Child Care Licensing Rules Guidance

Can children eat in a dine-in kitchen since stoves are accessible to children? Should information such as time and amount of feeding, toileting, sleep patterns, etc. be documented and shared with parents as well as educators? 1240-01-01-.11 Supervision 1240-04-01-.05 Ownership, Organization and Administration Are pacifiers prohibited? In terms of ratios, are they based upon the youngest and oldest in a classroom or the majority? For example, if we have a 2-4 year old room, do we need a child of each age currently enrolled in that class? Can educators be employed by agencies with “sister agencies” and work between the two (2) locations? 1240-04-01-.22 Specific Requirements for Child Care Centers According to Tenn. Comp. R. & Regs. Rules 1240-04-01-.11(8)(a)(2) “…no infant shall be allowed to sleep on a sofa/mattress/soft bed (which would include blankets pursuant to Tenn. Comp. R. & Regs. Rules 1240-04-01-.11(6)(a)(5). In remaining consistent with the definition of infant across all of the rules, the aforementioned rule would bar a twelve (12) month-old from sleeping with soft bedding/blankets. This is reiterated by Tenn. Comp. R. & Regs. Rules 1240-04-01-.14(4)(c)(12), which states that “…a blanket shall be available to each child thirteen (13) months or older.” A plain reading of the language above, coupled with definitions of “Infant” and “Toddler,” means that a twelve (12) month-old child is truly considered twelve (12) months until he or she officially turns thirteen (13) months. Thus, a child who is twelve (12) months-old should be transitioned to a cot or mat, but that same child, until he or she is thirteen (13) months-old, is prohibited from the use of soft bedding/blankets. According to Tenn. Comp. R. & Regs. 1240-04-01.03(3)(c), agencies of different regulatory oversight located in the same building may share space in the cafeteria as long as each group of children has distinct space so they are not intermingled with children of a different age group and each group is provided an adequate level of supervision. In order to prevent injury and to ensure adequate levels of supervision, children of different age groups cannot share playground space at the same time. In instances of cross programming where a child of an older age, at the same time, interacts with younger children in structured activities such as reading mentor, or activities guide, the child care provider must ensure adequate supervision is provided to all children by adult staff. According to Tenn. Comp. R. & Regs. 1240-04-01-.05(5)(d), the health history is required upon admission and can be updated as health / medical conditions change. 1240-01-01-.04 Procedures for Obtaining a License According to Tenn. Comp. R. & Regs.1240-04-01-.16(10)(d)6, "stoves, hot radiators, steam and hot water pipes, fans, or other potentially hazardous items shall be inaccessible to children." Program Evaluators will need to use technical assistance to assist the provider in making other arrangements for mealtime dining if the stove is deemed a safety hazard. The current rule, Tenn. Comp. R. & Regs. 1240-04-01-.02(44) reads, “School-Age Child: A child who has entered kindergarten through seventeen (17) years of age.” Licensing is providing the following clarification as a supplement to that rule; “A child may be considered school-aged during the summer immediately preceding their entry into kindergarten.” This clarification allows for those children enrolled in kindergarten in the summer immediately preceding entry into kindergarten to be grouped as a school-age child for purposes of supervision, etc. Tenn. Comp. R. & Regs. 1240-04-01-.13 do not specifically address sippy cups. Licensing Consultants will use technical assistance to help child care providers understand best practices regarding sippy cups. 1240-04-01-.02 Definitions We follow the suggested center operating hours set by our franchise. This includes early care from 6:30-8:00a; standard hours 8:00a-6:00p, and late care from 6:00p-6:30p. We do not always have children enrolled that attend early or late care, so we are not always operating during those hours. Do we need to have "non-traditional hours" on our license since there is a possibility of being open past 6:00p? 1240-04-01-.13 Food and Food Service Is it still permissible to do an after-hours "Parents Night Out" 1 time per quarter? According to Tenn. Comp. R. & Regs. 1240-04-01-.12(12)(a)(1), “All medications and all preventative products, such as non-prescription diaper cream, sunscreen and insect repellent, shall be received from the parent/guardian by a designated staff person or persons.” The rule is clear in the next section that, “…all preventative products…shall be administered by a designated staff person or persons.” (Tenn. Comp. R. & Regs. 1240-04-01-.12(13)(b)(1)). Thus, staff should be the only individuals handling and administering sunscreen. However, if the children are school-age, children may be able to self-administer the sunscreen if they have appropriate, signed authorization from physicians/parents to do so. However, a school-age child should only administer the sunscreen to his or her own body, and not to another child. Any adverse reaction resulting from application of the sunscreen to the child should be documented and communicated to parents. Yes, non-traditional care provided before 6AM or after 6PM requires prior approval by the Department. Please consult your LC to initiate the request to be approved for non-traditional hours. Demonstrating sustainable agency operations would include, but is not limited to, showing the following elements during licensure visits: completing required training, completing a workable/sustainable budget, achieving and maintaining consistent enrollment of children,completing four (4) in-person monitoring visits satisfactory to the Department, and demonstrating a working knowledge of childcare rules, regulations, and QRIS requirements. Can an agency notify parents of critical violations via an electronic messaging system? According to Tenn. Comp. R. & Regs. 1240-04-01-.13(1)(n)(3), “Microwave ovens and their immediate surrounding area, including cords, shall not be accessible to infants or pre-school children.” And “…School-age children shall use microwaves only under direct adult supervision.” If the microwave or the microwave cords can be accessed / reached by children then it would be impermissible pursuant to the rule. The surrounding area is any space in the area of the microwave that can be accessed by children which would include any area from where the microwave sits to the floor. According to Tenn. Comp. R. & Regs. Rules 1240-04-01-.17(10)(e)(1), an individual designated as a driver for transportation purposes "…"shall pass a drug screening test no later than ten (10) days prior to assuming driving duties." There may be a situation where an individual may not be driving for the agency during the summer months, but that should not trigger the need for a new drug screening before he/she can resume driving duties, so long as the break in driving is scheduled and self-controlled. Additionally, Tenn. Comp. R. & Regs. Rules 1240-04-01-.17(10)(e)(6) states that, "Based on reasonable suspicion, the Department may require that a driver have a drug screening test." This allows both the provider and the Department to take action when and if they feel it necessary to check on the sobriety of an employee/driver. The child care agency should ask the parent to return and complete sign in or out procedure per licensure rule 1240-04-01.11(e). 1240-04-01.13 Food and Food Service According to Tenn. Comp. R. & Regs. 1240-04-01-.06 et al. and 1240-04-01-.07 et. al, staff must adhere to specific requirements of training and background checks before working at any agency. The practice of moving employees between licensed centers is permissible so long as the agencies share the same FEID number, the category of care has not changed, and there has not been a break in employment that would require a new background check pursuant to Tenn. Comp. R. & Regs. 1240-04-01-.07 et al. 1240-04-01-.12 Health and Safety The written transition plan requires a "name to face roll call when transitioning children to and from the classroom." Do you only just need to say their name and look them in they eye? Should there be a list or roll to follow to make sure you have those specific children. Does this require calling each child by name or counting off the children? Yes, any service provider entering a child care agency needs to sign in and out every time they enter and leave a child care agency. According to Tenn. Comp. R. & Regs. 1240-04-01-.08(3)(c)(4), “Documentation signed by the examining licensed physician…verifying that the staff person is physically, mentally and emotionally capable of safely and appropriately providing care for children in a group setting…shall be on file within ten (10) calendar days of employment or work start date.” This is one time unless, according to Tenn. Comp. R. & Regs 1240-04-01-.06(3)(e)(1), there is reasonable cause/suspicion that a staff person is unable to satisfactorily perform their job duties, at which time the agency may “…obtain physical/mental health evaluations to determine their ability to satisfactorily perform their job duties.” According to Tenn. Comp. R. & Regs. 1240-04-01-.12(14)(a), “Firearms shall not be permitted on the premises of a child care agency, in any vehicle used to transport children or in the presence of a child.” If it is a personal residence, the rules further clarify, “In a private residence, firearms, other 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.” (Tenn. Comp. R. & Regs. 1240-04-01-.12(14)(d)(1)). A potentially hazardous item, including a deadly weapon, housed in a private vehicle, on the premises of a child care agency that is not a private residence, would be prohibited pursuant to state licensure requirements. Providers should consult their own legal counsel if they have additional questions. What qualifications does a security guard have to meet to carry a firearm in the agency? Is there a place that I can find the specific communicable diseases that the staff should be getting tested for as a new hire? According to Tenn. Comp. R. & Regs. 1240-04-01-.5(3)(a)1.2.3.4, those documents may include: "complete and accurate record of payments received; children’s attendance; a record of food served for each program in which the child care agency participates; and any other records required by the Department or any other child care agency for reimbursement for the child’s care and/or feeding." According to Tenn. Comp. R. & Regs. 1240-04-01-.05(9)(b)2, each child care agency is responsible for establishing and communicating to each family their policies and procedures regarding release of children from the care of the child care agency. Child care licensing rules do not specify an age requirement; however, it is best practice to release a child to someone who is responsible and with whom the child is familiar. 1240-04-01-.06 Staff Are children who arrive and depart to and from the agency via child care agency transportation services required to be signed in and out of the classroom by the teacher or agency designee? The temperature range is a recommendation; however child care agencies must always keep the health and safety of children as a primary consideration. Find heat and cold weather safety guidelines at: www.weather.gov DHS rules provides that staff shall be screened and/or tested for all communicable diseases “as required by the Department of Health prior to having contact with children . . .” Please reach out to your local health department with any specific questions on what specific screenings they recommend for these staff. What is the qualification for a family home educator when the primary educator is out? Can a noise machine be attached to a crib? According to Tenn. Comp. R. & Regs. 1240-04-01-.12(9)(b), all staff shall obtain first aid and CPR training within ninety (90) days of employment and at least one staff member with current certification in CPR and first aid must always be on site. This requirement is currently in place and effective and must be followed by all child care agencies. The requirement ensures that a director is on site a sufficient amount of time to know what is happening at the agency and to be able to monitor it. Regarding reporting hours for salaried directors, your staff records should already include your time in and out each day (see Rule 1240-04-01-.08 Staff records). Questions regarding specifics scenarios on leave should be directed to your LC and may be addressed on a case by case basis. Does a person providing speech therapy services for a child at the agency have to sign in/out each time they visit? The family home educator should be familiar with policies and procedures and should otherwise meet the qualifications of the position such as staff records requirements, education, background checks, etc. How often does the child’s health history need to be updated? Does the Department expect providers to report to the DHS child care complaint hotline anytime a DCS referral is made on a child, even if it is regarding allegations of abuse or neglect at home and unrelated to any occurrence at the child care agency? Why were QRIS bonus amounts removed? Have the amounts changed? Is there a way to know what the amounts are/ will be going forward? How would one know if they are receiving correct amounts going forward? According to Tenn. Comp. R. & Regs. 1240-04-01-.08(2)(f), certain “…information shall be documented and shared with all educators of an infant, toddler or non-verbal child during the day.” While that requirement is specific to the sharing of information between educators, Tenn. Comp. R. & Regs. 1240-04-01-.05(9)(e) states, “The child care agency shall have ongoing communication with parents/guardians to include curriculum, changes in personnel and any changes affecting children’s routine care.” Licensure encourages and recommends providers to work with parents/guardians to communicate as often and as transparently as reasonably possible. Are new employees required to have CPR and First Aid certifications upon hiring, or is there a "grace period" for them following their hire date? Yes, your actual roll/ class list would need to be utilized to accomplish the name-to-face roll call. You would need to use this list to ensure that you are accounting for all children in the classroom. According to Tenn. Comp. R. & Regs.1240-04-01-.13(2)(f), “children shall not be permitted to wear teething necklaces, pacifiers, or any item around their neck or attached to their clothing that are potentially hazardous and associated with choking" and strangulation, even with a doctor's note. Such items may be a parent's choice at home, but such items would put the child care provider in violation of licensing rules and cannot be allowed at the facility. Child care agencies are encouraged to apply best practices and educate parents about ways to protect their children. Health and safety guidance and best practices cand be found at the American Academy of Pediatrics website. Does the definition of a school-age child include those “enrolled” in kindergarten, or truly those who have “entered” kindergarten? Are standing diaper changes in the bathroom acceptable for a two (2) year old child? Can school-age children wear a necklace? Is an agency allowed to have scarves, neck ties, necklaces, etc. in the dramatic play area for school-age children? The specific bonus amounts were removed from the rules to reflect the fact that the Department may need to adjust those amounts based on fund availability from year to year. The specific bonus amounts will be publicized and made available to child care agencies. According to Tenn. Comp. R. & Regs. 1240-04-01-.11(3), agencies can address this in the mealtime supervision plan. Depending upon the activities in the classroom, when there are two (2) educators in the classroom, it may be appropriate for one educator to focus on children who are finished eating and the 2nd educator to focus on children who have not finished eating. Current child care licensing rules do not regulate the use of bottle warmers; how should Program Evaluators address the use of bottle warmers in classrooms? 1240-04-01-.11 Supervision Can an individual leave a gun in their own personal vehicle at a child care agency? Are different classrooms within the same agency able to use ratios from different charts? Is bleach water still considered a disinfectant for tables/toys and bodily fluids? Bleach water, when mixed correctly, serves as a disinfectant. You must have at least one child enrolled in the classroom at each age of the ratio range. Can a microwave be placed in a classroom? End of Worksheet 1240-04-01-.03 Requirements for Licensure as a Child Care Agency 1240-04-01-.11 Supervision Can a new director at an exisiting agency complete the New Director Academy instead of Small Business Academy? I would like to know if I can get some clarification on the required list of communicable diseases versus a DHS created list. Is there a threshold when these are to be reported? Is it always after 2 cases per classroom, or does it differ and can sometimes be only one case? I am not able to find any clarification on this so any is appreciated. Are children allowed to wear an amber necklace with a doctor’s note? Can I rent a van for a field trip? Can an infant sleep on a cot or a mat with a blanket? Yes, you may do that so long as the ratios align with the enrollment in the classroom. 1240-04-01-.13 Food and Food Services Can an agency take the children outside if the temperature is not within the temperature ranges of thirty - two (32) and ninety - five (95) degrees? A standing diaper change is acceptable for a two (2) year when it is done on a non-porous surface and the surface is cleaned after the standing diaper change Is a necklace, scarf, etc. allowable if it is considered cultural or religious? At meal time, if two educators are in the classroom, is one educator allowed to get up or are they both required to remain seated during the entire meal service until all children are finished eating? Example: At the end of the meal service, you have a few slow eaters and all other children have finished eating are becoming restless at the table. Can one educator get up and assist the children with handwashing, etc. while the other educator stays seated while the children finish eating? Does no smoking within fifty (50) feet of the child care agency entrance refer to the main entrance, all entrances that children use or all entrances of the building? All vehicles utilized by a child care agency which are designed to carry ten (10) or more passengers shall conform to all Federal Motor Vehicle Safety Standards (FMVSS) governing either “large” school buses or “small” school buses. According to Tenn. Comp. R. & Regs. 1240-04-01-.13 (2)(f), “Children are not permitted to wear pacifiers or any item around their neck or attached to their clothing that are potentially hazardous and associated with choking.” A child may have a pacifier that is not attached to clothing or around the neck, however, Caring For Our Children, 4th Edition, does not recommend pacifier use outside of a crib where there are mobile infants or toddlers. Mobile infants or toddlers may try to remove a pacifier from an infant’s mouth, put it in their own mouth, or try to reinsert it in another child’s mouth and these behaviors can increase risks for choking and/or transmission of infectious diseases. Use of a pacifier should be at the reasonable discretion of the provider and when there is adequate supervision to ensure that the pacifiers are handled safely when in use. Shift care is allowed as long as the following have occurred: The provider has registered with the Department the hours of operation that include all shifts The provider must maintain ratios and allowable capacity for each shift including drop-off, pick-up so there is no overlap The provider may never exceed their allowable capacity for any given “shift” If the provider has registered as having shifts, at least one quarterly monitoring visit must be conducted during the non-traditional shift hours According to Tenn. Comp. R. & Regs. 1240-04-01-.09(1)(d),"incidents; accidents; injuries and signs of serious illness to children shall be documented immediately." 1240-04-01-.09 Incident Reporting If a child has a food allergy, such as milk, and a physician’s note is on file stating that the child can have water, is the agency required to provide a milk substitute? Is sunscreen considered preventative medicine? How should it be applied? Can agencies of different regulatory oversight, such as Head Start, Department of Education Pre-K programs and YMCA programs located in schools, share playground and cafeteria space? Armed security guards/officers must meet all registration and training requirements as set forth in Tennessee Code Annotated, Title 62, Chapter 35 for providing security or patrol services at or in a public school, public charter school, private school, or church-related school. According to Tenn. Comp. R. & Regs. 1240-04-01-.11(8)(a)6, "mobiles and other toys that attach to any part of the crib are prohibited." Are aromatherapy diffusers allowed in the classroom? 1240-04-01-.07 Criminal Background Check and State Registry/Records Review Procedures According to Tenn. Comp. R. & Regs.1240-04-01-.09 (1) (f), a serious incident includes reports made to the Department of Children’s Service’s; however, child care providers should only report referrals made to DCS if it is *related* to an occurrence at the child care agency.  The idea would be that DHS would only be concerned with referrals that potentially affect the operations of the child care agency, and not incidents in the home or otherwise Can children carry a sippy cup with them throughout the day? 1240-04-01-.14 Equipment for Children What type of records would agencies need to maintain for auditing purposes? According to Tenn. Comp. R. & Regs 1240-04-01-.14(1)(b)," there shall be developmentally-appropriate equipment and furnishings for each age group enrolled." Agencies should use discretion and best practices in allowing these materials for school-age children. Caring For Our Children, 4th Edition recommends the removal or shortening of handles and straps on purses/bags; children under the age of three (3) years should not be allowed to use materials around the neck and those three (3) years of age and older should be supervised. According to Tenn. Comp. R. & Regs. 1240-04-01-.13(4)(a), expectations for child care agencies are outlined. Child care licensing rules do not require parents to provide food that is in accordance with the USDA guidelines; however, child care agencies can provide supplements to meet USDA guidelines or encourage parents to provide meals that meet their health expectations. What is the Department’s requirement for biometric fingerprint scans or an electronic sign in and out system? Does a staff driver need to submit an additional drug screening if he or she does not drive during the summer months, but remains employed by the agency? How often is the drug screening required? 1240-04-01-.08 Record Keeping According to Tenn. Comp. R. & Regs 1240-04-01-.12(1)(2), "child care agency staff is responsible for the health and safety of the children in care and should ensure the environment and practices support health child health and safety." If a child care agency decides to use an aromatherapy diffuser within the classroom setting, the health, safety and well-being of children should be considered and the following assessed: possible allergies and / or allergic reactions, children’s access, parental authorization and responsibility and accountability for the diffuser. What is the age limit on the person whom the parent authorizes the agency to release the child? How do we make sure staff are mentally able to work? How do we determine this? Do practicum students need to have background checks? According to Tenn. Comp. R. & Regs. 1240-04-01-.11 (2)(e), “Child care agencies shall maintain a daily sign-in and sign-out sheet that includes…Space for printed name and signature of parent/guardian or authorized representative.” If the electronic system does not have the capability of allowing an electronic signature, each person signing the child in and/or out should have a unique code or identifier and the agency shall maintain a list of all codes/identifiers on-site at all times. The agency must have a secondary plan in the event of power failure or system failure. The system should have the capability to print and retrieve records from prior dates. According to Tenn. Comp. R. & Regs.1240-04-01-.13(1)(n)7, the use of bottle warmers is not prohibited, but is not recommended by the Department.” All heated bottles shall be checked for safe temperatures before serving. Program Evaluators will provide technical assistance on best practices for warming bottles. 1240-04-01-.16 Physical Facilities Sometimes a parent at drop off or pick up forgets to sign their child in, or they put a time without name or name without time or print name but don’t sign. Staff will notice and will document so that they have record the child is there and who brought them. How should staff handle that documentation to stay in compliance if a parent fails to sign their child in or out? The Department of Health maintains the list of required reportable communicable diseases. Please reach out to your local health department with any specific questions on information that must/needs to be reported. Do parents have to provide a meat, a dairy, a vegetable, a fruit, and a grain in their child’s lunch? According to Tenn. Comp. R. & Regs. 1240-04-010.13(4)(a), if the child care agency provides food, it shall be in accordance with the USDA’s Child and Adult Care Food Program (CACFP) nutritional guidelines. A note from a parent, guardian or physician giving direction for an individual child should guide what is provided to that child. Find USDA Standards at: https://www.fns.usda.gov/cacfp/child-and-adult-care-food-program Parents Night Outs are not addressed in rules but are addressed in statute – these are permissible up to 12 times per year with certain limitations. Please reach out to your LC if you have specific questions about those limitations Violations points are taken off the score at different times depending on the type of violation. The two new pieces added to the rules in this revision provide that for critical violations, a deduction will be made from the final visit score and for an agency that has not completed all training requirements, points will be deducted from the annual quality rating improvement score before posting. Please clarify the conditions for Shift Care. For children’s health and safety, children should not be exposed to smoking or spaces where smoking occurs. For best practices, smoking is not allowed within fifty (50) feet of entrances that children use. 1240-04-01-.15 Program, Language and Literacy 1240-04-01-.17 Transportation To meet the defiintion of a practicum student, all practicum students must meet the same background check requirements as regular staff prior to beginning their duties. 1240-04-01-.20 Specific Requirements for Family Child Care Homes According to Tenn. Comp. R. & Regs. 1240-04-01-.13(2)(f), “Children shall not be permitted to wear teething necklaces, pacifiers, or any item around their neck or attached to their clothing that are potentially hazardous and associated with choking.” However, accommodations made for religious or cultural purposes may implicate federal protections that would be outside the scope of these FAQs. Providers should consult their own legal counsel if they have additional questions. Yes, a new director at an exisiting child care agency can complete New Director Academy in place of Small Business Academy. Small Business Academy is requred for new directors at new child care agencies. According to Tenn. Comp. R. & Regs. 1240-04-01.11(2)(e), "child care agency staff shall sign children in and out of the child care agency only when transported to and from the child care agency by the child care agency’s transportation services or local school transportation system and no parent / guardian or authorized representative is present." Teachers need to know which children are assigned to them and present in their classroom. The agency can use an electronic messaging system in conjunction with the licensing requirement as long as the agency can provide documentation that each parent observed and read the document. This information is included in the TDHS sample Child Care Provider Medical Report that is signed by a health professional. If an agency utilizes this form, the completion of the form with signature satisfies the rule requirement. According to Tenn. Comp. R. & Regs. 1240-04-01-.11(3)(a)(b), "an adult must be in the direct sight and sound of children ages six (6) weeks through five (5) years, not in kindergarten, while the child is eating. Also, direct supervision of children by the educator is required anytime the children are eating; the educator shall not be engaged in other activities while children are eating." On page 4 of the Quality Rating System guidelines under section 8 it talks about violations and scoring. If you have a single critical violation according to section B it states points off next visit. Section C states points off Final visit. And section D states at conclusion points will be taken off final score. How does that work exactly? Will each violation be counted off at 3 separate occasions? (During that visit or next, and final visit, and off final score). The new rules and regulations state that the director must be on the premises 50% of the time. How will these hours be monitored? Do salaried directors need to clock in and out to provide verification? Will accomodations be made for extended leave periods? Is the child care agency required to maintain documentation of the reporting of incidents? How often is staff required to update their physical examination on file? Do we have to document and save proof of name to face roll call? I could not find that documentation was required when I looked at licensing and QRIS rules. The rules do not require that you document name to face roll call but is a best practice to document the completion of name to face roll call for your agency records. What constitutes demonstrating a sustainable agency for purposes of the rule requirement to obtain or maintain licensure? Please clarify the terms ‘direct supervision’ and ‘supervision’ as used in the rules regarding supervision at mealtime.