cannot be given ?as needed?], duration, and expiration date); or
?span style="font:7.0pt "Times New Roman""> The provider signs a note or prescription that includes the information required on the pharmacist?s label; or
?span style="font:7.0pt "Times New Roman""> The provider signs a completed medication authorization form.
Parent/guardian instructions are required to be consistent with any prescription or instructions from health care provider.
Medication Storage
1. Medication is stored: Baby Room: in bottle bins and in other classes it is store in a area that is inaccessible to children.
It is:
? Inaccessible to children
? Separate from staff medication
? Protected from sources of contamination
? Away from heat, light, and sources of moisture
? At temperature specified on the label (i.e., at room temperature or refrigerated)
? So that internal (oral) and external (topical) medications are separated
? Separate from food
? In a sanitary and orderly manner
2. Rescue medication (e.g., EpiPen? or inhaler) is stored: Upper building: Taped at the top of the white storage cabinet, Lower Building: Taped to the top of the refrigerator.
(Location of rescue medications should be consistent in all classrooms.)
3. Controlled substances (e.g., ADHD medication) are stored in a locked container in the office or a locked cabinet. Controlled substances are counted and tracked with a controlled substance form.
Please see Appendix IV: CONTROLLED SUBSTANCES RECORD.
Medications no longer being used are promptly returned to parents/guardians, discarded in trash inaccessible to children, or in accordance with current hazardous waste recommendations. (Medications are not disposed of in sink or toilet.)
Staff medication is stored locking cabinet, out of reach of children. Staff medication is clearly labeled as such.
Emergency supply of critical medications
For children?s critical medications, including those taken at home, we ask for a 3-day supply to be stored on site along with our disaster supplies. Staff are also encouraged to supply the same. Critical medications ? to be used only in an emergency when a child has not been picked up by a parent, guardian, or emergency contact ? are stored locked cabinet.
Medication is kept current (not expired).
Staff Administration and Documentation
1. Medication is administered by child?s teacher.
2. Staff members who administer medication to children are trained in medication procedure and center policy by the director. A record of the training is kept in staff files.
3. The parent/guardian of each child requiring medication involving special procedures (e.g., nebulizer, inhaler, EpiPen?) trains staff on those procedures. A record of trained staff is maintained on/with the medication authorization form.
4. Staff giving medication document the time, date, and dosage of the medication given on the child?s medication authorization form. Each staff member signs her/his initials each time a medication is given and her/his full signature once at the bottom of the page.
5. Any observed side effects are documented by staff on the child?s medication authorization form and reported to parent/guardian. Notification is documented.
6. If a medication is not given, a written explanation is provided on authorization form.
7. Outdated medication authorization forms are promptly removed from medication binder/clipboard and placed in child?s file.
8. All information related to medication authorization and documentation is considered confidential and is stored out of general view.
Medication Administration Procedure
The following procedure is followed each time a medication is administered:
1. Wash hands before preparing medications.
2. Carefully read all relevant instructions, including labels on medications, noting:
? child?s name,
? name of the medication,
? reason for the medication,
? dosage,
? method of administration,
? frequency,
? duration (start and stop dates),
? any possible side effects, and
? any special instructions
Information on the label must be consistent with the individual medication form.
3. Prepare medication on a clean surface away from diapering or toileting areas.
? Do not add medication to child?s bottle/cup or food without health care provider?s written consent.
? For liquid medications, use clean medication spoons, syringes, droppers, or medicine cups with measurements provided by the parent/guardian (not table service spoons).
? For capsules/pills, measure medication into a paper cup.
? For bulk medication*, dispense in a sanitary manner.
4. Administer medication.
5. Wash hands after administering medication.
6. Observe the child for side effects of medication and document on the child?s medication authorization form.
*We use the following bulk medication:
□ diaper ointment
□ sunscreen
A medication authorization form is completed for each child receiving bulk medication.
Self-Administration by Child
A school-aged child is allowed to administer his/her own medication when the above requirements are met and:
1. A written statement from the child's health care provider and parent/legal guardian is obtained, indicating the child is capable of self-medication without assistance.
2. The child's medications and supplies are inaccessible to other children.
3. Staff supervise and document each self-administration.
HEALTH RECORDS
Each child?s health record will contain:
? health, developmental, nutrition, and dental histories
? date of last physical exam
? name and phone number of health care provider and dentist
? allergy information and food intolerances
? individualized care plan for child with special health care needs (medical, physical, developmental or behavioral)
Note: In order to provide consistent, appropriate, and safe care, a copy of the plan should also available in child?s classroom.
? list of current medications
? current immunization records (CIS form)
? consent for emergency care
? preferred hospital
? any assistive devices used (e.g., glasses, hearing aids, braces)
The above information will be updated annually or sooner for any changes.
CHILDREN WITH SPECIAL NEEDS
Our center is committed to meeting the needs of all children. This includes children with special health care needs such as asthma and allergies, as well as children with emotional or behavior issues or chronic illness and disability. Inclusion of children with special needs enriches the child care experience and all staff, families, and children benefit.
1. Confidentiality is assured with all families and staff in our program.
2. All families will be treated with dignity and with respect for their individual needs and/or differences.
3. Children with special needs will be accepted into our program under the guidelines of the Americans with Disabilities Act (ADA).
4. Children with special needs will be given the opportunity to participate in the program to the fullest extent possible. To accomplish this, we may consult with our public health nurse consultant and other agencies/organizations as needed.
5. An individual plan of care is developed for each child with a special health care need. The plan of care includes information and instructions for
? daily care
? potential emergency situations
? care during and after a disaster
Completed plans are requested from health care provider yearly or more often as needed for changes. Plans are reviewed, initialed, and dated quarterly by parent/guardian. The director and assistant director is responsible for ensuring care plans are kept updated. Children with special needs are not present without plan on site.
6. All staff receive general training on working with children with special needs and updated training on specific special needs that are encountered in their classrooms.
7. Teachers, cooks, and other staff will be oriented to any special needs or diet restrictions by director and parent.
Please see Appendix V: CARE PLAN TRACKING FORM. For individual plan templates or assistance with individual plans, please contact your Public Health Nurse Consultant.
HANDWASHING
Soap, warm water (between 85? and 120? F), and individual towels are available for staff and children at all sinks, at all times.
All staff wash hands with soap and water:
(a) Upon arrival at the site and when leaving at the end of the day
(b) Before and after handling foods, cooking activities, eating or serving food
(c) After toileting self or children
(d) Before, during (with wet wipe - this step only), and after diaper changing
(e) After handling or coming in contact with body fluids such as mucus, blood, saliva, or urine
(f) Before and after giving medication
(g) After attending to an ill child
(h) After smoking
(i) After being outdoors
(j) After feeding, cleaning, or touching pets/animals
(k) After giving first aid
Children are assisted or supervised in handwashing:
(a) Upon arrival at the site and when leaving at the end of the day
(b) Before and after meals and snacks or cooking activities (in handwashing, not in food prep sink)
(c) After toileting or diapering
(d) After handling or coming in contact with body fluids such as mucus, blood, saliva or urine
(e) After outdoor play
(f) After touching animals
(g) Before and after water table play
Handwashing Procedure
The following handwashing procedure is followed:
1. Turn on water and adjust temperature.
2. Wet hands and apply a liberal amount of soap.
3. Rub hands in a wringing motion from wrists to fingertips for a period of not less than 20 seconds.
4. Rinse hands thoroughly.
5. Dry hands using an individual paper towel.
6. Use hand-drying towel to turn off water faucet(s) and open any door knob/latch before discarding.
7. Apply lotion, if desired, to protect the integrity of skin.
Handwashing procedures are posted at each sink used for handwashing.
CLEANING, SANITIZING/DISINFECTING, AND LAUNDERING
Cleaning, rinsing, and sanitizing/disinfecting are required on most surfaces in child care facilities, including tables, counters, toys, diaper changing areas, etc. This 3-step method helps maintain a more sanitary child care environment and healthier children and staff.
1. Cleaning removes a large portion of germs, along with organic materials - food, saliva, dirt, etc. ? which decrease the effectiveness of sanitizers/disinfectants.
2. Rinsing further removes the above, along with any excess detergent/soap.
3. Sanitizing/disinfecting kills the vast majority of remaining germs.
Storage
Our cleaning and sanitizing/disinfecting supplies are stored in a safe manner
Area that are kept inaccessible to children.
All such chemicals are:
? inaccessible to children,
? in their original container,
? separate from food and food areas,
? in a place which is ventilated to the outside,
? kept apart from other incompatible chemicals
(e.g., bleach and ammonia create a toxic gas when mixed), and
? in a secured cabinet, to avoid a potential chemical spill in an earthquake
Cleaning
We use the following product for cleaning surfaces soapy water
then wipe surface with a wet paper towel or rinsing rag.
Rinsing
We use the following method for rinsing clean we rag.
Sanitizing/Disinfecting
We use the following product for sanitizing/disinfecting surfaces bleach and water solutions as required, then wipe surface with a clean rag.
Cleaning and sanitizing spray bottles for diaper changing areas are prepared in the large sink areas.
Bleach solutions* are prepared and used as outlined below:
|
Body fluids (BF) solution for disinfecting: |
Amount of Bleach |
Amount of Water |
Contact Time |
|
Diapering areas, body fluids, bathrooms and bathroom equipment. |
1 tablespoon ? cup |
1 quart 1 gallon |
2 minutes |
|
General purpose (GP) solution for sanitizing: |
Amount of Bleach |
Amount of Water |
Contact Time |
|
Table tops, counters, toys, dishes, mats, etc. |
? teaspoon 1 teaspoon |
1 quart 1 gallon |
2 minutes |
? Bleach solution is applied to surfaces that have been cleaned and sanitized.
? Bleach solution is allowed to remain on surface for at least 2 minutes or air dry.
? Bleach solutions are made up daily by opening staff members using measuring equipment. For those handling full-strength bleach, we supply protective gear, including gloves and eye protection, as per manufacturer?s instructions.
* Please see Appendix VI: ALTERNATE CLEANING/SANITIZING/DISINFECTING CHEMICALS if other chemicals are used for cleaning/sanitizing/disinfecting.
Cleaning and Sanitizing/Disinfecting Specific Areas and Items
We do all of our own cleaning.
[?BF? and ?GP? indicate which bleach solution is used.]
Bathrooms
? Sinks and counters are cleaned, rinsed, and sanitized (BF) daily or more often if necessary.
? Toilets are cleaned, rinsed, and disinfected (BF) daily or more often if necessary. Toilet seats are monitored and kept sanitary throughout the day.
Cribs, cots, and mats
Door handles
Drinking Fountains
Floors
Furniture
Garbage
(Diaper and food-waste cans must have tight-fitting lids and be hands-free. Garbage cans for paper towels must be hands-free; that is, lid-free or with a pedal-operated lid.)
Infant equipment
? Infant saucers, seats, and swings are cleaned and sanitized (GP) and laundered (as appropriate) weekly and as needed.
Kitchen*
? Kitchen counters and sinks are cleaned, rinsed, and sanitized (GP) every day before and after preparing food.
? Equipment (such as blenders, can openers, and cutting boards) is washed, rinsed, and sanitized (GP) after each use.
*For more details, please see the handbook ?Food Safety and Sanitation? from the Child Care Health Program, Public Health - Seattle & King County.
Laundry
? Cloths used for cleaning or rinsing are laundered after each use.
? Bibs and burp cloths are laundered when wet or soiled and between uses by different children.
Child care laundry is done on site.
Laundry is washed at a temperature of at least 140?F or with bleach added during rinse cycle (measured amount as per manufacturer?s instructions).
Mops
? Mops are cleaned, rinsed, and sanitized (GP/BF) in a utility sink, then air dried in an area with ventilation to the outside and inaccessible to children.
Tables and high chairs
? Tables and high chair trays are cleaned, rinsed, and sanitized (GP) before and after snacks or meals.
? High chairs are cleaned, rinsed, and sanitized (GP) daily and as necessary.
Toys
Water Tables
Other: ______________________________________________________ __________
___________________________________________________________________________________.
General cleaning of the entire facility is done as needed.
There are no strong odors of cleaning products in our facility.
SOCIAL-EMOTIONAL-DEVELOPMENTAL CARE
We have a developmentally-appropriate curriculum in each classroom. We consider the social-emotional needs of each age group. Our behavior policy outlines our discipline practices and our plan for helping children who have behavioral difficulties.
INFANT CARE
Program and Environment
1. Infants are at least one month of age when enrolled.
2. The infant room is street-shoe-free to reduce infant exposure to dirt, germs, dangerous heavy metals, chemicals, and pesticides. All staff and other adults entering the room wear socks, slippers, inside-only shoes, or shoe covers over their street shoes.
3. The infant room has areas where all infants can be safely placed on the floor at any given time. (Mats are recommended because they are easy to clean and disinfect when soiled. Blankets may be placed on the floor if they are used only for that purpose and are changed when soiled with vomit or other body fluids.)
4. All infants spend time on the floor ? including on their ?tummies? ? each day. (Floor time ? especially tummy time ? encourages brain and muscle development.)
5. Infants do not spend more than 20 minutes per day in swings, infant seats or saucers. Saucers are used only with infants who are developmentally ready and are adjusted so that infant?s feet are in contact with the bottom surface of the equipment at all times.
6. A nurse consultant visits the infant room monthly. The nurse consultant is a Registered Nurse, currently licensed, with training and/or experience in Pediatric Nursing or Public Health.
Sleep/Napping
1. Each infant is allowed to follow his/her individual sleep pattern. Infant providers look for and respond to cues as to when an infant is sleepy.
2. Infants are visible to providers at all times while asleep. Rooms are kept light enough to allow easy observation of sleeping infants.
3. Infants are placed to sleep on their backs in a crib or on a cot or mat. (Infants sleeping on their stomachs are at a higher risk of death from S.I.D.S. - Sudden Infant Death Syndrome.)
4. Cribs meet current safety requirements, including:
5. Crib sheets fit mattresses snugly, but do not cause mattresses to curl up at corners.
6. Cribs do not contain bumper pads, pillows, soft toys, cushions or thick blankets. If a blanket is used on a sleeping infant, it is:
(Overheating during sleep is associated with an increased risk of S.I.D.S.)
7. Infants do not sleep in car seats, swings or infant seats. Any child who arrives at the center asleep in a car seat, or who falls asleep in a swing or infant seat, is immediately moved to a crib, cot, or mat. (Sleeping in infant seats or swings makes it harder for infants to breathe fully and may lead to head and neck issues.)
8. Any alternate sleep position must be specified in writing by the parent/guardian and the child?s health care provider.
9. Cribs are spaced at least 30 inches apart or separated by Plexiglas barrier.
10. Cribs are not located next to windows unless windows are constructed of safety glass.
11. Nothing is stored above cribs unless securely attached to wall.
12. Crib wheels are locked in order to prevent movement in an earthquake.
Evacuation Cribs
1. Evacuation cribs are available for all infants (max. 4 infants per crib).
2. Evacuation cribs have:
3. A clear pathway is kept between evacuation cribs and emergency exits at all times.
4. Nothing is stored below or around evacuation cribs that would block immediate exit of cribs.
INFANT BOTTLE FEEDING
?/span> Infants are fed breastmilk or iron-fortified infant formula until they are one year old.
?/span> Written permission from the child?s licensed health care provider is required if an infant is to be fed an electrolyte solution (e.g., Pedialyte?) or a special diet formula.
?/span> No medication, cereal, supplements, or sweeteners are added to breastmilk or formula without written permission from the child?s licensed health care provider.
?/span> Bottles contain formula or breastmilk. Juice, if offered, is served only in a cup.
?/span> Cups of water, formula or breastmilk are introduced around 6 months of age.
Storage
1. All bottles are labeled with infant?s full name and date.
2. Filled bottles are capped and refrigerated upon arrival or after being mixed, unless being fed to an infant immediately.
2. Bottles are stored in the coldest part of the refrigerator, not in the refrigerator door.
3. A thermometer is kept in the warmest part of the refrigerator (usually the door) and is at or below 41? F at all times. (It is recommended that the refrigerator be adjusted between 30? and 35? to allow for a slight rise when opening and closing the door.)
4. Frozen breastmilk is stored at 10? F or less and for no longer than 2 weeks. Containers of breastmilk are labeled with the child?s full name and date. Unused, thawed breastmilk is returned to the family at the end of the day.
Bottle Preparation
We prepare bottles on site:
? A minimum of eight feet is maintained between the food preparation area and the diapering area. (If this is not possible, a moisture-proof, transparent 24-inch high barrier ? such as Plexiglas - must be installed.)
? Preparation surfaces are cleaned, rinsed, and sanitized before bottles are prepared.
? Staff wash hands in the handwashing sink before preparing bottles. The food preparation sink is not used for handwashing or general cleaning.
? Frozen breastmilk is thawed in the refrigerator or in warm water (water under 120? F) and then warmed as needed before feeding. Thawed breastmilk is not refrozen.
? Bottles of formula are prepared with cold water from the following clean source.
Water from a handwashing sink is not used for bottle preparation.
(Hot tap water can be contaminated with lead. Only cold water should be taken from the tap for cooking or drinking.)
? Formula cans are dated when opened and used within 30 days.
? Formula is mixed as directed on the can and not used past expiration date.
? Gloves are worn when scooping powdered formula from a can. Gloves used for food preparation are kept in food preparation area.
? Bottles are labeled with infant?s full name and date. Bottles are capped and refrigerated if not immediately used. Bottle nipples are covered at all times, except during feeding, to reduce the risk of contamination and exposure.
Bottle Warming
1. Bottles are not warmed in a microwave.
2. Bottles are warmed using the following method:
We use a crock pot (not recommended), and
? Water temperature in crock pot is monitored and kept below 120?F.
? Crock pot contains no more than 1 1/2 inches of water.
? Crock pot is secured to the counter or wall.
? Crock pot is cleaned, rinsed, and sanitized daily.
□ Other: Crock pot is kept on the low setting and the lid is off. Crock pot temperature is monitored several times a day to insure proper temperature.
3. Bottles are warmed no longer than 5 minutes.
4. Temperature is checked before bottle is fed to infant (wrist method).
Bottle Feeding
1. Infants are fed on demand. Staff watch for and respond appropriately to hunger cues such as:
▪ fussiness/crying ▪ opening mouth as if searching for a bottle/breast
▪ hands to mouth and turning to caregiver ▪hands clenched
2. Bottles are labeled with time feeding begins.
3. The name on each bottle is checked before the bottle is offered to an infant.
4. During bottle feeding, infants are held by a caregiver who makes eye contact with the infant and talks to and touches the infant in a nurturing way. Bottles are not propped.
5. Older infants who can sit and hold a bottle independently are either held or placed in a high chair or chair that allows the feet to touch the floor at an appropriately-sized table.
6. Infants are not allowed to walk around with bottles and are never given a bottle while lying down or in a crib. (Lying down with a bottle puts a baby at risk for baby bottle tooth decay, ear infections, and choking.)
7. Staff watch for and respond appropriately to fullness cues such as:
▪falling asleep ▪decreased sucking ▪arms and hands relaxed
▪pulling or pushing away
8. Unconsumed bottles are dumped into a sink after 1 hour to prevent bacterial growth.
Bottle Cleaning
Used bottles and dishes are not stored within eight feet of the diapering area or placed in the diapering sink.
□ Bottles are not re-used at our center. Families provide a sufficient number of bottles to meet the daily needs of the infant.
If we need to re-use bottles during the day, bottles, bottle caps, and nipples are placed in a tub for dirty dishes (or directly into dishwasher), then
□ Washed in dishwasher.
INFANT AND TODDLER SOLID FOODS
1. Food is introduced to infants when they are developmentally ready for pureed, semi-solid and solid foods. Food, other than formula or breastmilk, is not given to infants younger than 4 months of age, unless there is a written order by a health care provider.
2. No egg whites (allergy risk) or honey (botulism risk) is given to children less than 12 months of age. (This includes other foods containing these ingredients such as honey graham crackers.)
3. Cups and spoons are encouraged at mealtime by 9 months of age.
4. Chopped, soft table foods are encouraged after 10 months of age.
5. Children 12-23 months are given whole milk, unless the child?s parent/guardian and health care provider have requested low-fat milk or a non-dairy milk substitute in writing. (Low-fat diets for children under age 2 may affect brain development.)
6. When parents provide food from home, it is labeled with the child?s name and the date. Perishable foods are stored at or below 41? F.
7. Before food is prepared, preparation surfaces are cleaned, rinsed, and sanitized.
8. Staff wash hands in the handwashing sink before preparing food. The food preparation sink is not used for handwashing or general cleaning.
9. Staff serve commercially packaged baby food from a dish, not from the container. Foods from opened containers are discarded or sent home at the end of the day.
10. Gloves are worn or utensils are used for direct contact with food. (No bare hand contact with ready-to-eat food is allowed.) Gloves used for food preparation are kept in food preparation area.
11. Children eat from plates and utensils. Food is not placed directly on table.
12. Children are not allowed to walk around with food or cups.
13. Teachers sit with infants and young children when eating and engage in positive social interaction.
For allergies or special diets, see the NUTRITION section of this policy.
TODDLER NAPPING
Children 29 months of age or younger follow their individual sleep patterns. Alternate quiet activities are provided for a child who is not napping (while others are doing so).
Rooms are kept light enough to allow for easy observation of sleeping children.
DIAPERING
We use disposable diapers at our center.
Children are never left unattended on the diaper-changing table. Safety belts are not used on the diaper changing table. (They are neither washable nor safe.)
The diaper changing table is used only for diapering. Toys, pacifiers, papers, dishes, blankets, etc., are not placed on diapering surface.
Diaper changing pads are replaced when they become torn/ripped. No tape is present on diaper changing pad.
The following diapering procedure (also available on WA Department of Health poster) is posted and followed at our center:
1. Wash Hands.
2. Gather necessary materials. If using bulk diaper ointment, put a dab of ointment on paper towel.
3. Put on disposable gloves, if desired.
4. Place child gently on table and remove diaper. Do not leave child unattended.
5. Dispose of diaper in hands-free container with cover (foot pedal type).
6. Clean the child?s diaper (peri-anal) area from front to back, using a clean, damp wipe for each stroke.
7. Wash hands. If wearing gloves, remove gloves and wash hands. Please note: A wet wipe or damp paper towel may be used for this handwashing only. Do not leave child unattended.
8. If parent/guardian has completed a medication authorization for diaper cream/ointment/lotion, put on gloves and apply to area. (Please refer to the Medication section.) Remove gloves.
9. Put on clean diaper (and protective cover, if cloth diaper used). Dress child.
10. Wash child?s hands with soap and running water (or with a wet wipe for young infants).
11. Place child in a safe place.
12. Clean diaper changing pad with detergent and water, rinse, and then disinfect with bleach solution (1 tablespoon bleach in 1 quart water). Allow the bleach solution to air dry or to remain on the surface for at least 2 minutes before drying with a paper towel.
13. Wash Hands.
Please note: Even if gloves are used, all of the above handwashing must still be done.
Stand-Up Diapering for Older Children
We do stand up diapering as appropriate.
Stand-up diaper changing takes place in the classroom bathroom.
Diaper changing procedure is posted in stand-up diaper changing area. Stand-up diaper changing procedure is followed:
1. Wash hands.
2. Gather necessary supplies (diaper/pull-up/underpants, wipes, cleaner and sanitizer, paper towels, gloves, plastic bag).
3. Put on disposable gloves, if desired.
4. Coach child in pulling down pants and removing diaper/pull-up/underpants (and assist as needed).
5. Put soiled diaper/pull-up/underpants in plastic bag (or assist child in doing so).
6. Coach child in cleaning diaper area front to back using a clean, damp wipe for each stroke (and assist as needed).
7. Put soiled wipes in plastic bag (or assist child in doing so).
8. Close and dispose of plastic bag into hands-free covered trash can lined with a plastic garbage bag.
9. Remove gloves, if worn.
10. Wash hands (in sink or with wipe) and coach child in doing the same.
11. If a signed medication authorization indicates, apply topical cream/ointment/lotion using disposable gloves then remove gloves.
12. Coach child in putting on clean diaper/pull-up/underpants and clothing and washing hands (in bathroom/handwashing sink).
13. Close and put any bag of soiled clothing or underpants into child?s cubby.
14. Use 3-step method on floor where change has occurred:
a. Clean with detergent and water.
b. Rinse with water.
c. Disinfect with bleach solution (1 T. bleach in 1 quart water). Allow the bleach solution to air dry or to remain on the surface for at least 2 minutes before drying with a paper towel.
15. Wash hands (in bathroom/handwashing sink).
FOOD SERVICE
We prepare meals and snacks at our center.
1. Food handler permits are required for staff who prepare full meals and are encouraged for all staff. An ?in charge? person with a food handler permit is onsite during all hours of operation, to assure that all food safety steps are followed.
2. Orientation and training in safe food handling is given to all staff. Documentation is located in staff files.
3. Ill staff or children do not prepare or handle food. Food workers may not work with food if they have:
? diarrhea, vomiting or jaundice
? diagnosed infections that can be spread through food such as Salmonella, Shigella, E. coli or hepatitis A
? infected, uncovered wounds
? continual sneezing, coughing or runny nose
4. Child care cooks do not change diapers or clean toilets.
5. Staff wash hands with soap and warm running water prior to food preparation and service in a designated hand-washing sink ? never in a food preparation sink.
6. Gloves are worn or utensils are used for direct contact with food. (No bare hand contact with ready-to-eat food is allowed.) Gloves must also be worn if the food preparation person is wearing fingernail polish or has artificial nails. We highly recommend that food service staff keep fingernails trimmed to a short length for easy cleaning. (Long fingernails are known to harbor bacteria).
7. Employees preparing food shall keep their hair out of food by using some method of restraining hair. Hair restraints include hairnets, hats, barrettes, ponytail holders and tight braids.
8. Refrigerators and freezers have thermometers placed in the warmest section (usually the door). Thermometers stay at or below 41? F in the refrigerator and 10?F in the freezer.
9. Microwave ovens, if used to reheat food, are used with special care. Food is heated to 165 degrees, stirred during heating, and allowed to cool at least 2 minutes before serving. Due to the additional staff time required, and potential for burns from ?hot spots,? use of microwave ovens is not recommended.
10. Chemicals and cleaning supplies are stored away from food and food preparation areas.
11. Cleaning and sanitizing of the kitchen is done according to the Cleaning, Disinfecting and Laundering section of this policy.
12. Dishwashing complies with safety practices:
? Hand dishwashing is done with three sinks or basins (wash, rinse, sanitize).
? Dishwashers have a high temperature sanitizing rinse (140? F residential or 160?F commercial) or chemical disinfectant.
13. Cutting boards are washed, rinsed, and sanitized between each use. No wooden cutting boards are used.
14. Food prep sink is not used for general purposes or post-toilet/post-diapering handwashing.
15. Kitchen counters, sinks, and faucets are washed, rinsed, and sanitized before food production.
16. Tabletops where children eat are washed, rinsed, and sanitized before and after every meal and snack.
17. Thawing frozen food: frozen food is thawed in the refrigerator 1-2 days before the food is on the menu, or under cold running water. Food may be thawed during the cooking process IF the item weighs less than 3 pounds. If cooking frozen foods, plan for the extra time needed to cook the food to the proper temperature. Microwave ovens cannot be used for cooking meats, but may be used to cook vegetables.
18. Food is cooked to the correct internal temperature:
|
Ground Beef 155? F Pork 145? F |
Fish 145? F Poultry 165? F |
19. Holding hot food: hot food is held at 140? F or above until served.
20. Holding cold food: food requiring refrigeration is held at 41?F or less.
21. A digital thermometer is used to test the temperature of foods as indicated above, and to ensure foods are served to children at a safe temperature.
22. Cooling foods is done by one of the following methods:
? Shallow Pan Method: Place food in shallow containers (metal pans are best) 2? deep or less, on the top shelf of the refrigerator. Leave uncovered and then either put the pan into the refrigerator immediately or into an ice bath or freezer (stirring occasionally).
? Size Reduction Method: Cut cooked meat into pieces no more than 4 inches thick.
Foods are covered once they have cooled to a temperature of 41? F or less.
23. Leftover foods (foods that have been below 41? F or above 140? F and have not been served) are cooled, covered, dated, and stored in the refrigerator or freezer. Leftover food is refrigerated immediately and is not allowed to cool on the counter.
24. Reheating foods: foods are reheated to at least 165? F in 30 minutes or less.
25. □ We do not use catered foods at our center.
26. Food substitutions, due to allergies or special diets and authorized by a licensed health care provider, are provided within reason by the center.
27. When children are involved in cooking projects our center assures safety by:
? closely supervising children,
? ensuring all children and staff involved wash hands thoroughly,
? planning developmentally-appropriate cooking activities (e.g., no sharp knives),
? following all food safety guidelines.
28. Perishable items in sack lunches are refrigerated upon arrival at the center.
NUTRITION
1. Menus are posted at least one week in advance. Menus are dated and include portion sizes.
2. Food is offered at intervals not less than 2 hours and not more than 3 ? hours apart.
Our site is open over 9 hours; we provide breakfast, lunch and 3 snacks
The following meals and snacks are served by the center:
Time Meal/Snack
6:30am to 8:00am Breakfast
10:00am Mid-morning snack
12:00pm Lunch
3:30pm Afternoon Snack
5:30pm Late night snack to go?
3. Each snack or meal includes a liquid to drink. This drink is water or one of the required components such as milk or 100% fruit juice.
4. Menus include hot and cold food and vary in colors, flavors and textures.
5. Ethnic and cultural foods are incorporated into the menu.
6. Menus list specific types of meats, fruits, vegetables, etc.
7. Menus include a variety of fruits, vegetables, and entr? items.
8. Foods served are generally moderate in fat, sugar, and salt content.
9. Children have free access to drinking water (individual disposable cups or single use glasses only).
10. Menu modifications are planned and written for children needing special diets.
11. Menus are followed. Necessary substitutions are noted on the permanent menu copy.
12. Permanent menu copies are kept on file for at least six months. (USDA requires food menus to be kept for 3 years plus the current year.)
13. Children with food allergies and medically-required special diets have diet prescriptions signed by a health care provider on file. Names of children and their specific food allergies are posted in the kitchen, the child?s classroom, and the area where food is eaten by the child.
14. Children with severe and/or life threatening food allergies have a completed individual care plan signed by the parent and health care provider.
15. Diet modifications for food allergies, religious and/or cultural beliefs are accommodated and posted in the kitchen and classroom and eating area. All food substitutions are of equal nutrient value and are recorded on the menu or on an attached sheet of paper.
16. Mealtime and snack environments are developmentally appropriate and support children?s development of positive eating and nutritional habits. We encourage staff to sit, eat and have casual conversations with children during mealtimes.
17. Coffee, tea, and other hot beverages are not consumed by staff while children are in their care, in order to prevent scalding injuries.
18. Staff provide healthy nutritional role modeling.
19. Families who provide sack lunches are notified in writing of the food requirements for mealtime.
TOOTHBRUSHING
Toothbrushing decreases the colonization of bacteria on teeth by disrupting the formation of plaque. The use of fluoridated toothpaste strengthens tooth enamel making the enamel more resistant to the acid produced by bacteria. Toothbrushing in the classroom improves the child?s oral health, teaches the child basic hygiene and health promotion, and helps establish a lifelong prevention habit.
Toothbrushing is not done at our center.
DISASTER PREPAREDNESS
Plan and Training
Our Center has developed a disaster preparedness plan/policy. Our plan includes responses to the different disasters our site is vulnerable to, as well as procedures for on- and off-site evacuation and shelter-in-place. Evacuation routes are posted in each classroom. Our disaster preparedness plan/policy is located in the upper building hallway and posted on our website at bbecare.com.
Staff are oriented to our disaster policy annually. Parents/guardians are able to access the plan at any time via our website.
Staff are trained in the use of fire extinguishers annually using a video. The following staff persons are trained in utility control (how to turn off gas, electric, water): management.
Disaster and earthquake preparation and training are documented.
Supplies
Our center has a supply of food and water for children and staff for at least 72 hours, in case parents/guardians are unable to pick up children at usual time. Managment is responsible for stocking supplies. Expiration dates of food, water, and supplies are checked bi-monthly and supplies are rotated accordingly. Essential medications and medical supplies are also kept on hand for individuals needing them.
Hazard Mitigation
We have taken action to make our center earthquake/disaster-safe. Bookshelves, tall furniture, refrigerators, crock pots, and other potential hazards are secured to wall studs. We continuously monitor all rooms and offices for anything that could fall and hurt someone or block an exit ? and take action to correct these things. Management staff are responsible for hazard mitigation, although all staff members are expected to be aware of their environment and make changes as necessary to increase safety.
Drills
Fire drills are conducted and documented each month. Disaster drills are conducted monthly by management.
STAFF HEALTH
1. New staff and volunteers must document a tuberculin skin test (Mantoux method) within the past year, unless not recommended by a licensed health care provider.
2. Staff members who have had a positive tuberculin skin test in the past will always have a positive skin test, despite having undergone treatment. These employees do not need documentation of a skin test. Instead, by the first day of employment, documentation must be on record that the employee has had a negative (normal) chest x-ray and/or completion of treatment.
3. Staff members do not need to be retested for tuberculosis unless they have an exposure. If a staff member converts from a negative test to a positive test during employment, medical follow up will be required and a letter from the health care provider must be on record that indicates the employee has been treated or is undergoing treatment.
4. Our center complies with all recommendations from the local health jurisdiction. (TB is a reportable disease.).
5. Staff members who have a communicable disease are expected to remain at home until no longer contagious. Staff are required to follow the same guidelines outlined in EXCLUSION OF ILL CHILDREN in this policy.
6. Staff members are encouraged to consult with their health care provider regarding their susceptibility to vaccine-preventable diseases.
7. Staff who are pregnant or considering pregnancy are encouraged to inform their health care provider that they work with young children. When working in child care settings there is a risk of acquiring infections which can harm a fetus or newborn. These infections include Chicken Pox (Varicella), CMV (cytomegalovirus), Fifth Disease (Erythema Infectiosum), and Rubella (German measles or 3-day measles), In addition to the infections listed here, other common infections such as influenza and Hand Foot and Mouth disease can be more serious for pregnant women and newborns. Good handwashing, avoiding contact with ill children and adults, and cleaning of contaminated surfaces can help reduce those risks.
Recommendations for adult immunizations are available at http://www.doh.wa.gov/cfh/Immunize/adult_immunization.htm
CHILD ABUSE AND NEGLECT
1. Child care providers are state mandated reporters of child abuse and neglect; we immediately report suspected or witnessed child abuse or neglect to Child Protective Services (CPS). The phone # for CPS is 1-800-609-8764.
2. Signs of child abuse or neglect are documented in a classroom journal which is located in each classroom.
3. Training on identifying and reporting child abuse and neglect is provided to all staff and documentation kept in staff files.
4. Licensor is notified of any CPS report made.
ANIMALS ON SITE
We have animal visitors: regularly
1. We have an animal policy, which is located in the Parent Handbook.
2. Animals at or visiting our center are carefully chosen in regards to care, temperament, health risks, and appropriateness for young children. We do not have birds of the parrot family that may carry psittacosis, a respiratory illness. We do not have reptiles and amphibians that typically carry salmonella, bacteria that can cause serious diarrhea disease in humans, with more severe illness and complications in children.
3. Parents are notified in writing when animals will be on the premises. Children with an allergic response to animals are accommodated.
4. Animals, their cages, and any other animal equipment are never allowed in kitchen or food preparation areas.
5. Children and adults wash hands after feeding animals or touching/handling animals or animal homes or equipment.
[1] WAC 246-101-415 Responsibilities of child day care facilities. Child day care facilities shall: (1) Notify the local health department of cases or suspected cases, or outbreaks and suspected outbreaks of notifiable conditions that may be associated with the child day care facility. (2) Consult with a health care provider or the local health department for information about the control and prevention of infectious or communicable disease, as necessary. (3) Cooperate with public health authorities in the investigation of cases and suspected cases, or outbreaks and suspected outbreaks of disease that may be associated with the child day care facility. (4) Child day care facilities shall establish and implement policies and procedures to maintain confidentiality related to medical information in their possession.