Licensing Standards for DayCare Centers

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Section E
Child Care Program

1. Staffing
   
   
   • a. Child/staff ratio and grouping shall be as follows:
     
     (1)
     Age Ratio Group Size
     3 weeks up to 18 months 1 to 6 6
     18 months up to 2 1/2 yrs. 1 to 8 8
     2 1/2 years up to 4 years 1 to 12 12
     4 up to 6 years 1 to 20 20
     6 up to 8 years 1 to 22 22
     8 years and older 1 to 25 25
     
     (2) Children younger than age 2 1/2 years shall be grouped separately. Exceptions may be permitted with written approval from the Department representative. Such exceptions would allow children to be grouped based on individual needs. Ratios would be according to the multiple grouping ratio (see (3) below). Exceptions may also be granted to permit children age 24 months up to 36 months to be grouped together with a child/staff ratio of one to 9, with a group size of nine.
     (3) When multiple age grouping is used, child/staff ratio and group size shall be according to the age of the youngest child in the group if more than 20% of the children are in the youngest age category. If children in the youngest age category make up 20% or less of the group, staffing and group size shall be according to the next highest category.
     (4) Staff such as director and service staff, shall be counted in the child-staff ratio only during the time that they are giving full attention to the direct supervision of the children. Service staff acting as child care workers shall meet the qualifications of child care workers.
     
     
   • b. Staff Coverage shall be determined by the following:
     
     (l) All children shall have staff supervision at all times.
     (2) Each staff person giving care to infants and toddlers shall be assigned the responsibility of caring for the same infants/toddlers daily, except in the absence of the regularly assigned child care worker.
     (3) When a regular staff person is absent, there shall be a substitute present in order to maintain the regular child-staff ratio.
     (4) During the director's absence, an adult staff person, meeting at least child care worker qualifications, shall be designated as the responsible person in charge.
     (5) One staff person shall be present in each room of children during napping/resting time.
     (a) The number of napping/resting children, ages 2 1/2 years and older, shall not exceed 40 per staff person.
     (b) Child-staff ratio shall be one staff person to 16 children during nap time for children from 1 1/2 to 2 1/2 years of age.
     (c) Child-staff ratio for children under 1 1/2 years shall be one staff person to 6 children at all times of the day.
     (6) A staff person at least 19 years of age shall be present in the day care center during all hours of operation.
     (7) There shall be a second person age 19 or older available in the day care center building or on the premises, whenever 7 or more children are present.
     (a) The director shall have a staff person on call in case he/she is needed during the time there is only one adult staff person at the center.
     (b) The director shall post identifying information regarding emergency help. Information including name, address, telephone number, age and reference data shall be on file in the center.
     (8) No staff person shall be on duty with the children for more than 8 continuous hours, on a regular basis.
     (9) Staff persons shall be free from all other duties during the hours they are working directly with the children.
     (10) Volunteers working 3 hours or more per day shall be eligible, if other qualifications are met, to assume responsibilities of a child care worker and shall be counted in the child-staff ratio.
     (11) Volunteers working less than 3 hours per day shall work in assisting positions with the regular child care worker and shall not counted in the required child-staff ratio.
     
     
2. Daily Program
   
   
   • a. Infants
     
     (1) Learning/growth activities
     
     (a) Infants shall be encouraged to play with and handle a variety of toys. (See section Furnishings and Equipment, page 16, for equipment regulations.)
     (b) Infants shall spend time outdoors daily, when weather permits.
     (c) Infants shall have daily indoor opportunities for freedom of movement, outside their cribs, in an open, uncluttered space.
     (d) The staff shall talk to each infant often and encourage him/her to respond.
     (e) Cries of infants shall be investigated immediately.
     (f) Each infant shall receive daily personal contact and attention, such as being held, sung to, rocked, taken on walks.
     (g) Each infant's position and/or place shall be changed at least each half hour, when infant is awake.
     
     (2) Diapering/toileting
     
     (a) There shall be a safe and sanitary diapering procedure.
     ((1)) Wet or soiled diapers and other clothing shall be changed promptly.
     ((2)) Diapers and other soiled and wet clothing shall be changed in each child's crib or on a surface which is cleaned and disinfected after each use.
     ((3)) No infant shall be left unattended while being diapered.
     ((4)) Staff persons shall wash hands with soap and warm running water before and immediately after diapering.
     (b) There shall be a plan for the provision of diapers and clothing so that sufficient dry and clean clothing is available for each child.
     ((1)) If parent(s)/guardian(s) supply diapers and are responsible for laundering, soiled diapers shall be rinsed immediately, kept separate from every other child's diapers in plastic bags or plastic-lined covered containers and sent home daily.
     ((2)) If the center supplies diapers and is responsible for laundering, soiled diapers shall be rinsed immediately, placed in plastic-lined, covered containers and removed daily for washing. The containers shall be cleaned and disinfected daily.
     ((3)) If disposable diapers are used, they shall be placed in a covered, plastic-lined, container and disposed of daily.
     ((4)) Individual, disposable wipes or a clean single use cloth shall be used at each diaper change, placed in a covered plastic-lined container, and disposed of properly, out of the reach of children.
     (c) The staff shall not initiate any attempts to toilet train infants.
     
     (3) Napping/resting
     
     Each infant shall be allowed to form his/her own pattern of sleeping and waking.
     
     (4) Cribs and bedding
     
     (a) Placement of cribs shall allow a minimum of 2 feet of space between occupied cribs.
     (b) Cribs used by any infants shall be cleaned and disinfected and the sheets washed before being used by another child.
     (c) Clean sheets shall be provided daily, or more often as needed when wet or soiled.
     
     (5) Feeding
     
     (a) Food
     
     ((1)) Formula and foods to be provided by the center to infants shall be planned in writing with the infant's parent(s)/guardian(s) or by the child's physician with the parent(s)/guardian(s) knowledge and consent.
     ((2)) If the center provides formula for infants, commercially prepared, ready-to-feed formula shall be provided. All formula, bottles, nipples, and other equipment used in bottle preparation shall be prepared, handled, and stored in a sanitary and sterile manner.
     ((3)) If formula is provided by the parent(s)/guardian(s) it shall be labeled with the child's name and stored in the refrigerator. All bottles shall be sent home or discarded at the end of the day.
     ((4)) If baby food is provided by the parent(s)/guardian(s), all jars shall be labeled with the child's name. No previously opened jars shall be accepted by the center. All opened jars shall be sent home or discarded at the end of the day.
     ((5)) Meals and snacks provided by the center for infants shall be planned in accordance with child care infant meal patterns of the Food and Nutrition Service, USDA. (See Appendix 16).
     ((6)) Drinking water shall be offered to infants several times a day.
     
     (b) Service and serving equipment
     
     ((1)) The feeding schedule shall be in accordance with the infant's needs rather than according to the hour.
     ((2)) The infant shall be held for bottle feeding. No bottles shall be propped.
     ((3)) When an infant is able to sit in a chair or feeding table, he/she shall be allowed to do so.
     ((4)) Infants shall be encouraged to experiment with self-feeding with hands and/or spoon.
     ((5)) Each infant's solid foods shall be fed/eaten from a dish. For infants who eat a whole jar of baby food at one serving, the child care worker may feed the infant directly from the baby food jar. Any food remaining in the jar shall be discarded.
     ((6)) Dishes and nursing bottles used shall be unbreakable.
     ((7)) Infants shall not be forced to eat.
     ((8)) Food shall not be used as a punishment or reward.
     
     (c) Weaning
     
     ((1)) Weaning shall begin only when the child is determined ready by the child's physician and parent(s)/guardian(s).
     ((2)) Parent(s)/guardian(s) and staff shall work together to insure consistency in the weaning process.
     ((3)) The infant shall be allowed to became familiar with drinking from the cup prior to substituting it for the bottle.
     
     
   • b. Toddlers
     
     (1) Learning/growth activities
     
     (a) The staff shall plan and provide activities, in accordance with the toddler's developmental level, which shall include, but need not be limited to, stories, music, and creative art.
     (b) The staff shall give personal, undivided attention to each toddler daily.
     ((1)) The staff shall talk to each toddler often and encourage him/her to respond.
     ((2)) The staff shall work with each toddler to guide his/her play with a variety of toys.
     ((3)) The staff shall have pleasant physical contact with each toddler.
     (c) Toddlers shall spend time outdoors daily, when weather permits.
     
     (d) Toddlers shall have daily indoor opportunities for freedom of movement, in an open, uncluttered space.
     (e) Cries of toddlers shall be investigated immediately.
     
     (2) Diapering/toileting
     
     (a) There shall be a safe and sanitary diapering procedure.
     
     ((1)) Wet or soiled diapers and other clothing shall be changed promptly.
     ((2)) Diapers and other soiled and wet clothing shall be changed in each child's crib or on a surface which is cleaned and disinfected after each use.
     ((3)) No toddler shall be left unattended while being diapered.
     ((4)) Staff persons shall wash hands with soap and warm running water before and immediately after each diaper change.
     
     (b) There shall be a plan for the provision of diapers and clothing so that sufficient dry and clean clothing is available for each child.
     
     ((1)) If parent(s)/guardian(s) supply diapers and are responsible for laundering, soiled diapers shall be rinsed immediately, kept separate from every other child's in plastic bags or plastic-lined, covered containers and sent home daily.
     ((2)) If the center supplies diapers and is responsible for laundering, soiled diapers shall be rinsed immediately, kept separate from every other child's in plastic bags or plastic-lined, covered containers and removed daily for washing. The containers shall be cleaned and disinfected daily.
     ((3)) If disposable diapers are used, they shall be placed in a covered, plastic-lined, container and disposed of daily.
     ((4)) Individual disposable wipes or a clean single use cloth shall be used at each diaper change and placed in a plastic-lined covered container and disposed of properly, out of the reach of children.
     
     (c) Toileting practices
     
     ((1)) The staff shall begin toilet training toddlers only when the child is able to communicate his/her needs to use the toilet.
     ((2)) Staff shall work together with parent(s)/guardian(s) to determine when to initiate toilet training procedures and to ensure a consistent and relaxed toilet training process.
     ((3)) Potty chairs, if used, shall be emptied and rinsed and disinfected after each use.
     
     (3) Napping/resting
     
     The staff shall recognize different needs of a toddler for sleep/rest and each child shall be allowed to follow his/her own sleep/rest pattern.
     
     (4) Cots and bedding
     
     (a) Cots used by any toddler shall be cleaned before being used by another child, and clean sheets shall be provided.
     (b) Clean sheets and coverings shall be provided at least once each week or as frequently as needed when wet or soiled.
     (c) Cots shall be positioned to allow space for staff access to the children and to allow space for safe exit in case of emergency.
     
     (5) Feeding
     
     As a toddler's eating patterns change from those of the infant to those of the pre-school child, the regulations for pre-school feeding shall apply.
     
     
   • c. Pre-school and/or school-age children
     
     (1) Learning/growth activities
     
     (a) There shall be a posted written daily plan or schedule of the day for each group of children.
     (b) Indoor and/or outdoor experiences such as creative art, rhythm and music, books and stories, discussion, natural science, block building, home living, manipulative toys and games, water play, climbing, riding, sand and digging, shall be available.
     (c) Indoor and/or outdoor experiences for school-age children, such as creative art, music, story and discussion, science, dramatic play, crafts and games, recreational sports, and real tasks, such as cooking, sewing, or wood working, shall be available.
     (d) There shall be periods of indoor work/play time when the children shall be permitted to proceed from one activity to another, alone or in small groups.
     (e) Pre-school and school-age children shall spend time outdoors daily when weather permits.
     (f) There shall be periods of vigorous activity and opportunity for quiet play.
     (g) There shall be daily periods of staff-directed activity planned according to the child's stage of development.
     (h) Provisions shall be made for a quiet area for use by children desiring to be alone or to work on homework.
     (i) The staff shall encourage the child's independence in routines and activities by assigning simple housekeeping duties, offering planned activities and projects, etc.
     (j) The staff shall encourage conversation among children.
     (k) The staff shall give individual attention to each child daily, such as conversation between staff and child.
     (l) Radio and television and VCRs shall be used only when they supplement and enhance the daily plan for the children. No child shall be required to watch television or VCRs. All video tapes shall be previewed by a staff person to ensure their appropriateness for the age of the children. Sexually explicit, violent, or frightening materials are prohibited.
     (m) The staff shall assist the child needing help during the early morning and late afternoon periods in coping with separation from parents and usual end-of-the-day fatigue.
     (n) In cases when children participate in "away from center" activities, there shall be a written plan from the child's parent(s)/guardian(s) and agreed to by the staff concerning:
     ((1)) the number and type of community activities in which the child shall participate, and means of transportation to be used.
     ((2)) the amount and kind of freedom allowed for the child using the center as "home base".
     (o) The staff shall note that the child arrives at the center from school or "away from center" activities when expected and shall follow up on his/her whereabouts, if late (see Transportation Policies.)
     
     (2) Napping/resting
     
     The staff shall recognize differing needs of children for sleep/rest.
     
     (a) A supervised rest period shall be scheduled for preschool children in attendance at the center for more than 5 hours.
     
     ((1)) Rest period shall not be less than 45 minutes and shall not exceed 2 1/2 hours.
     ((2)) Children who do not sleep after 45 minutes of rest shall be permitted to engage in quiet activities.
     ((3)) School age children shall not be required to nap.
     
     (b) Cots and bedding
     
     ((1)) Cots shall be cleaned and clean sheets provided before the cot is used by another child.
     ((2)) Clean bottom sheets and covers shall be provided at least once each week or as frequently as needed when wet or soiled.
     ((3)) Cots shall be positioned to allow space for staff access to the children and to allow space for a safe exit in case of emergency.
     
     (3) Toileting
     
     Children's toileting shall be according to individual need.
     
     (4) Feeding
     
     (a) Food
     
     ((1)) Children in attendance shall be served breakfast or a morning snack, a nutritious midday meal, and at least one afternoon snack.
     ((2)) The meal and snack patterns provided by the Food and Nutrition Service, USDA, shall be used in meal planning. (See Appendix 14). Meal components and serving sizes shall be in accordance with these guidelines.
     ((3)) No child shall be deprived of a meal or snack if he/she is in attendance at the time the meal or snack is served.
     ((4)) Meals and snacks shall be spaced at least 2 1/2 hours apart.
     ((5)) Meals and snacks for children with special dietary needs shall be provided in accordance with the child's needs and written instructions of the child's parent(s)/guardian(s) or a licensed physician.
     ((6)) Menus shall be planned, at least one week in advance, dated and posted where they may be seen by the parent(s)/guardian(s). Menus shall include a variety of foods. Food substitutions shall be noted on the menu.
     ((7)) Meals and snacks shall be provided by the center. When a parent(s)/guardian(s) chooses to provide food for their child, a written signed statement indicating this shall be on file in the center.
     
     (b) Service and serving equipment
     
     ((1)) Meals shall be served in a pleasant atmosphere and in a manner which permits the children to assist in serving themselves.
     ((2)) Staff shall sit at the tables with the children at mealtime.
     ((3)) Portions of food served shall be suited to the child s age and appetite. Second portions shall be available.
     ((4)) Easily breakable dinnerware shall not be used.
     ((5)) Single-use cups or glasses or drinking fountains shall be supplied for water service during the day. A common drinking container shall not be used.
     ((6)) Children shall not be forced to eat.
     ((7)) Children shall not be allowed in the kitchen.
     
     (c) When food service is catered, the plan shall be approved by the county health department. Meals which are catered shall meet the meal patterns provided in Appendix 14.
     
     
3. Disciplinary Practices
   
   Disciplinary practices shall be according to the following requirements:
   
   
   • a. Developmentally appropriate limits or rules shall be understandable to the staff and children to whom they apply.
     
   • b. Staff shall agree on acceptable and unacceptable behavior and on limits set.
     
   • c. Expected behavior shall be on the child s level.
     
   • d. A kind, firm voice shall be used.
     
   • e. Discipline shall be consistent and fair.
     
   • f. Positive reinforcement shall be encouraged. Developmentally appropriate reward systems may be used.
     
   • g. Discipline shall not be associated with food, naps, or bathroom procedures.
     h No corporal/physical punishment shall be used.
     
   • i. Techniques of discipline shall not be humiliating, shaming, or frightening to the child.
     
   • j. Discipline shall be related to the misbehavior and it shall be administered immediately, usually by the worker primarily responsible for the child. In occasional situations, consultation with the director may be indicated.
     
   • k. No verbal abuse, threats, or derogatory remarks about the child or his/her family shall be used.
     
     
4. Staff-Parent Communication
   
   
   • a. The staff shall be responsible for communicating with the parent(s)/guardian(s) concerning changes in the child's behavior patterns.
     
   • b. The staff and parents shall discuss severe discipline or behavior problems to determine appropriate action consistent with disciplinary practices above.
     
   • c. Visits to the center by the parent(s)/guardian(s) and other interested persons shall be encouraged.
     
   • d. The center shall be open to visits from parent(s)/guardian(s) at any time of the day.
     
   • e. Staff shall be available for communication and/or conferences with the parent(s)/guardian(s) at a mutually convenient time.
     
     
5. Health and Medical Needs
   
   
   • a. Medical information
     
     (1) Results of medical examination, screening or assessment shall be on file.
     
     (a) Each child under five years of age shall have, within 12 months prior to initial admission, a physical examination or medical screening or assessment (such as MEDIKIDS). The physical examination shall be performed by a licensed, practicing medical doctor or physician's assistant (as defined in Section 34-24-290(4). Code of Alabama 1975). A medical screening or assessment shall be performed by a licensed, practicing medical doctor, other medical personnel who are administratively responsible to a licensed, practicing medical doctor or a licensed Registered Nurse who has access to consultation on a regular, planned basis from a licensed, practicing medical doctor. Documentation of the availability and frequency of consultation must be in written form.
     (b) Record of the examination, screening or assessment, dated and signed by the appropriate medical staff, and additional information provided by the parent(s)/guardian(s), concerning health matters which would affect the child's participation in, or adjustment to, the day care program shall be on file in the center prior to the child's admission. (See Appendix 10 for suggested medical form.)
     (c) In situations where medical services are not available, written verification of appointment to receive needed examination shall be substituted for no more than three months and shall be on file.
     
     (2) Minimum Standards regarding Immunizations
     
     Effective July 1, 1993, each child under five years of age and five year olds who are not enrolled in public/private school kindergarten shall have an unexpired State of Alabama Certificate of Immunization (ADPH-F-IMM-50) on file in the center prior to the child's admission or one of the following conditions shall be meet:
     
     An unexpired Alabama Certificate of medical Exemption (ADPH-F-50) shall be on file in the center; or
     
     Where immunizations are waived on religious grounds, an Alabama Certificate of religious exemption (ADPH-F-IMM-52) shall be on file in the center.
     
     
   • b. Illness and injury
     
     (1) Inspections
     
     (a) No child who appears ill shall be admitted to the center.
     (b) Any evidence of suspected child abuse/neglect shall be recorded in the child's record and reported as required. (See Appendix 13 for reporting form.)
     
     (2) Isolation and removal
     
     (a) Any child in attendance who becomes ill shall be isolated promptly from the group, but shall have continuous supervision by a staff person. Toys, bedding, equipment and bathroom facilities used by an ill child or adult shall be cleaned and disinfected prior to use by another person.
     (b) The ill child's parent(s)/guardian(s) shall be notified immediately and required to come for, or arrange for another designated person to come for the child.
     
     (3) Communicable diseases
     
     (a) When a communicable disease has been introduced into the center, parent(s)/guardian(s) of exposed children shall be notified.
     (b) The center shall urge parent(s)/guardian(s) to notify center when their child is known to have been exposed to a communicable disease outside the center.
     (c) The center shall report any known/suspected case of communicable disease to the local health department.
     
     (4) Readmission
     
     A child who does not appear to be fully recovered from an illness shall not be readmitted to the center without a statement from an attending physician or physician's assistant, that the child is able to return and participate in the activities of the center, or is no longer infectious.
     
     (5) First aid
     
     (a) A copy(s) of any First Aid reference book, current edition, shall be readily available in the center.
     (b) The center shall maintain emergency first aid supplies for minor cuts and abrasions.
     
     (6) Emergency plan
     
     A written description of procedures to be followed in emergency situations shall be developed and known by all staff persons.
     
     (a) The planned source of emergency medical care, such as a hospital emergency room, clinic, or other constantly staffed facility, shall be known to staff and parent(s)/guardian(s).
     (b) A vehicle shall be immediately accessible for use by staff persons in case of emergencies.
     (c) Parent authorization for the center to obtain emergency medical treatment, name and telephone number of physicians designated by parents, telephone number and/or address where parent(s)/ guardian(s) may be contacted, and other emergency telephone numbers including hospital emergency room, ambulance service, rescue squad, fire and police departments, shall be posted by the center's telephone so as to be immediately accessible. (See Children's Records, Section B. 3.)
     
     (7) Authority and procedure for administering medication shall be clearly defined.
     
     (a) When parent(s)/guardian(s) of the child(ren) are unavailable to administer medication, one designated staff person shall be authorized to administer medication.
     (b) Medication and/or special medical procedures shall be administered to a child by the designated staff person(s) only when there is a written, signed, and dated request from the parent(s)/guardian(s).
     (c) Any prescription drug sent to the center shall be in its original container and clearly labeled with the child's name and directions for administering the drug.
     (d) All medication or drugs (children's or staff's members) shall be kept in an area inaccessible to the children and shall be removed when no longer needed.
     (e) provided, in writing, to child's parent(s)/guardian(s).
     
     
   • c. Hygienic practices
     
     (1) Face and hand washing
     
     (a) Children's hands shall be washed with soap and water before snacks and meals, and after toileting. Children's hands and faces shall be washed after meals.
     (b) Staff shall wash their hands with soap and water before food preparation and/or service and after assisting with toileting or diapering.
     (c) Paper towels, or individual single use wash cloths, shall be supplied for each washing.
     
     (2) Toilet articles
     
     (a) A disposable wipe or single use cloth shall be provided each time, for washing hands and face and for diapering. Used cloths or wipes shall be disposed of properly out of the reach of children.
     (b) Each child's toilet articles, (such as combs, or toothbrushes, etc.) shall be labeled with the child's name, stored separately, and maintained in a sanitary condition.
     (c) Facial tissues shall be disposed of immediately following each use.
     
     (3) Extra children's clothing shall be available in the center.
     
     
   • d. Healthy animals, which present no apparent threat to the children, shall be permitted on the premises, unless prohibited under local health ordinances.
     
     (1) A certificate of rabies inoculation shall be on file in the center for animals on the premises, when required.
     (2) Animals on the premises shall be confined. Cages and other areas used to confine animals shall be kept clean, with appropriate food and water available.
     (3) Aggressive animals or breeds of animals that have shown a reputation of aggressive or violent tendencies toward persons, shall not be permitted on the premises.
     (4) Children and staff shall wash hands with soap and warm running water immediately after handling animals.

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