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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