Current through September 24, 2024
(1) Current and
comprehensive first aid information shall be available to all staff who
interact with children. A standard first aid kit (for example, one (1) approved
by the American Red Cross) shall be available to all staff, and all staff shall
be familiar with its contents and use. Each Program shall provide periodic
training and updates on basic first aid and the use of the first aid
kit.
(2) At least one (1) staff
member who has current certification in first aid from a certifying
organization recognized by the Department shall be on duty at all times. The
first aid certification course shall be a minimum of three (3) hours and shall
be taught by a certified first aid instructor.
(3) At least one half (1/2) of the staff
members on duty shall hold current certification in Infant/Pediatric
Cardiopulmonary Resuscitation (CPR) from the American Red Cross, the American
Heart Association, or other certifying organization, as recognized by the
Department.
(a) The initial CPR course shall
be a minimum of four (4) hours and shall be taught by an individual currently
certified, as recognized by the Department, to provide CPR
instruction.
(b) When school-age
children are present, and/or in a school-age only Program, at least one (1)
staff member shall hold current certification in adult CPR.
(4) Each Program, in consultation with
appropriate local authorities, shall develop a written plan to protect children
in the event of disaster such as, but not limited to, fire, tornado,
earthquake, chemical spills, floods, etc. and shall inform parents of the plan.
(a) The Program shall implement these
emergency procedures through timely practice drills to meet local regulations
and local emergency services plans and shall maintain documentation of drills
for one (1) year.
(b) Extended
Care: At least one (1) of these drills shall be conducted during extended care
hours.
(5) Smoking is not
permitted on the premises of a childcare Program.
(6) The consumption or possession of alcohol
is not permitted on the premises of a childcare Program.
(7) Firearms shall not be on the premises of
a childcare Program, or in any vehicle used to transport children or in the
presence of a child.
(8) Kitchen
knives and other potentially dangerous utensils or tools shall be secured so
that they are not accessible to children.
(9) Staff's personal belongings (such as, but
not limited to, contents of purses, backpacks, coat pockets, diaper bags, etc.)
shall be inaccessible to children at all times.
(10) The following emergency telephone
numbers shall be posted next to all telephones and be readily available to any
staff member:
(a) Fire department;
(b) Police department/sheriff;
(c) Nearest hospital emergency
room;
(d) Child abuse
hotline;
(e) Local emergency
management agency;
(f) Ambulance or
rescue squad;
(g) Poison control
center;
(h) 911 or a similar
generic number operated in the community; and
(i) Contact numbers for parents.
(11) Programs shall comply with
the following rules for the health of children:
(a) All children shall be checked upon
arrival and observed for signs of communicable disease during the
day.
(b) A child's temperature
should be taken using a non-invasive method unless otherwise prescribed by a
physician. Symptomatic children shall be removed from the group until parents
are contacted and health issues are resolved.
(c) Impetigo and diagnosed strep shall be
treated appropriately for twenty-four (24) hours prior to readmission of the
child to the Program.
(d) Children
diagnosed with scabies or lice shall have proof of treatment prior to
readmission.
(e) The Program may
not provide care and/or isolation for a child with contagious condition unless
written instructions are obtained from a licensed physician or certified health
care provider.
(f) All children
born in countries other than the United States, Canada, Western Europe,
Australia, New Zealand, and Japan shall present evidence of a tuberculin skin
test performed in the United States at any time after twelve (12) months of
age. Any child with a positive tuberculin skin test shall be referred to a
physician for evaluation. After the initial evaluation, future periodic
screening is not required unless the child develops persistent pulmonary
symptoms or there is contact with tuberculosis.
(g) Staff shall make every reasonable attempt
to notify parents or guardians immediately when a child shows signs of serious
illness, including but not limited to, high temperature, disorientation,
coughing, vomiting or diarrhea with blood present, severe difficulty breathing,
seizure, etc. to arrange for emergency treatment.
(h) In no event shall the Program delay
seeking emergency treatment due to a delay in making contact with the parent or
guardian.
(i) Parents or guardians
of every child enrolled shall be notified immediately if one (1) of the
following communicable diseases has been introduced into the Program:
1. Hepatitis A;
2. Food borne outbreaks;
3. Salmonella;
4. Shigella;
5. Measles, mumps, and/or rubella;
6. Pertussis;
7. Polio;
8. Influenza type A or B;
9. Meningococcal meningitis;
10. Staphylococcus aureus; and
11. Any other illness identified by the state
or local Department of Health.
(j) The Program shall report the occurrence
of any of the above diseases to the local health department as soon as
possible, but no later than the end of the day in which it occurred.
(12) Program staff shall make
every reasonable attempt to notify parents or guardians immediately when a
child sustains serious injury/injuries, including but not limited to, massive
bleeding, broken bones, head injuries, possible internal injury, etc., to
arrange for emergency treatment.
(13) Tuberculosis (TB) screening prior to
on-going contact with children is recommended for any individual who:
(a) Was born in a country other than the
United States, Canada, Western Europe, Australia, New Zealand, and
Japan;
(b) Has a weakened immune
system (including but not limited to Human Immunodeficiency Virus (HIV),
cancer, taking chemotherapy drugs, etc.); or
(c) Has been recently exposed to
tuberculosis.
(14) The
administration of medication shall be in compliance with the following:
(a) All medications, prescription and
non-prescription shall be received from the parent or guardian by a designated
staff person or management level staff person. An alternate staff person shall
be available to administer medication in the event the designated staff person
is absent.
(b) The designated staff
person shall document verification of the following:
1. The parent's or guardian's written
authorization to administer medication and instructions on the methods of
administration;
2. That medicines
or drugs are in the original prescription container, are not out of date, and
are labeled with the child's name; and
3. The specific dosage and times medication
is to be administered to the child.
(c) The following documentation of
administration shall be maintained in the child's file and a copy provided to
the parent or guardian:
1. Times medications
administered;
2. Noticeable side
effects; and
3. Name of staff
person administering medication to child.
(d) The parent or guardian of a child
receiving medication shall sign documentation verifying the receipt of
documentation of administration required by subparagraph (c) above and that all
unused medication was returned to the parent or guardian.
(e) Medication shall not be handled by
children, with the exception of children with a physician's authorization for
the self-administration of a medication. Assistance to school-age children
self-administering medication must be in accordance with Guidelines for Use of
Health Care Professionals and Health Care Procedures in a School
Setting.
(f) Medication shall never
be administered in bottles or infant feeders unless authorized by a
physician.
(g) All medicines,
prescription and non-prescription shall be stored in a locked compartment or
container.
1. If medicine requiring
refrigeration is kept in a refrigerator the medicine shall be put in a
leak-proof locked container.
2.
Keys for these compartments shall be inaccessible to children.
3. Medication requiring emergency
administration, as directed by the physician, nurse practitioner or physician's
assistant, e.g., "EpiPen," asthma inhaler, etc., may be kept in an unlocked
container that is inaccessible to children.
(h) Public school-administered Programs shall
follow the procedures for student medications defined in the School Health
policy, adopted by the Local Education Agency.
(15) The following safe sleep practices shall
be followed:
(a) Infants shall be positioned
on their backs when placed in a crib for sleeping.
(b) A crib shall only have a tight-fitting
sheet; soft bedding for infants is prohibited.
(c) Infants shall not be wrapped tightly or
swaddled in blankets for sleeping.
(d) Infants should be dressed lightly for
sleep and the room temperature shall be in a range that is comfortable for a
lightly clothed adult. Infants may be clothed in sleep sacks that have been
approved by the Consumer Product Safety Commission and the Tennessee Department
of Health as long as the sleep sack is not handmade, not on the recall list,
and children are able to move their arms freely while wearing the sleep
sack.
(e) Infants that fall asleep
during tummy time shall be placed in their crib immediately.
(f) Infants shall be touched by a teacher
every fifteen (15) minutes in order to check breathing and body
temperature.
(g) Pillows and
blankets shall be prohibited for infants.
(h) If a child appears not to be breathing,
the Program must immediately begin CPR and call for emergency medical
assistance.
(i) Before any teacher
can assume duties of any type in an infant room they must be oriented in the
foregoing sudden infant death syndrome (SIDS) procedures.
(j) The areas where infants sleep shall have
adequate lighting which allows the teacher to quickly, at a glance, verify that
the child's head is uncovered, that the child is breathing, and otherwise
visually verify the child's condition.
(16) For the protection of children and
adults, the Centers for Disease Control guidelines for hand washing and
diapering procedures shall be followed. Hand Sanitizer shall not be a
substitute for soap and water and shall be kept out of reach of
children.
(17) Diapering shall
comply with the following:
(a) Children shall
be diapered/changed and cleaned immediately when wet or soiled.
(b) The diapering area and/or toilet training
area shall be located near a hand washing lavatory and shall be located in a
separate area from the food preparation/service area.
(c) All diapering surfaces must be off the
floor, and nonporous and shall be sanitized using solutions for general
cleaning and sanitizing purposes, including:
1. For general cleaning and sanitizing
purposes, a fresh solution of one quarter (1/4) cup chlorine bleach to one (1)
gallon of water (or one (1) tablespoon bleach to one (1) quart of water) shall
be made daily.
2. Substitutions for
the bleach solution required in part 1. above that are approved for the
childcare setting by the Department of Health are permissible.
3. The solution required in part 1. above is
not appropriate for items associated with food preparation or for items that
children frequently place in their mouths, and the Health Department does not
permit the use of higher concentrations than these in food preparation areas.
Specific jurisdictions may have even more stringent requirements; therefore,
the local health department should be consulted.
(d) A tightly covered container with plastic
liner shall be used for diaper disposal and shall be inaccessible to children.
This container shall be emptied by closing the liner and disposing of it in an
outside receptacle.
(18)
Program equipment shall meet the following safety requirements:
(a) Manufacturer's safety instructions shall
be followed for the use and/or installation of all indoor and outdoor equipment
and appliances. Such instructions shall be retained and communicated to all
appropriate staff.
(b) All indoor
and outdoor equipment shall be well made and safe. There shall be no dangerous
angles, sharp edges, splinters, nails sticking out, open S-hooks or pinch
points within children's reach.
(c)
Electrical cords on equipment for children shall be inaccessible to the
children.
(d) Damaged equipment
shall be repaired or removed from the room or playground immediately.
(e) Equipment shall be kept clean by washing
frequently with soap and water.
(f)
There shall be developmentally appropriate equipment and furnishings for each
age group in attendance.
(g)
Individual lockers, separate hooks and shelves or other containers, placed at
children's reaching level, shall be provided for the belongings of each child,
ages infant - preschool.
(h) In
infant/toddler rooms, equipment and space shall be provided for climbing,
crawling, and pulling without the restraint of playpens or cribs.
(i) A place shall be provided for each
school-age child's belongings.
(j)
There shall be equipment for napping or sleeping for each preschool child who
is in care for six (6) hours or more.
1. A
quiet rest area and cots or mats shall be available for children who want to
rest or nap. However, no child shall be forced to nap.
2. No child shall be forced to stay on a cot
or on a mat for an extended period of time.
3. In order to avoid the spread of airborne
diseases, children shall be positioned on mats in a face-to-feet alternating
pattern.
4. Spacing of cots, cribs,
and mats shall allow sufficient space to walk between them.
5. All nap/sleep equipment shall be in good
condition and comply with the following requirements:
(i) Individual cots or two-inch (2") mats
shall be provided for children ages twelve (12) months to five (5)
years.
(ii) Individual beds or cots
shall be provided for children sleeping for extended periods of more than two
and one half (2-1/2) hours, such as during nighttime care.
(iii) Each child under twelve (12) months
shall have an individual, free-standing, crib at least twenty-two inches (22")
x thirty-six inches (36") with an open top.
(iv) Mattresses and foam pads shall be
covered with safe, waterproof material.
(v) A clean sheet or towel shall be used to
cover whatever the child sleeps on.
(vi) A clean coverlet shall be available to
each child.
(vii) Soiled sheets and
coverlets shall be replaced immediately.
(viii) Each crib, cot, bed or mat shall be
labeled to assure that each child naps on his own bedding.
6. Crib mattress shall not be positioned
directly on the floor for napping. Pack 'n plays may be used for
naptime.
(19)
All Program staff, including volunteers, are individually responsible, and are
required by T.C.A. §§
37-1-403,
37-1-605, and
49-6-1601 to immediately report
any knowledge or reasonable cause for suspicion of child abuse or neglect, or
child sexual abuse, including, but not limited to, any statement from a child
reasonably indicating abuse/neglect of that child or another child or any
evidence of abuse or neglect observed on a child, to the Department of
Children's Services and law enforcement.
(20) If the information is received from a
child, the following procedures shall be followed:
(a) If a child voluntarily discloses
information about possible abuse to Program staff or a volunteer in a Program,
then the child shall be provided with a quiet and private place to speak and
the person receiving the information shall listen openly and speak at the
child's level in a positive, non-judgmental tone.
(b) The person receiving the information from
the child shall:
1. Allow the child to say
what happened in the child's own words;
2. Avoid conducting an investigation by
asking the child detailed questions;
3. Make every effort to write down the
child's exact words;
4. Refrain
from making any statements to the child about the alleged abuse, the alleged
abuser, or the consequences of the child reporting the alleged abuse;
and
5. Immediately notify the
Program child abuse coordinator and report the information to the Department of
Children's Services and law enforcement, provided, however, when the alleged
abuse involves someone employed by, previously employed by, or otherwise
affiliated with the Program, the report may be made directly to the Department
of Children's Services and law enforcement prior to notifying the Program child
abuse coordinator. This requirement does not relieve a Program teacher, Program
official, or other Program personnel from the duty to report alleged abuse
under federal law.
(21) If a third party informs a Program
personnel of a reasonable suspicion that a child at the Program may be the
victim of child abuse or neglect, or child sexual abuse, then the Program
personnel must:
(a) Encourage the third party
to report the suspicion to the Department of Children's Services and law
enforcement;
(b) Notify the
Program's child abuse coordinator; and
(c) Report all information received from the
third party to the Department of Children's Services and law
enforcement.
(22) Each
Program shall designate a child abuse coordinator and an alternate child abuse
coordinator. The designation of an alternative child abuse coordinator is not
required when only one (1) adult is employed by or responsible for the care of
children at the Program. The child abuse coordinator and alternative child
abuse coordinator must:
(a) Have access to an
area providing privacy and access to a telephone for reporting suspected child
abuse, neglect, and child sexual abuse;
(b) Receive training as required by T.C.A.
§
49-6-1601(c)(2);
(c) Be available for Program personnel to
share information about suspected child abuse, neglect, and child sexual
abuse;
(d) Assist Program personnel
in reporting suspected child abuse, neglect, and child sexual abuse to the
Department of Children's Services and law enforcement;
(e) Serve as a liaison between the Program,
the Department of Children's Services, and law enforcement;
(f) Assist the Department of Children's
Services and law enforcement by sharing available information regarding
suspected child abuse, neglect, and child sexual abuse, and by providing a
private area within the Program for Department of Children's Services and law
enforcement personnel to meet with the child and the reporting Program
personnel as a group or individually if required; and
(g) Maintain confidential files in accordance
with T.C.A. §§
37-5-107 and
37-1-612 regarding all reported
suspicions of child abuse, neglect, and child sexual abuse.
(23) All Program staff shall
receive annual training regarding the procedures to report child abuse,
neglect, and child sexual abuse as is required by T.C.A. §
37-1-408.
(24) The Program shall not attempt to
validate the allegation prior to making a report. A final determination of the
validity of the report of child abuse or neglect, or child sexual abuse shall
be made exclusively by the Department of Children's Services and law
enforcement upon the report by the Program's staff.
(25) The Program shall not develop or
implement policy that inhibits, interferes with or otherwise affects the duty
of any staff, including substitutes and volunteers, to report suspected abuse,
neglect, or sexual abuse of a child as required by this rule and T.C.A.
§§
37-1-403,
37-1-605, and
49-6-1601 and shall not otherwise
directly or indirectly require staff to report to the Program management or
child abuse coordinator or seek the approval of Program management or child
abuse coordinator prior to any individual staff member reporting the suspected
abuse, neglect, or sexual abuse to the Department of Children's Services and
law enforcement.
(26) A report of
suspected child abuse or neglect, or sexual abuse of a child enrolled in the
Program by a Program staff member or volunteer shall not be made to any other
entities or persons, including, but not limited to, hospitals, physicians, or
educational institutions as an alternative to or substitute for the reporting
requirements to the persons or entities specifically listed in this
rule.
(27) A Program staff member
or volunteer shall not suggest to, advise or direct a parent or caretaker of a
child enrolled in the Program to make a report of suspected child abuse or
neglect, or child sexual abuse regarding that parent's or caretaker's own child
who is enrolled in the Program as a means of fulfilling the duty of the Program
staff member or volunteer to report child abuse or neglect, or child sexual
abuse as required by T.C.A. §§
37-1-403,
37-1-605, and
49-6-1601.
(28) Program personnel should be observant of
any bruising, injury, markings, or other unusual behavior that may be the
result of child abuse or neglect, or child sexual abuse, and immediately
coordinate with the Program's child abuse coordinator to report any suspicions
to the Department of Children's Services and law enforcement. However,
photographs of such bruising, injury, or markings shall not be taken by any
Program personnel.
(29) Any action
that does not comply in all respects with these rules, will not fulfill the
statutory duty to report child abuse or neglect, or child sexual abuse and the
certification of approval requirements of this Chapter.
(a) Failure to make the reports required by
this Chapter or the use of prohibited methods as an attempt to fulfill the duty
to report suspected child abuse or neglect, or child sexual abuse, for children
in the care of the Program are, by themselves, grounds for suspension, denial
or revocation of the Program's certificate of approval.
(b) If the facts established by a
preponderance of the evidence indicate that there has not been strict
compliance with the requirements of this Chapter or that the prohibited
procedures have been utilized as an alternative means of fulfilling the
requirements, these circumstances shall create a rebuttable presumption for the
Administrative Law Judge and the Child Care Advisory Council Review Board that
the duty to report child abuse or neglect, or child sexual abuse, has not been
fulfilled, and this ground for suspension, denial, or revocation of the
Program's certificate of approval by the Department of Education shall be
sustained unless such presumption is rebutted by a preponderance of the
evidence.
(c) All Program staff and
volunteers in a Program certified as approved by the Department of Education
shall fully cooperate with all agencies involved in the investigation of child
abuse or neglect, or child sexual abuse.
1.
The Program shall provide access to records of children and staff.
2. The Program shall allow appropriate
investigators to interview children and staff.
3. The Program shall not interfere with a
child abuse or neglect, or child sexual abuse, investigation.
4. The Program shall protect the child by
requesting the investigator's identification.
5. The Program shall maintain confidentiality
of the investigation and shall not disclose the investigation or details of the
investigation except as required to carry out procedures for the protection of
children or as otherwise directed by the Department of Children's Services, law
enforcement or the Department of Education.
(d) Upon notification of a pending child
abuse or neglect, or child sexual abuse investigation of any Program staff
member, the Program shall enter into a safety plan with the Department
regarding the individual's access to the Program and the children in the care
of the Program.
Authority: T.C.A. §§
37-1-401, et seq.; 37-1-601, et
seq.; 49-1-302; 49-1-1101 through 49-1-1109; 49-6-1601; 49-6-5001; and
49-6-5002; and 20 U.S.C.
§
6081.
