Environmental Child Care Program

1. Environmental Child Care Program An Overview

2. Discussion Points Types of facilities/licensing status DHSS Environmental Child Care Program Interaction between ECC and LPHAs Inspection considerations Sanitation issues unique to child care

3. Regulated Child Care in Missouri • Family Homes • 10 unrelated kids • Usually in-home • Fewest requirements

4. Regulated Child Care in Missouri • Group Homes • 11 to 20 kids • Occasionally in-home • Moderate requirements

5. Regulated Child Care in Missouri • Centers • 21+ kids • Commercial setting • Most stringent rules

6. Regulated Child Care in Missouri • License-Exempt • Religious organizations • Nursery schools • Capacity varies • Very little difference in sanitation requirements versus child care centers • Sanitation requirements are based on capacity

7. Unregulated Child Care in Missouri Homes with up to four unrelated children Summer camps Businesses for convenience of customer Facilities operated by school systems Registered providers

8. Regulated Child Care in Missouri Child Care Licensing Specialist Visits (Safety, supervision, proper documentation) + DPS Division of Fire Safety inspections + DHSS Environmental Child Care Program sanitation inspections = Licensing status determined by the DHSS Section for Child Care Regulation

9. Environmental Child Care Program • Authority: RSMo 210.201 to 210.278 • RSMo 210.252 “All buildings and premised used by a child-care facility to care for more than four children except those exempted from the licensing provisions of DHSS pursuant to subdivisions…shall be inspected annually for fire and safety by the state fire marshal, the marshal’s designee or officials of a local fire district and for health and sanitation by DHSS or officials from the local health department.”

10. Environmental Child Care Program Licensing status is evaluated by the DHSS Section for Child Care Regulation (SCCR) Evidence of compliance with sanitation/fire inspections is required to remain in good standing for licensure

11. Environmental Child Care Program The ECC program is located in the Division of Community and Public Health in the Section for Environmental Public Health in the Bureau of Environmental Health Services

12. Environmental Child Care Responsibilities • Conduct all Initial Inspections • New, Change of Ownership, Change in category, addition of space, etc. • Conduct Special Circumstance Inspections • Conduct all inspections in counties that do not have a contract or an EPHS • Conduct contract monitoring • Review of inspections submitted • Quality Improvement Evaluations

13. Environmental Child Care Responsibilities • Train new local public health agency EPHS’ • Must inspect at least six facilities • Provide annual mandatory training for all inspectors • Conduct all Lead Risk Assessments • Provide guidance for LPHA EPHS

14. Environmental Child Care Contract • The DHSS retains a Participation Agreement with Local Public Health Agencies to conduct annuals/renewals, re-inspections, and some special circumstance inspections. • LPHAs conduct these inspections in all counties except Dent, Lincoln, and Greene.

15. LPHA EPHS Responsibilities • Conduct annual and special circumstance child care inspections in response to receipt of inspection request from SCCR or BEHS • Conduct one reinspection as necessary per inspection request

16. LPHA EPHS Responsibilities • Notify DHSS District EPHS for: • Suspected lead hazards • Conducting more than one reinspection • Technical advice • Compliance issues

17. Inspection Considerations • Annual/Renewal inspections must be conducted by the due date on the inspection request • Completed inspections must be submitted to SCCR within 10 days • Most reinspections should occur within 30 days of the annual inspection

18. Inspection Considerations • Inspections must be unannounced • Try to arrive as to observe food prep or serving • Avoid 1-3 PM when possible • Observed violations must be documented • Must achieve 100% compliance before approval is given.

19. Inspection Considerations • Be aware of differences in requirements between licensing categories • Be considerate when inspecting a provider’s home • Utilize district staff

22. Sanitation Inspection Issues Unique to Child Care • No lead hazards • LBP • Recalls

23. Sanitation Inspection Issues Unique to Child Care • No high hazard cross-connections • Hose attached to mop sink • Kitchen sink spray nozzle • Boiler

24. Sanitation Inspection Issues Unique to Child Care • Toxics • Medicines and toxics inaccessible • Stored to prevent food contamination • Toxic/poisonous plants

25. Sanitation Inspection Issues Unique to Child Care • Hot water at 100-120 degrees Fahrenheit • Can utilize mechanical mixing valves, hot water stops, or other tempering devices

26. Sanitation Inspection Issues Unique to Child Care • Pets • NO reptiles • Animals in good health • Documentation for dogs, cats, parrots • No pets in food prep area • Poop patrol

27. Sanitation Inspection Issues Unique to Child Care • Water Supply • Sewage System • On-Site Systems must function properly • All lagoons must be fenced

29. Sanitation Inspection Issues Unique to Child Care • Hand washing • BEFORE: preparing, serving, and eating food, glove use • AFTER: toileting, diapering, assisting with toileting, nose blowing, handling raw food, glove use, cleaning and sanitizing, outdoor play, handling animals, eating, smoking, and as necessary • Children, including infants, must be taught good hand washing practices

30. Hand Washing • During the annual inspection the EPHS must emphasize the importance of hand washing. If hand washing is not observed, staff must demonstrate. • Sanitizing hand gels and commercially prepared wipes cannot be used as a substitute for hand washing. These items may be used on field trips when soap and water are not available. • Hand sanitizing gels may be used in addition to hand washing.

31. Sanitation Inspection Issues Unique to Child Care • Food exemptions in Family Homes: • Date-Marking not required • Bare hand contact not prohibited • Unapproved food sources may be present for personal consumption but not served to children in care

32. Sanitation Inspection Issues Unique to Child Care

34. Sanitation Inspection Issues Unique to Child Care

35. Sanitation Inspection Issues Unique to Child Care • Dishwashers: • Family Homes—Residential W/R • Group Homes—Residential or Commercial W/R/S • Centers—Commercial W/R/S

36. Sanitation Inspection Issues Unique to Child Care • CIP W/R/S after each use: • Diapering surface • Food contact surfaces • Potty chairs

37. Sanitation Inspection Issues Unique to Child Care • CIP W/R/S daily: • Sinks • Toilets • I/T floor*

38. Sanitation Inspection Issues Unique to Child Care • W/R/S as needed: • Surfaces (walls, floors, toys*, etc.) contacted by bodily fluids • Food equipment • Laundry

39. Sanitation Inspection Issues Unique to Child Care • I/T food prep sinks: • Labeled and used for food/bottle preparation only. • At least 18” (spigot to rim) from any hand washing sink.

40. Sanitation Inspection Issues Unique to Child Care • I/T Units: • Hand washing sinks shall be used for hand washing only. They shall not be used for any other purpose such as rinsing bottles, pacifiers, toys or other items that children may mouth. • Toys that have been mouthed or contaminated by bodily fluids must be inaccessible to children until they are washed, rinsed, sanitized and air dried.

41. DIAPERING AREA • No quilted/textured diapering surfaces • Hand sink within 3’ • Soap/paper towels at sink • Supplies in area/not accessible to children • Soiled diapers stored/disposed of properly • Cloth diapers handled properly • No food related items/activity

42. DIAPERING PROCEDURE • Make sure all supplies are accessible • Hold child away from body • Remove soiled diaper and clean child • Place clean diaper on child • Wash your hands then child’s hands • Wash/ rinse/ sanitize diapering surface • Wash hands

43. Questions?