Health and Safety Procedures for Center-Based Services for Children

Physical Space and Equipment

What You Will Learn

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Indoor and Outdoor Space

Indoor and outdoor spaces must be free from:

• Crumbling plaster
• Debris
• Holes in the walls, floors and ceilings
• Litter
• Loose, flaking, peeling or chipped paint and/or wallpaper

Outdoor space must be:

• Enclosed if adjacent to a body of water, railroads, traffic, machinery or other environmental hazards (this does not apply to public parks or playgrounds)
• Free of litter, toxic materials, water hazards, machinery, animal waste and sewage contaminants
• Hazardous areas and objects

The following areas and objects must be inaccessible to people who receive services:

• Bodies of water (e.g., ponds, pools, lakes), unless staff are supervising directly
• Electrical outlets, exposed electrical cords and other electrical objects
• Hazardous objects (e.g., sharp objects, medicines, plastic bags, household supplies, poisonous plants and chemicals)
• Kitchens, stairs and other hazardous areas, unless staff are supervising directly
• Radiators, fireplaces, hot pipes and other hot surfaces

Therapeutic Environment

Maintain a therapeutic environment that has a minimum amount of sensory distration at all times.

• Keep the clinic clean,orderly and clutter-free at all times
• Store all toys and treatment supplies, paper, art supplies, etc. out of site in cabinets and closets
• Teach children how to access toys and supplies and include putting them away when finished in the treatment routine
• Structure the environment to support treatment with defined work/play areas
• Follow a defined schedule so that children develop an expected routine
• Offer, as much as possible, defined spots and spaces for children during group activities, using visual cues to define them
• Create and use cozy and comfortable calming areas, with calming objects in them and encourage children who become overwhelmed to use them
• Incorporate sensory/fidget items for children who need them
• Secure all sharp and dangerous objects (including kitchen knives) in locked cabinets and, where possible, allow access to the kitchen only for supervised skills training.

Helpful Tips

This excellent webpage discusses therapeutic learning environments and provides helpful suggestions for children with autism and ADHD.

Equipment, Furniture and Toys

All equipment, furniture and toys at the provider agency must be:

• cleaned and disinfected daily and when mouthed or soiled,
• durable and structurally stable (following assembly and installation),
• free of sharp edges, dangerous protrusions, openings or angles that could crush or trap part of a child's body,
• stored in locations that are accessible to a child who receives services (unless this is contrary to his or her individual treatment plan),
• lead-free, and
• made of a material that can be cleaned and disinfected easily

Following each visit by a child or children, providers will ensure that toys, materials, dishes, furniture and toileting and other equipment are sanitized.

Floor Coverings

Assure that all floor coverings are firmly fastened without loose edges or tiles that may cause a tripping hazard.

Rugs if used must have a non-skid backing or be firmly fastened to the floor. They must be free from tears, curled or frayed edges, and hazardous wrinkles.

Personal Storage Space

Provide accessible, separate, personal storage space for each child who receives services.

Room Temperature

Set thermostats betwee 68º and 75º degrees.

Emergency Preparedness

Equipment

Have the following equipment on-site

• Battery-operated flashlight
• Battery operated portable radio
• Fire extinguisher and instructions for its use that are accessible to all staff
• First aid kit that contains sterile bandages, sterile compresses, scissors, an ice bag or cold pack, an oral or surface thermometer, and adhesive tape
• First aid kit and manual that is accessible to all staff
• Additional first aid kit and manual to take with people who receive services if they travel off-site
• Landline telephone that is accessible to all staff

Fire and Fire Extinguisher Inspections

All treatment centers will have fire inspections at least every three years, and after significant remodeling (remodeling that includes construction of new rooms, moving or installing doors, windows, or entrances/exits, and electrical or plumbing work.

A qualified inspector must service all fire extinguishers annually. The name of the inspector and date of the inspection must be written on a tag attached to the extinguisher.

Emergency Information

Identify and post the following information on site;

• A list of staff responsible for each area of the facility in case of an emergency
• Evacuation routes from the facility
• Instructions on how to close off a fire
• List of emergency numbers posted next to the telephone for:
1. emergency medical and dental care,
2. local fire department,
3. police department,
4. emergency transportation,
5. state health authority, and
6. poison control center
• Primary and secondary exits from the facility
• Tornado shelter area
• Written emergency and accident procedures

Food and Water Provisions

If we provide food for children, it will meet the following food and water requirements.

Individual Dietary Needs Identified

Document the child’s special dietary needs and the duration of those needs in.. and Inform all staff who provide services to the child of his or her special dietary needs.

Inform all staff who provide services to the child of his or her food allergies. And Make information about his or her food allergies available in food preparation and serving areas.

Meals and Snacks Availability

We will provide the following for or ensure they are available to each child:

• One snack if he or she receives services at the agency for more than two hours but less than five hours, and
• Either one meal and two snacks, or two meals and one snack if he or she receives services at the agency for five or more hours.

An EIDBI staff member must sit with and oversee the child during meal and snack times.

Food Storage

Refrigerate all perishable foods, including food the child or his or her parent/primary caregiver supplies. The temperature of the refrigerator must be 40 degrees Fahrenheit or less.

Sanitation

Use sanitary procedures to prepare, handle and store all food and drinks, and clean dishes and utensils provided to the child by the agency.

Wash surfaces used for meals (e.g., tables, highchair trays) with soap and water before and after each use.

Water

Provide clean drinking water available to people who receive services throughout all hours of operation and offer drinking water to people who receive services at frequent intervals.

Medical Requirements

Required Information

The following information must be kept in the health service record that is on file for each child and readily available to each staff member. Current when the child begins to receive EIDBI services no less than one month prior to his or her start date and update it ass need, no less than annually thereafter. Gather and record this information on the...

• Emergency contact information
• Each child's physical and medical status
• Allergies
• Current medications and schedule

Required Documentation

Gather this and other essential information on the health form linked below and upload it to Tabs in the child's file under the category Intake and Admission. This form is mandatory for center-based children and should be updated as needed.

Procedures for Illness

If a child who receives services becomes sick at the center, provider staff must immediately:

• notify the child’s parent/primary caregiver,
• provide a space for him or her as they wait for transportation home that is separate from areas used by other people who receive services,
• provide a cot or bed, and a blanket for the sick child, and
• provide constant supervision until transportation arrives.

Reporting Illness

If an illness occurs while a child is receiving services, the provider staff member who was responsible for the child at the time of the illness must complete a report.

Contagious Diseases or Conditions

If a medical or dental provider diagnoses a child who receives services with certain diseases or conditions, the child’s parent/primary caregiver must inform the provider agency within 24 hours (not including weekends and holidays):

A contagious, reportable disease specified in Minnesota Rule 4605.7040 and Chicken Pox, Impetigo, Lice, Ringworm, Scabies.

When a child who receives services is diagnosed with one of these diseases or conditions, the provider agency must notify the legal guardians of all other people who receive services and were exposed to the disease or condition on the same day it receives notification from the sick child’s legal guardian.

Refer to the Minnesota Department of Health for what conditions must be reported there and how to report them or use the following document as a quick guide:

Educating Parents

The Hennepin County Community Health Department, with the support of the local and state disease prevention and control staff and childcare consultants, created a manual for childcare and schools. It contains technical and parent fact sheets about a variety of infectious diseases, as well as information for disease prevention and control.

Open the link below and then tap on "Infectious diseases in childcare settings and schools manual."

Medications

Administering medications to children should be avoided if at all possible. If we must administer either prescription or non-prescription medication to a child who receives services, administering providers must:

• Have written permission from the child’s legal guardian
• Keep all medication in its original container
• Label each child’s medication with his or her name
• Only give a medication to the child whose name is on the label
• Follow written instructions from either the medication’s manufacturer or a medical provider who is legally authorized to prescribe medications (the child’s name and instructions on the label constitute instructions)
• Not administer a medication after the expiration date (check the expiration date before accepting the medication from the parent or guardian.)
• Store all medications according to the directions on the original container and in a place inaccessible to people who receive services
• Return unused portions to the child’s legal guardian or destroy them

Examples of other products that require a legal guardian’s permission to administer include:

• Diapering products
• Sunscreen lotions
• Insect repellents

Each time prescribed medication is given to a child, the provider agency must document the following in the child’s health record:

REQUIREMENT FOR MEDICATION ADMINISTRATION TRAINING?

• Child’s name
• Medication name or prescription number
• Date and time
• Dosage amount
• Name and signature of the staff member who dispensed it

Toileting and Sanitation

Assure that all of the following are available at each site:

• Toilet paper
• Liquid hand soap
• Facial tissues
• Single-use paper towels or warm air hand dryers
• Private toileting or diapering space for people who are school age and for younger children when the need for this adaptation is written in their ITP
• Toilets for toddlers and preschoolers as needed, including:
• Step stool and child-size toilet seat cover to access a regular-size toilet
• Child-size toilet
• Toilet training chair

Specialized Toiletry Items

If a child needs specialized toiletry items, his or her legal guardian should provide them. If he or she does provide specialized toiletry items, make instructions for using these items available to all staff who work with the child.

Diaper Changing

Providers must change diapers in a diaper changing area or in the bathroom. The diaper changing area must:

• be separate from areas used for food storage, food preparation and eating
• have a hand sink with hot and cold running water within three feet of it
• have a smooth, nonabsorbent surface and floor covering
• have a sanitary container for soiled and wet diapers
• include posted diaper changing procedures

Hand Washing

Staff must monitor and assist a child who needs help with hand washing. A child must wash his or her hands or be assisted with washing his or her hands with soap and water:

• after his or her diaper is changed,
• after he or she uses a toilet or toilet training chair, and
• before he or she eats a meal or snack.

Staff must wash their hands with soap and water:

Helpful Tips:

• after they change a child’s diaper,
• after they assist a child with toileting or eating,
• after they use toilet facilities, and
• before they handle food, eat or assist a child with eating.

Hand Sinks and Steps

Do not use a common basin or hand sink filled with standing water. You may use sturdy and washable portable steps to meet toddlers and preschooler's hand washing needs. Hand sinks in the toilet area must not:

• be used for custodial work or food preparation, or
• exceed 120 degrees Fahrenheit for hot water temperature

Cleaning

Clean toilet facilities daily.

Empty, wash (with soap and water) and disinfect toilet training chairs after each use.

Wash (with soap and water) and disinfect toilets and toilet seats daily and whenever soiled.

Therapy Animals

If therapy animals or pets are permitted at the provider agency, the agency must notify people’s legal guardians that an animal is present. The animal must be approved for use as a therapy animal by the Clinical Director.

Capacity Requirements and Limitations

To assure the safest and most therapeutic treatment environmennt, adhere to guidelines identified for each space and capacity of children served.

Feedback or Questions about this Chapter

This guide is a living document. We want to improve it with your help. Do you have questions? Found a typo? Find yourself wanting more information? Please send us your thoughts about anything in this chapter by tapping on the link below.

Updates to this Chapter

November 15, 2022: Updated section on reportable illness/disease with links to resources on this subject, including educational resources for parents.

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