Tenn. Comp. R. & Regs. 1240-04-01-.12 - HEALTH AND SAFETY

(1) The on-site staff shall be responsible for the daily health and safety of children in care.

(2) The child care agency shall ensure that the child care environment and practices support child health and safety.

(3) The receiving educator shall observe each child upon arrival each day for signs of illness and injury.

(4) Designated staff shall immediately contact a parent/guardian when a child shows sign of illness or infection.

(5) The receiving educator shall document any obvious marks or injuries and shall note any comments from the parents pertaining to the marks or injuries.

(6) A child showing signs of illness shall be cared for apart from other children to the extent that supervision can be maintained for all children, and the parent shall be contacted and arrangements made for pick up.

(7) A child's temperature shall be taken using a non-invasive method unless otherwise prescribed by a physician.

(8) Universal and standard precautions, as defined by the Centers for Disease Control, shall be followed when handling or cleaning bodily fluids.

(9) First Aid.

(a) A standard first aid kit, as defined by the current National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care shall be accessible to all staff, and all staff shall be familiar with its contents and use.

(b) All staff shall obtain first aid training within ninety (90) days of employment. At least one staff member who has current certification in first aid from a certifying organization recognized by the Department shall be on-site at all times.

1. The certification shall be applicable to the ages present in the classroom:

(i) Infant/Child first aid; and/or

(ii) Adult first aid if children over age twelve (12) are present.

(c) Current and comprehensive first aid information shall be prominently posted in each area that children use.

(d) Extended Care First Aid Requirements. One (1) staff person on duty at all times shall have current certification or the equivalent in first aid from a certifying organization recognized by the Department.

(10) Cardiopulmonary Resuscitation (CPR) Requirements.

(a) All staff on duty shall receive training in Cardiopulmonary Resuscitation (CPR) as recognized by the Department within ninety (90) days of employment. At least one staff member who has certification in CPR from a certifying organization recognized by the Department shall be present on-site at all times.

1. The certification shall be applicable to the ages present in the classroom:

(i) Infant/Child CPR; and/or

(ii) Adult CPR if children over age twelve (12) are present.

(11) Communicable Diseases.

(a) A child diagnosed with a communicable disease shall have proof of treatment prior to readmission if necessary.

(b) Parents/guardians of every child enrolled shall be notified immediately if a diagnosed communicable disease has been identified in the child care agency.

(c) The child care agency shall report the occurrence of any communicable disease to the local health department no later than the end of the day on which it is discovered.

(12) Medications.

(a) Receiving Medications.

1. All medications shall be received from the parent/guardian by a designated staff person.

2. The designated staff person(s) shall:

(i) Obtain the parent's/guardian's written authorization to administer each medication;

(ii) Document that the medicines or drugs are in the original container, are not expired, and are labeled with the child's name;

(iii) Document the specific dosage and times the medication is to be administered to the child; and

(iv) Document that the parent/guardian has provided the child care agency with instructions on the means and method of administration.

(b) Administering Medications.

1. All medications shall be administered by a staff person or persons who have received training in medication administration. Online training is available through the American Academy of Pediatrics at no cost.

2. The following documentation shall be maintained in the child's file and a copy provided to the parent/guardian:

(i) Medication was administered according to parent/guardian or health care provider instruction, including times and amounts of medications administered;

(ii) Any side effects observed;

(iii) Name of staff person administering medication to child; and

(iv) Unused medication was returned to the parent/guardian.

3. Medication shall never be administered in bottles or infant feeders unless authorized by a physician. Educators shall ensure that medication administered in this way is not accessible to other children.

(c) Accessibility of Medications.

1. Medication shall not be accessible to children unless a physician's authorization for the current school year is on file that allows a school-age child to have selfadministered medication.

2. All medication shall be stored in a child-proof compartment or container.

3. If medications requiring refrigeration are kept in a refrigerator used for food storage, the medicine shall be put in a leak-proof, child-proof container.

4. Medication requiring emergency administration, as prescribed by a licensed medical professional, e.g. an "Epi-Pen" or asthma inhaler, may be kept in an unlocked container that is inaccessible to children.

(d) Diaper cream, ointments, sunscreens and lotions shall be inaccessible to children.

(13) Prohibited Practices and Products.

(a) Smoking.

1. Smoking/vaping is not permitted in any indoor area or vehicle of the child care agency at any time.

2. Smoking/vaping is not permitted on the playground or in any outdoor area accessible to children during the time children are present.

3. Smoking/vaping is not permitted within fifty (50) feet of the child care agency entrance.

4. "No Smoking" signs shall be posted conspicuously at each child care entrance, as required by state law.

(b) Alcoholic Beverages.

1. The use of alcoholic beverages is not permitted in a child care agency during the hours of operation.

2. Alcoholic beverages stored in areas of the child care agency where care is provided shall not be accessible to children.

(c) Illegal activities, inappropriate activities, or any activities that otherwise place children at risk that occur on the premises, property, or in a vehicle on the property of the child care agency.

(d) Firearms shall not be permitted on the premises of a child care agency, in any vehicle used to transport children for the child care agency, or in the presence of a child.

1. In a private residence, deadly weapons and potentially hazardous items, such as power tools, are permitted on the premises, but shall be kept locked, out of sight, and inaccessible to children at all times. Firearms kept in a private residence shall be locked and unloaded with ammunition locked up separately.

2. The provisions of this subparagraph (d) are not applicable to law enforcement officers.

(e) Kitchen knives and other potentially dangerous utensils or tools shall be secured so that they are inaccessible to children.

(f) All items labeled "keep out of reach of children" shall be stored so that they are inaccessible to children.

(g) Personal belongings of residents and staff (such as, but not limited to, contents of purses, backpacks, coat pockets, diaper bags, etc.) shall be inaccessible to children at all times.

(14) Diapering.

(a) Children shall be checked regularly throughout the day to determine if they are wet or soiled.

(b) Children shall be diapered/changed and cleaned promptly when wet or soiled.

(c) The diapering area and/or toileting area shall be located near a hand-washing station and shall be located in a separate area from the food preparation area.

(d) Diapering surfaces shall be off the floor and nonporous.

(e) Children shall never be left unattended on an off-the-floor diapering surface.

(f) Educators shall provide rich social interchanges such as smiling, talking, touching, singing, calling child by name, and engaging in eye contact.

(g) Educators shall utilize sanitary diapering procedures:

1. Adults shall wash their hands, using soap and running water, following each diaper change;

2. The child's hands shall be cleaned when soiled;

3. Diapering surface shall be washed with soap and water and sanitized after diapering each child;

4. Soiled diapers and wipes shall be disposed of in such a manner as to prevent access by children and to prevent cross-contamination;

5. The required diapering procedure shall be used with children of all ages and abilities who require diapering;

6. Pre-school and school-age children requiring assistance with toileting needs shall receive assistance in a location designated for that purpose which provides privacy from other children and adults;

7. Children who require diapering may be diapered on a nonporous, washable diapering surface that adequately protects the floor from contamination and is not located in the food preparation area; and

8. The floor beneath and surrounding the diapering surface shall be immediately cleaned and sanitized if the area has become contaminated after each diapering.

(h) Cleaning, Sanitizing and Disinfecting.

1. Child care agencies shall use U.S. Environmental Protection Agency (EPA)-registered products for cleaning, sanitizing and disinfecting. Environmentally friendly products may be used if they have been certified by Green Seal, UL/EcoLogic, and/or EPA's Safer Choice.

2. Cleaning, sanitizing and disinfecting products should not be used in close proximity to children, and adequate ventilation should be maintained when the products are in use.

3. Bleach and Water solution:

(i) Agencies should refer to current Department of Health guidelines on making an appropriate bleach solution.

(ii) After cleaning the area with bleach and water solution, spray or wipe the surfaces with disinfectant. Make sure to allow surfaces to fully air dry.

(15) Staff Health.

(a) Staff members with signs of a communicable disease shall not be present, and the child care agency shall take prompt steps to prevent further spread of the illness.

Notes

Tenn. Comp. R. & Regs. 1240-04-01-.12

Original rules filed May 1, 2018; effective July 30, 2018. Amendments filed March 31, 2022; effective 6/29/2022.

Authority: T.C.A. §§ 4-5-201, et seq.; 71-1-105(a)(5); 39-17-1803; 71-3-501, et seq.; 71-3-502(a)(2)-(3); and 71-3-508.