(1)  Children's Health Records 





        (A)  Before a preschool child older than eight 


weeks is accepted for care, he/she must have proof of being 


age-appropriately immunized against the following diseases:  


diphtheria, tetanus, pertussis, polio, measles, mumps, 


rubella, and haemophilus influenza type B by having a 


certification form signed or stamped by a certified health 


care provider.  (Children six through eight weeks may be 


enrolled before immunizations are begun.) 





        (B)  Records of children older than 18 months must 


state whether immunizations required for care are complete, 


and if not complete, when future immunizations will be 


given.  If immunizations are not continued on time by the 


parent, the child must not remain in care.  If a child has any 


known allergies, they must be indicated in the child's health 


record.  Foreign-born children must also present evidence of 


tuberculosis screening.  (See Appendix B for information 


about TB screening.) 





        (C)  A copy of each infant/toddler's or preschool 


child's immunization record must be on file in the child care 


center and available to the appropriate staff.  (Children six 


through eight weeks of age may be enrolled before 


immunizations are begun.) 





        (D)  Exceptions to requirements (a) and (b) of this 


section may be made only if: 





                1.  The child's physician or the health 


department provided a signed and dated statement, giving a 


medical reason why the child should not be given a 


specified immunization; or 





                2.  The child's parent provides a signed 


written statement that such immunizations conflict with 


his/her religious tenets and practices. 





        (E)  Before an infant or toddler is accepted for care, 


the parent must have proof of the child's physical 


examination within three months prior to admission, signed 


or stamped by a physician or health care agency.  Each 


infant must have on file an official health record of the first 


medical checkup at eight weeks of age. 





        (F)  Before a school age child is accepted for care, 


the center must have on file a statement from the parent (or 


school) that the child's immunizations are current and that 


his/her health record is on file at the specified school which 


the child attends.  The statement must indicate whether 


immunizations are complete and, if not complete, when 


future immunizations must be given so that the child will be 


protected. 





        (G)  Each school age child must have a health 


history on file at the center, and it must be available to the 


appropriate staff.  If a child has any known allergies, they 


must be indicated in the child's health record. 





        (H)  If children with mental, physical or other 


impairment or with a medical disorder are enrolled, their 


health records must include a physician;s statement which 


identifies the condition and which gives the physician's 


special instructions for the child's care. 


 


(2)  Children's Health 





        (A)  Children must be checked upon arrival and 


observed for signs of communicable disease during the day.  


Accidents and injuries to children must be noted in their 


records, including date and time occurred, description of 


circumstances, and action taken by caregivers.  Injuries of 


more than a minor nature, fevers over 100¡F, and other 


serious illness must be immediately reported to a parent.  


Any child showing or developing symptoms of fever or 


diarrhea or other symptomatic illness must be excluded 


from the group until the parent can call for him/her, or until 


other arrangements can be made for care elsewhere.  


Impetigo and diagnosed strep must be treated appropriately 


for 24 hours prior to readmission to the center.  Children 


having scabies or lice must show proof of treatment to be 


readmitted.  The center can provide care and/or isolation for 


a child with a contagious condition only upon written 


instructions of a licensed physician or certified health care 


provider. 





        (B)  Parents of every child enrolled must be 


notified immediately if one of the following communicable 


diseases has been introduced into the child care center:  


hepatitis A, foodborne outbreaks, (food poisoning) 


salmonella, shigella, measles, mumps, rubella, pertussis, 


polio, haemophilus influenza type B, meningococcal 


meningitis.  Occurrences of any of the above diseases must 


be reported to the local health department. 





        (C)  Prescribed and non-prescribed, internal and 


external medication must not be administered to a child by 


center staff except under the direction of a physician or with 


the parent's written authorization.  Medications or drugs 


must be labeled with the child's name and specific 


instructions for administering them.  Administration of 


medications and noticeable side effects must be charted and 


reported to parents.  Medication must not be handled by 


children. 





        (D)  All medicines, prescription and 


nonprescription, must be made inaccessible to children by 


storing them in a locked compartment or container.  If 


medicine requiring refrigeration is kept in a refrigerator 


used for food storage, the medicine must be put in a leak-


proof locked container.  Keys for these compartments must 


be inaccessible to children. 





        (E)  Individual disposable tissues must be available 


for wiping noses.  Used tissues must be disposed of 


promptly, and hands must be washed. 





        (F)  Disposable wipes and towels are preferable, 


but if cloths are used, they must be laundered after each use.  


Cloth towels must be labeled with children's names if used 


more than once. 





        (G)  If toothbrushes are used, they must be labeled 


with the children's names.  They must be stored to air dry 


without contact with other toothbrushes.  If toothpaste is 


used, care must be taken for sanitary dispensing. 





        (H)  If combs and brushes are used, each child 


must have his/her own which must be labeled and stored in 


labeled containers. 





                        (i)  There must be no smoking in 


the presence of children. 





        (J)  Each child must be allowed to form his own 


patterns of sleep.  The child must not be left in ac rib or on a 


cot for an unreasonable length of time after his/her rest is 


completed. 





        (K)  Children must not be forced to sit on the potty 


of toilet for more than 5 minutes. 





        (L)  Toilet training must never be begun 


immediately upon admission of the child to the center.  


Toilet training must be delayed until the child is adjusted to 


staying at the center and is able to understand, cooperate, 


and communicate his/her need to use the bathroom. 





        (M)  Children must be diapered and cleaned when 


wet or soiled. 





        (N)  Diapering must be done in a designated area 


that is off the floor, on a washable surface, and located near 


a handwashing lavatory.  The diapering area must not be 


located in a food service area. 





        (O)  The diapering surface must be covered with 


paper that can be disposed of after use with each child, or it 


can be cleaned with soap and friction immediately after use 


and before using with another child. 


 


(3)  Staff Health 





        (A)  Before beginning to work, all staff members 


must have on file written evidence of a physical 


examination and statement that their general physical and 


mental condition will permit them to direct and actively 


participate in the activities of a group of young children.  


The form or statement must have the signature or stamp of a 


licensed physician, a certified nurse practitioner, or a 


certified physician's assistant. 





        (B)  An updated statement of each staff member's 


physical health must be obtained every third year or more 


often if deemed necessary by the Department.  A statement 


of mental or emotional health must be obtained from a 


psychiatrist or clinical psychologist when deemed necessary 


by the Department. 





        (C)  Each staff member (whether employed full-


time or part-time), volunteers and others who are in contact 


with the children 30 or more calendar days per year must 


have on file evidence of a tuberculin test or chest x-ray with 


negative results, in accordance with Department of Health 


recommendations.  (See Appendix B.) 





        (D)  For the protection of children and adults, 


caregivers and helpers must wash their hands under running 


water immediately after changing a child's diaper, or aiding 


in toileting, before changing or aiding another child, after 


personal toileting, and before handling food. 





        (E)  For the protection of children and adults, when 


blood is to be handled (e.g., resulting from injury to a child 


or adult, from nosebleed, or from spillage), vinyl or latex 


gloves must be used and properly disposed of following use 


with/by one individual. 





        (F)  Following a diaper change or blood spillage, 


surfaces must be cleaned and sanitized with a solution of 1/4 


cup chlorine bleach to one gallon of water. 


 


(4)  Safety 





        (A)  At least one staff member who has completed 


the basic CPR course must be on duty at all times.  The 


course must be a minimum of 3 hours and must be taught by 


a qualified instructor. 





        (B)  At least one staff member who has completed 


a first aid course within the last three years must be on duty 


at all times.  The course must be a minimum of three hours 


and must be taught by a certified instructor. 





        (C)  A first aid chart must be posted, and caregivers 


and helpers must be familiar with its contents. 





        (D)  A first aid kit containing a thermometer, 


bandages, and other items listed in Appendix C must be 


available to the staff. 





        (E)  Firearms must not be on the premises of a 


child care agency.  Kitchen knives and other potentially 


dangerous utensils or tools must be secured so that they are 


inaccessible to children. 





        (F)  Emergency telephone numbers must be posted 


next to the telephone and readily available to any staff 


member as follows:  fire department, police 


department/sheriff, hospital, child abuse hotline, civil 


defense/emergency management, and numbers where 


parents can be reached.  Rescue squad, ambulance, and 


poison control center telephone numbers must also be 


posted if available in the community. 





        (G)  Suspected child abuse or neglect must be 


reported immediately to the local Department of Human 


Services office.  Failure to do so is, by itself, grounds to 


deny or revoke the agency's license. 





        (H)  1.  A child care provider shall protect the child 


by knowing the identity of the person(s) entitled to custody 


of the child and by requesting the identity of any 


investigator of child abuse or neglect.  An investigator may 


take a child off the premises of the agency if he/she has 


obtained custody of the child through voluntary placement 


agreement with the parent, through court order or through 


emergency assumption of custody under T.C.A. ¤ 31-1-113 


without parental permission, or if the child's parent or 


guardian approves, or in conjunction with investigative 


procedures under the child abuse laws. 





                2.  A parent/guardian must be notified 


before the child leaves the premises except as described in 


Part 1, or because of emergency circumstances. 





                        (i)  Staff must be reasonably 


prepared to protect children in the event of a disaster and to 


cooperate with the local Emergency Management Plan.  The 


Department will provide information regarding the agency 


to contact concerning this.