As of May 1st, surveyors are now required to ask 3 additional questions:

1. Do children brush their teeth after snacks?

2. Do children brush their teeth after meals?

3. Is your facility breastfeeding friendly?

Depending on a provider's answers (yes or no) to these questions, a surveyor may add a consultation to the Notice of Survey Findings. The surveyor may discuss good practices for teeth brushing and when to replace toothbrushes. For breastfeeding, surveyors may also discuss how to encourage breastfeeding mothers to continue breastfeeding after enrolled in care.

As of right now, teeth brushing is NOT mandatory for home daycares, but it sounds as if they are heading for some new regulations, teeth brushing being one.


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The Administration for Children and Families (ACF) has come up with some basic standards and are allowing comment until midnight, February 17, 2015. This is a chance for providers to have input in what they are considering the basic requirements for the safety of children. To provide input, email This was published in an article on the Federal Register. The article can be found here.  The article is lengthy, so I've tried to summarize some of the parts that differ from Kansas providers' regulations.


  • All caregivers, substitutes, and family members over 18 (living in the home) have a background check that includes fingerprinting.
  • All caregivers should have training in infectious disease prevention; emergency preparedness; nutrition and age-appropriate feeding; medication administration; and care plan implementation for children with special health care needs.
Healthy Development
  • Require developmental/behavioral screening of all children at the start of care and yearly thereafter. 
Health Promotion and Protection
  • All children with teeth should brush or have their teeth brushed at least once during the hours the child is in care.
  • After diaper changes, record diaper changing and contents/any problems .
  • Washing hands before and after applying creams or giving medication.
  • Washing hands before and after playing in water or swimming activities. 
  • Annual training on exposure to infectious fluids.
  • Apply sunscreen with written parental consent.
  • Children with Special Needs should have a Routine and Emergent Care Plan developed.
Nutrition and Food Service
  • Children with allergies should have a written care plan for avoiding the allergy.
  • Caregivers/teachers should not offer foods that are associated with young children's choking incidents to children under 4 years of age (round, hard, small, thick and sticky, smooth, compressible or dense, or slippery).
  • Infants and toddlers should not have access to the kitchen where food is prepared. 

Facilities, Supplies, Equipment, Environmental Health
  • No electrical devices near a body of water, including a sink or tub.
  • Integrate a pest management program.
  • If the state requires them, carbon monoxide detectors. Detectors must be tested monthly, annual battery replacement, and completely replaced every 5 years.
  • No toy guns

Play Areas/Playgrounds and Transportation
  • All play areas should be enclosed with a fence or natural barrier. Fences should have at least 2 exits, with one being away from a building.
  • Gates should have self-closing latches placed where a child could not open the gate.
  • Fence openings should be no more than 3 1/2 inches apart.
  • Any climbing equipment must have ground cover.
  • Anyone transporting children must be at least 21 years of age.
  • Anyone transporting children must have a clear driving record of no crashes requiring a citation in the last 5 years. 
  • Providers should not use 15-passenger vans whenever possible.

  • Written policies for the following: Lost or missing child, Suspected maltreatment of a child, Suspected sexual, physical, or emotional abuse of staff, volunteers, or family members occurring while they are on the premises of the program, Injuries to children requiring medical or dental care, Illness or injuries requiring hospitalization or emergency treatment, Mental health emergencies, Health and safety emergencies involving parents/guardians and visitors to the program, Death of a child or staff member, The presence of a threatening individual who attempts or succeeds in gaining entrance to the facility.
  • All providers have a sign in/sign out procedure.
  • Updated health assessments in the child's file.
  • Health history completed by the parent/guardian at admission in child's file.
  • Two inspections a year--at least one unannounced.
  • States should post results of complaints for public view.


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         I've been a licensed provider for 5 years now, but I never posted any of the stack of exceptions I had heard about because none of the exceptions applied to me at the time. I just had my survey this week, and I found out about the one exception that was not written into the Lexie's Law changes in 2012 and about a newer exception form that some might not know about since it's so new.

       1.  The one exception that didn't get into Lexie's Law states that providers are allowed to use any child health assessment form instead of only being able to use the KDHE form. I know over the years I've witnessed providers ask other providers if a form from a foster care system or something else was ok instead of making everyone get the KDHE form. If you have this exception posted, you can take forms other than KDHE. If you need to print out this form, you can find it here.

       2. The new exception that might need posted in your daycare became effective March 10, 2014. Before this date, the KDHE health assessment only allowed a doctor or nurse to sign it and not a PA. This new exception form allows a PA to sign the form, which is good because so many doctor's offices have PAs now. If you need to print out this form, you can find it here.

If these don't effect your daycare, you of course don't need them. But, I thought I'd put the information out there because I wasn't aware of these 2 exceptions until my recent survey.


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As of July 1, 2014, providers now need to develop additional emergency plans. These new plans include missing child, chemical release, utility failure, acts of violence/terrorism, or other situations that might require evacuation, lockdown, or shelter in place. See the information here on KDHE's website.

Some surveyors have sent out emails to providers but other areas have not been informed yet of these changes. Providers who have had recent surveys have been told that they have until next year to develop these plans.

Here are some links as you develop your plans. I'll post an example of the ones I developed.

UPDATE: After my survey, I found out that I needed to add something to my evacuation plan. You need to put in your plan the route you will take to your evacuation location so that parents could follow your "footsteps" if needed. (Also, it is ok to transport the kids in an evacuation even if you don't transport. KDHE was told that providers should put the kids in a vehicle and transport if being told to evacuate. Providers don't have to fill out the transportation paperwork [first aid kit, insurance, etc] because it would be an emergency situation.)

I've also been told that the City of Wichita would like to have providers call the police first thing for the missing child. I'm not sure about other police departments. My surveyor didn't say I needed to change anything about how my Missing Child policy was written.

Missing Child: In the event that a child seems to be missing, a thorough search of the home and grounds would be made after making sure that the remaining children were safe. Parents/guardians and police would be notified immediately if the child were not found. Police procedures would then be followed after the police arrived.

If a child does not arrive within an hour of the scheduled drop-off time, the provider will contact parents/guardians if parents/guardians have not contacted the provider to say the child will be late.

Utility Failure: In the event that utilities should fail, the provider will contact the company to see how long until the service is back up and running. If the service will be down for less than 2 hours, the provider will contact parents/guardians to give them the option to pick up their child/children until the service has returned. If the service will be longer than 2 hours, parents/guardians will be contacted to pick up their child (ren).

Chemical Release: In the event of a chemical release, the following steps would be followed if the situation requires the daycare to follow a “shelter-in” procedure:
1.     Move inside immediately if not inside already.
2.     Close and lock all windows and doors.
3.     Turn off all ventilation systems.
4.     Enter and seal a room to prevent air from entering by sealing doors/windows with towels and tape.
5.     Turn on the radio to wait for further instructions.
6.     Stay off the phone lines, as emergency responders will need the phone lines.

If an immediate evacuation is required, the provider has signed up for Emergency Alerts from the City of Andover. The instructions in the alert will tell the provider how to proceed. The provider will take the children’s files with us in the event of an evacuation so that she can contact parents/guardians.

Violent Act/Terrorism: In the event of a violent act or an act of terrorism, the following steps will be taken to keep the children safe:
1.     Make sure all doors and windows are locked.
2.     Gather all the children into the daycare bathroom, which is located away from windows and doors.
3.     Contact parents and police to advise them of the situation.

Evacuation: The provider has signed up for Emergency Alerts from the City of Andover. The instructions in the alert will tell the provider how to proceed. The provider will take the children’s files with us in the event of an evacuation so that she can contact parents/guardians. If the instructions do not contain an evacuation location but evacuation is necessary, the provider will take children to the Fire Station located at 911 North Andover Road.

Lockdown: In the event of a lockdown situation, the following procedures will be followed:
1.     Make sure all doors and windows are locked.
2.     Gather all the children into the daycare bathroom, which is located away from windows and doors.
3.     Contact parents and police to advise them of the situation.

Shelter in place: In the event that it is safer for the provider and children to remain inside rather than evacuate, the provider will keep all children in the basement playroom with her. If the situation is one that requires the provider and children to be away from windows, the provider and children will move to the daycare bathroom. Parents/guardians will be notified to pick up when the situation is safe.


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KDHE is working on a system which will change the way surveys are completed and hopefully help the health departments catch up if they're behind on surveys. This has not been implemented yet, but I was told that it is coming down the pike.  I've included a basic overview of how I understand how the new system should work:

What KDHE will do is look at a certain number of areas on the previous surveys (say 6 items or so) and come up with a mathematical equation on whether or not a provider should get an abbreviated survey or a full survey. For example, if you don't have paperwork issues, supposedly it would show you are a detail-oriented person. Thus, you would likely get the abbreviated survey. 

The supervisor from my health department said those with open complaints at the time of a survey would likely get the full survey. She also mentioned that KDHE will decide--not those at the health department. The local health department can't change it if KDHE decides you get the full survey and the daycare across the street gets an abbreviated. 

If a provider has an abbreviated survey for 2 years, she/he would have a full survey on the 3rd year. 


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I just learned of this, so I am trying to get this out to as many providers as I can before Wednesday.

Ladies, this COMING Wednesday, December 19, 2012 there will be an open meeting of the Health Policy Oversight Committee at 10:00am, 300 South West 10th, Topeka, KS 66612, Room 548-S to discuss Lexie's Law. Please submit your opinions to Representative Brenda Landwehr Send a forward to Iraida Orr at the Kansas Legislative Research Department

Tell them how the law has affected you and your business. Be sure to include the good along with the bad to show we aren't all complaining only. Do you feel consultations should be included in the online notes, possibly misleading parents searching for care? Tell them! What are your thoughts on the state requiring liability insurance? Tell them! How has it impacted you? How is care different day to day? Do you feel that the information about complaints is enough? From my research, all the information given is "completed" or "needs corrections." How does that tell providers or parents the correct information about complaints? 

There have been improvements but also hair-pulling frustrations. TELL THEM!

Please also see some updates and new information here if you haven't already viewed this.


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