Health and Safety Standards for the Early Intervention Program

Table of Contents

List of Appendices

Purpose

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The purpose of this document is to provide guidance to providers, which include agencies, individuals and municipalities, approved to participate in the New York State Department of Health (NYSDOH) Early Intervention Program (EIP), for the delivery of EI services in a manner that protects the health and safety of children receiving EI services. The standards are intended to ensure that all services delivered to children with disabilities and their families are of the highest quality with regard to health and safety. The standards are prevention-oriented and responsive to the needs of children and families receiving EI services. Compliance with these standards ensures that the health and safety of children are protected.

EI services can be delivered in a range of settings such as providers facilities, as well as natural environments, including children's' homes, child care sites, or other community settings. The location of services should be decided jointly by the family, providers and the EIO as part of the Individualized Family Services Plan. The health and safety standards for EI providers described within this document address the general standards with which all providers must comply, as well as standards providers must follow in facility, community and home settings. Additionally, EI providers may deliver services to children in groups in a facility or community setting.

For purposes of this document, a facility setting is defined as a site that the provider owns, rents, or leases for the provision of early intervention services. For example, a provider's home office is considered a facility. A community setting is defined as a setting in which children under three years of age are typically found. Examples of community settings include libraries, YMCAs, or day care centers other than those located at the same premises as EI providers and family day care homes. A home setting is defined as the child's or caregiver's home. EI providers may provide EI services in one or more of these settings and must comply with the health and safety standards appropriate to the type of provider and to the service setting.

These standards are based upon the requirements in New York State Public Health Law (NYSPHL) and EI regulations related to heath and safety, including:

  • Section 2550 of the NYSPHL requires NYSDOH to establish standards for evaluators, service coordinators, and providers of early intervention services.
  • 10 NYCRR 69-4.9(d), (e) and (f) state that providers of early intervention services shall maintain physical plants that comply with standards promulgated by the approving state early intervention service agency, meet all applicable health and safety codes (including local health and safety codes), and ensure a safe environment for eligible children, including when services are delivered in the providers' homes or offices. The providers shall also have policies to address health, safety, and sanitation issues submitted as part of the approval process and monitored by the approving agency. 2
  • 10 NYCRR 69-4.9(b)(1) states that if an Early Intervention Official (EIO) believes that the provider is not in compliance with health and safety standards or otherwise posing an imminent risk of danger to children, parents, or staff, the municipality shall take immediate action to ensure the health and safety of such persons (see Appendix B).
  • 10 NYCRR 69-4.9(b)(2) states that if any such action is taken by the municipality, the EIO shall immediately notify the Department of Health, for purposes of the initiation by the Department of an investigation which may result in the disqualification of the early intervention service provider.

EI providers are required to adhere to New York State Social Services Law Section 424-a, which requires that procedures are implemented to ensure that a State Central Register for Child Abuse and Maltreatment (SCR) database check is completed and submitted for newly hired or contracted providers prior to unsupervised contact with children.1

In addition to complying with EIP health and safety standards, it is the responsibility of EI providers to be aware of and comply with established regulations, policies, and directives of each federal, state, or local agency that governs their approval or practice. Facility-based EI providers also licensed by the New York State Office of Children and Family Services (OCFS)3 or the New York City Bureau of Day Care as day care providers must comply with the health and safety standards promulgated by their respective licensing agencies. For providers who deliver EI services at a site that is licensed also by OCFS or the New York City Bureau of Day Care, compliance with health and safety standards imposed by those agencies meets many of the standards set forth in this document. Early Intervention monitoring reviews will focus on EI-related requirements and any other standards contained in this document that are not assessed by OCFS or the New York City Bureau of Day Care. If EI services are provided at a location not within the day care premises, all of the standards will be assessed, as appropriate to the service setting. If an Early Intervention provider observes instances of noncompliance with OCFS or New York City Bureau of Day Care standards, it is recommended that the provider report concerns related to health and safety to the respective agency.

Monitoring of Compliance with Health and Safety Standards

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Providers must develop and comply with policies and procedures for addressing health and safety that are consistent with Department standards. Written health and safety policies and procedures are submitted to the NYSDOH for review as part of the EI provider approval and re-approval process. All providers, including employees and subcontractors, must be familiar with and comply with those policies and procedures. As part of its monitoring activities, NYSDOH will evaluate health and safety policies and procedures of EI providers to ensure that services provided in facility, community or home settings are provided in a manner that protects the health and safety of children who are receiving EI services. The NYSDOH may modify these standards as necessary, and notify EI providers of such modifications. EI providers will then be required to promptly modify their policies and procedures to reflect any modifications.

NYSDOH monitoring of health and safety standard compliance may vary by setting. In facility settings, evaluation of standards compliance will be accomplished by direct observation and inspection. For community service settings, it is required that the EI provider assess the safety of those settings that are accessed on a regular basis, and those settings where the parent will not be present during service delivery, through the use of a Department Community Health and Safety Survey, provided in Appendix A. The EI provider can be accompanied by a parent, if they are interested and available to observe the community site. If the parent is not available to accompany the provider when the assessment is completed, the provider may collaborate with the parent to discuss the results of the assessment, if it is not appropriate for the provision of EI services. It is required that the Community Health and Safety Survey, which describes the date and results of the evaluation of the community setting, be maintained on file with the provider. For home settings, EI providers need to have policies and procedures in place to address situations related to specific issues, for example, the presence of peeling lead paint in older homes, situations related to child abuse and neglect or other situations that pose danger to children.

NYSDOH monitoring procedures also address situations which present immediate threat or risk to children and require immediate remediation. When this occurs, NYSDOH will inform the municipality(ies) contracting with the provider, of the problem. The municipality(ies) must directly assess the seriousness and scope of the problem, and confirm that actions have been taken to resolve the issue as quickly as possible. NYSDOH will simultaneously issue written notice to the provider indicating that, due to the serious nature of the problem and potential risk of harm to children, immediate remediation must be taken, and a written plan of correction must be submitted to the NYSDOH within 10 business days. The provider will then be notified that failure to respond with corrective action may result in disqualification from the EIP; referral to the NYS Office of the Medicaid Inspector General and/or NYS Education Department's Office of Professions or Office of Teaching, as appropriate; sanctions under the county contract and Public Health Law which may include imposition of monetary penalties or requirement of repayment of funds; and/or that failure to respond will be taken into consideration upon the provider's application to the NYSDOH for re-approval.

If at any time the provider or EIO deems that serious health and safety problems are present in the service setting that pose an imminent danger to the safety of the child, procedures must be in place to assure that appropriate action is taken based upon the circumstances. These actions may include referral to the child abuse hotline, contacting the EIO and the service coordinator to cease services and discuss alternate settings for service delivery for that session or subsequent sessions and providing parent education.

Appendix B provides a listing of possible actions that the EIO should consider when serious health and safety problems are reported.

General Standards For All EI Providers

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General Standard 1

All EI providers will develop, maintain and implement policies and procedures that comply with federal, state, and local standards and codes; that are appropriate for the type of provider and the setting(s) where services are delivered; and, are consistent with NYSDOH EI health and safety standards.

General Standard 2

All EI providers, including employees and subcontractors, must be informed of, and must comply with, NYSDOH EI health and safety standards.

2.1 All EI providers, including individual, municipal and agency providers, must develop and comply with health and safety policies and procedures that are consistent with NYSDOH EI health and safety standards. These policies and procedures will be appropriate for the type of service provider (agency or individual) and the setting(s) where the provider renders services (facility, home, community). These policies and procedures will be reviewed by the NYSDOH at the time of initial approval, at re-approval and during periodic provider monitoring, at which time these policies and procedures and related information must be available for review by the NYSDOH. In addition, as part of the provider approval/re-approval or provider monitoring process, the NYSDOH may conduct observations of the physical premises where EI services are delivered to ensure compliance with NYSDOH EI health and safety standards.

2.2 Municipality contracts with EI providers should require contracted providers, including the employees and subcontractors of those contracted providers, to develop and comply with health and safety policies and procedures that are consistent with NYSDOH EI health and safety standards.

2.3 Provider agencies that subcontract for the delivery of EI services, should, in their contracts, include language that requires subcontractors to comply with NYSDOH EI health and safety standards, and any modifications thereto, and agency health and safety policies and procedures that are consistent with NYSDOH EI health and safety standards.

2.4 Agencies must inform any employees delivering services on their behalf regarding NYSDOH health and safety standards and agency health and safety policies and procedures. This information should be provided prior to the employee providing services. Agency employees must be provided a copy of the agency health and safety policies and procedures, and must receive training on health and safety requirements. Employees should be notified on a timely basis when modifications to NYSDOH EI health and safety standards and agency health and safety policies and procedures are made. Documentation must be maintained in employee personnel files that these requirements have been met.

General Standard 3

EI providers must comply with NYSDOH standards related to qualified personnel and must be cleared through the State Central Register of Child Abuse and Maltreatment (SCR) as required by Social Services Law.

3.1 Municipalities must ensure that providers are approved providers under the EIP prior to entering into contracts with providers for EI service provision. Municipalities must provide documentation during auditing and/or monitoring visits demonstrating that their employees and contractors have current licensure or certification as appropriate, and are qualified to deliver EI services initially upon contracting and on an ongoing basis. Municipalities should include language in their contracts with EI agency providers requiring that agency providers ensure that all employees and/or subcontractors are qualified personnel who have been approved to provide services in the EIP.

3.2 Individual providers must document at the time of approval/re-approval and during auditing and/or monitoring visits that they have current licensure or certification, as appropriate, and are qualified to deliver EI services.

3.3 Agency providers must document at the time of approval/re-approval and during auditing and/or monitoring visits that their employees have current licensure or certification, as appropriate, and are qualified to deliver EI services. Agency providers must also document that agency subcontractors have current licensure or certification and are qualified to deliver EI services and have been approved to provide services in the EIP.

3.4 Agency providers maintain written policies/procedures that minimally require that prospective employees and subcontracted individuals who will have the potential for regular and substantial contact with children receiving EI services be screened through the SCR, as appropriate. Database checks through the SCR must be completed for employees, consultants, contractors, and volunteers who are being actively considered for employment or prospectively considered to provide goods or services and will have the potential for regular and substantial contact with children who receive early intervention services as of the effective date of the New York State Social Services Law Chapter 578 (September 17, 1997). Current employees, consultants, contractors and volunteers may be screened.

Agencies must review and maintain documentation of database checks completed. If notice is received from the SCR that a person is the subject of an indicated report of child abuse or maltreatment, the EIO or provider agency should seek appropriate counsel for making a determination as to whether to hire an applicant for employment; retain a current employee; enter or continue a contract; engage a volunteer; or, hire a consultant who will have the potential for regular and substantial contact with children receiving early intervention services. Guidelines for evaluating persons who are the subjects of indicated reports of child abuse and maltreatment have been developed for use by OCFS.3

3.5 Municipalities must conduct screening and maintain written policies/procedures that require that prospective employees and contracted individual providers who will have the potential for regular and substantial contact with children receiving EI services be screened through the SCR, as appropriate. Database checks through the SCR must be completed for employees, consultants, and contractors who are being actively considered for employment or prospectively considered to provide goods or services and will have the potential for regular and substantial contact with children who receive early intervention services as of the effective date of New York State Social Services Law Chapter 578 (September 17, 1997). Current employees, consultants, contractors and volunteers may be screened. An employee or contractor can provide early intervention services prior to receipt of an acceptable response from the SCR, if the employee/contractor is supervised by an employee who is in the same physical location and within direct visual contact of the child receiving early intervention services.

Municipalities must review and maintain documentation of database checks completed. If notice is received from the SCR that a person is the subject of an indicated report of child abuse or maltreatment, the EIO should seek appropriate counsel for making a determination as to whether to hire an applicant for employment; retain a current employee; enter or continue a contract; engage a volunteer; or, hire a consultant who will have the potential for regular and substantial contact with children receiving early intervention services. Guidelines for evaluating persons who are the subjects of indicated reports of child abuse and maltreatment have been developed for use by OCFS.

3.6 Policies and procedures must demonstrate that individual providers, agency employees and subcontractors are aware of the requirements to report suspected child abuse and maltreatment or to cause a report to be made, including notification to the SCR according to Section 413 of the Social Services Law. If the individual provider, agency employee or subcontractor is not a mandated reporter, policies and procedures should address reporting the suspected abuse or maltreatment either directly to the SCR or to an appropriate authority. 1

General Standard 4

Providers protect the health and safety of children receiving EI services with respect to infection control while EI services are provided.

4.1 All providers delivering services, including agency employees must demonstrate the following prior to rendering EI services:

  • an annual statement from a health care provider which provides evidence that the individual has no diagnosed disorder that would preclude him/her from providing child care, and is free from communicable disease;
  • has received the following requirements:
    • measles, mumps, and rubella titer and/or vaccine;
    • annual Mantoux/PPD or chest X-ray with the exception of EI providers who are also licensed day care providers by the New York City Bureau of Day Care.
    • NYC Bureau of Day Care providers must demonstrate that upon commencement of work, a record of testing performed for tuberculosis infection, and further testing at any time, if required by the NYC Bureau of Day Care.
  • has received the following recommended vaccines or has documented refusal:
    • Hepatitis B vaccine
    • Tetanus immunization within the past 10 years
    • Diphtheria
    • Pertussis
    • Varicella
    • Influenza

4.2 Hand-washing procedures are followed before providing services to children, before and after assisting children with eating, after diapering, and after handling animals.

4.3 Disposable gloves are available in the service area and are used when in contact with body fluids.

4.4 Universal precautions are utilized when handling body fluids, including adequate disposal of waste. A 1:10 solution of bleach and water is prepared fresh each day (or an equivalent product to be used to disinfect) when body fluids are present. Providers should ensure that any equivalent product utilized is stated in writing to be effective against HIV and Hepatitis, and is safe for use with children.

4.5 Universal precautions are utilized when cleaning and disinfecting soiled surfaces, including adequate disposal of waste. Minimally, this includes hand washing and regular cleaning of toys used during the provision of services, surfaces, and diapering areas, as appropriate to the setting where services are provided, with a bleach solution of one tablespoon bleach per quart of water made fresh daily.

4.6 Provider ensures that items such as hairbrushes, washcloths, toothbrushes, and combs, are not shared with other children in the course of EI service delivery.

General Standard 5

Providers protect the health and safety of children with respect to handling food while EI services are provided.

5.1 Disposable gloves are used in the provision of feeding therapy and other oral motor exercises.

5.2 Children do not share drinking cups, even among siblings in the home setting.

5.3 The provider's use of highchairs may only be used for feeding purposes or therapy and is consistent with the child's developmental status and cannot be used as a restraint.

5.4 Foods should be nutritious, nontoxic and should be based on the child's developmental abilities, and allergies are considered (e.g., avoid popcorn and peanuts).

5.5 Adaptive utensils used in the provision of services must be sanitized after each use.

General Standard 6

Providers protect the general health, safety, and welfare of children with respect to the direct supervision of and interaction with children, as appropriate to the setting where services are delivered while EI services are provided.

6.1 Children are clean and comfortable, and diapers are changed when wet or soiled.

6.2 Children do not have access to small or potentially harmful objects, plastic bags, or other choking hazards during the time services are delivered.

6.3 Corporal punishment and emotional or physical abuse or maltreatment is prohibited. The use of physical aversives or restraints of any form are strictly prohibited when providing EI services.

6.4 If the child is displaying self-injurious or aggressive behavior that threatens the well-being of the child, or others, the provider must intervene immediately to protect the child and the parent and the EIO must be notified immediately.

6.5 Delivering services while under the influence of alcohol or controlled substances is prohibited.

6.6 Smoking is prohibited during the delivery of EI services.

General Standard 7

Providers protect the general health and safety of children with respect to illness, injury, and emergencies, as appropriate to the setting where services are delivered while EI services are provided.

7.1 Providers have written procedures to address child illnesses, including:

  • parent notification of onset of child illness;
  • sick day policy stating that if fever, vomiting, or diarrhea are present, EI service is rescheduled according to municipal make-up policy;
  • specific child allergy information is maintained;
  • providers have written procedures to address emergency situations, including: responding to children with allergic reactions, and administration of first aid and CPR (if certified) or contacting appropriate medical personnel;
  • provider illness, emergency, or other inability to provide services.

7.2 Providers have emergency contact numbers for medical assistance and transportation readily available and an available telephone to report emergency situations.

7.3 Documentation demonstrates that records of all health- and safety-related incidents or injuries involving children while they are receiving services are maintained (see Appendix B).

7.4 Documentation demonstrates that policies are in place to ensure that all incidents or injuries requiring medical treatment involving children while they are receiving services includes notification to the EIO as soon as possible.

General Standard 8

Providers protect the health and safety of children with respect to the equipment, materials, or other items used during the delivery of EI services.

8.1 Equipment, materials, and/or toys used by the provider are appropriate for the child's developmental age and skill level.

8.2 Equipment, materials, and/or toys used by the provider are in good condition, free of lead and are cleaned regularly and disinfected weekly.

Standards For Services Delivered Within A Facility

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Facility Standard 1

Providers ensure the physical environment is maintained in a manner that protects the health and safety of children receiving EI services with respect to location.

1.1 All provider sites are approved for the delivery of EI services.

1.2 All sites are in compliance with applicable federal, state and local building, fire and safety standards or codes.

1.3 Provider has documentation of the facility's Certificate of Occupancy/Certificate of Compliance or other proof of building code compliance, based on federal, state and local code requirements, for the purpose of providing services to children.

1.4 Provider maintains a record of any authority that has conducted an inspection of the facility, and corrections made in response to identified deficiencies, if any.

1.5 To the extent that water is not provided through a public water supply, recent well water inspection is conducted to verify that the well water is safe for human consumption and use.5, 6

1.6 Water temperature must not exceed 115° Fahrenheit in areas where children are present or have access.

1.7 Use of hot tubs, spas, or saunas is prohibited. Special purpose pools located at the provider's facilities that are used for the provision of EI services are permitted and must comply with 10 NYCRR Section 6.1. Swimming pools used for the provision of EI services must be constructed, maintained, staffed, and used in accordance with Chapter 1; Subpart 6-1 of the NY State Sanitary Code and in such a manner as will safeguard the lives and health of children. Safeguards in place must include the pool being inaccessible unless there is supervision, use of a locked gate or door is locked when the pool is not in use, and lifesaving equipment is readily available.5, 6

1.8 Radiators are insulated or covered to prevent burns.

1.9 In areas where EI services are delivered, electrical outlets are inaccessible to children and have outlet covers.

1.10 In areas where EI services are delivered, plaster and paint are not peeling, chipping, friable, or damaged.

1.11 Ceilings do not leak or have hanging electrical wires.

1.12 Hallways and/or exits are not obstructed and are free from clutter. Stairs are lighted.

1.13 Child access to building hazards is restricted.

1.14 Stairs, decks, walkways, ramps and/or porches are free of ice, snow and/or other hazards and have railings and/or barriers to prevent children from falling.

1.15 Clear glass panels are marked to avoid accidental impact. Glass in outside windows that are less than 32" above floor level is of safety grade or protected against accidental impact by barriers. All windows have locking devices, window guards, or other barriers to prevent children from falling out.

1.16 For areas accessible to children, closet doors allow children to open the door from the inside. Bathroom doors permit opening of the locked door from the outside. Exit doors open from the inside without using a key.

1.17 Playground equipment that is used in the provision of EI services to children is securely mounted, clean, safe, and appropriate for children's age and developmental skill level. There is a mechanism in place (physical or by supervision) to prevent children from wandering into unsafe areas.

1.18 There are adequate barriers to any water hazards, including swimming pools, drainage ditches, wells, ponds, or other bodies of open water located on or adjacent to the property.

1.19 Pesticide application, if any, is performed in accordance with applicable state and local requirements and includes notification to parents prior to such application.

1.20 Cleaning products and toxic materials are stored and locked up away from children to prevent access.

1.21 Pets on premises do not pose a potential threat to children and are restricted from food preparation and service delivery areas.

Facility Standard 2

Providers ensure the facility is maintained in a manner that protects the health and safety of children receiving EI services with respect to fire protection. Standards must meet municipal fire codes.

2.1 Provider must have documentation of a fire inspection report issued within the last three years without violations or a report with subsequent proof of corrections demonstrating the facility meets state or local municipal fire safety code requirements, in accordance with 19 NYCRR Part 1203: Uniform Code Enforcement and Administration.4

  • Fire suppression systems (i.e., fire extinguishers and sprinkler systems) are tested and inspected by the appropriate officials in the time period required by local codes. Documentation of testing and inspections is maintained.
  • Local government authorities (i.e., New York State Department of Education [for public schools], fire code enforcement agencies) have determined compliance with NYS Uniform Fire Prevention and Building Code.
  • Fire alarm and detection systems are available in close proximity to where services are delivered and are checked according to manufacturer's requirements to ensure they are in working order.

2.2 All providers delivering services in the facility have a working knowledge of the use of fire extinguishers.

2.3 Providers have knowledge of a current emergency evacuation plan, accurate emergency telephone numbers, and evacuation routes. Such information is posted on the premises in the area of service delivery.

2.4 Evacuation drills are documented and conducted quarterly and at various times of the day.

2.5 Toxic and flammable materials are stored away from heat sources and locked up so they are not accessible to children.

2.6 When EI services are provided on the same floor as the furnace/boiler room, or if children receiving EI services have access to the floor where the furnace/boiler room is located, the furnace/boiler room is locked and clear of combustibles. There is no odor or holes in the walls or ceilings. The fresh air intake is not blocked in the furnace/boiler room.

2.7 Kitchen stove hood and exhaust fans are free of grease. Kitchen area is not accessible to children.

2.8 Storage areas do not contain flammable materials and are not accessible to children.

2.9 Dryer vents in laundry areas are properly connected, and gas dryers are vented to the exterior. Dryers are cleaned and cleared of lint after each use. Laundry areas are inaccessible to children.

2.10 Portable heaters are not used during the time that EI services are provided.

Facility Standard 3

Providers ensure the physical environment is maintained in a manner that protects the health and safety of children receiving EI services with respect to building security.

3.1 Areas where children are receiving EI services have entrances and exits that prevent children from wandering out of the immediate area.

3.2 There is a method for controlling visitor access to the facility. Visitors are required to sign in and identify their purpose for being in the facility.

3.3 The location of EI children in the facility is known at all times, and daily attendance and sign-out procedures are utilized.

3.4 Children are supervised at all times by direct visual contact, to ensure they remain in the vicinity of the location of services.

3.5 Children receiving EI services are released only to parents, caregivers, or adults given authorization by a parent/guardian.

Facility Standard 4

4.1 Providers ensure the physical environment is maintained in a manner that protects the health and safety of children receiving EI services with respect to sanitation.

4.2 Trash is covered and stored away from heat sources and areas where EI children are located and services are delivered.

4.3 Bathroom facilities are available, clean, and adequately supplied. Running water is available in bathroom facilities.

4.4 Toilets/sinks are appropriately positioned for children.

4.5 Potty chairs are emptied, cleaned, and sanitized after each use.

4.6Diapering facilities are available and located near a sink not used for food preparation and include disposal containers. Diapering area is cleaned and sanitized after each use.

4.7 Linens, blankets, bedding, cribs and cots are cleaned when they are soiled and before use by other children, and washed weekly.

Facility Standard 5

Providers protect the health and safety of children with respect to handling medications and food.

5.1 Prescription and over-the-counter medications are stored and administered in a safe manner in accordance with law and applicable state standard.

5.2 Clean utensils and/or sanitary gloves are used to prepare and serve food. Waxed paper or napkins may also be used to serve food.

5.3 Food contact surfaces are clean and tableware is washed and rinsed after each use.

5.4 Any child that has a food allergy shall have a plan developed by the parent, primary care provider, EI provider and EIO, which includes identification and documentation of the allergy, prevention of exposure, and required plan to treat an allergic reaction.

Facility Standard 6

Providers protect the general health, safety, and welfare of children participating in the EIP with respect to the direct supervision of and interaction with children.

6.1 Children are directly supervised at all times, including during toileting, as applicable.

6.2 Children receiving services in groups are supervised by direct visual contact at all times to ensure they remain in the location of service delivery.

Facility Standard 7

Providers protect the general health, safety, and welfare of children during transportation provided as part of the EIP.

7.1 Smoking is not permitted in vehicles during the transportation of children for purposes of EI service delivery, when the provider is responsible for such transportation.

7.2 Vehicles used for transporting children for purposes of EI service delivery, and their operators, shall meet the licensing requirements of New York State Department of Motor Vehicles law and be insured for the type of transportation being provided.

7.3 Transportation operators are required to be cleared through the SCR, prior to transporting children.

7.4 Provider ensures that preventative maintenance of transportation vehicles is carried out in accordance with the manufacturers' specifications.

7.5 All providers, including employees and/or contractors of a municipality, who drive children directly and all drivers utilized by providers, including transportation monitors and assistants, utilize proper procedures in the following:

  • use of developmentally appropriate safety restraints;
  • proper placement of the child in the motor vehicle;
  • handling of emergency situations, including medical conditions of children being transported and possession of child health summaries, and emergency parent contacts;
  • child supervision during transport, including never leaving a child unattended in a vehicle;
  • appropriate child-to-staff ratio during transport.

Facility Standard 8

Providers protect the general health and safety of children participating in the EIP with respect to illness, injury, and emergencies, including allergic reactions.

8.1 Providers have the following:

  • readily available, portable first aid kits that minimally include disposable gloves, soap, hydrogen peroxide, tweezers, various sized bandages, nonallergic tape, sterile gauze, scissors, and thermometer;
  • readily available working flashlights;
  • posted or readily available Infant/Toddler Choking First Aid instructions;
  • posted notice of specific allergy-free areas in food preparation and eating areas;
  • posted or readily available emergency system contact numbers for medical assistance and transportation;
  • readily available, up-to-date information for contacting parents in the event of an emergency;
  • readily available, up-to-date emergency consents;
  • an available telephone to report emergency situations;
  • a plan in case of natural disaster (fire, tornado, and earthquake) or other disasters (power failure, bomb threat, biological agent) which includes reporting the incident through the emergency system, to the EIO and the parent; evacuation procedures; and a staff training plan;
  • any child that has a food allergy shall have a plan worked out among the parent, primary care provider, EI provider and EIO, which includes identification and documentation of the allergy, prevention of exposure, and required plan to treat an allergic reaction. The treatment plan should include training of EI providers in administration of medications (e.g., epinephrine) that are provided by the child's parents and prescribed by the child's primary care provider.

Facility Standard 9

Providers deliver EI services in outdoor environments that are maintained in a manner that protects the health and safety of children while they are receiving EI services.

9.1 The site is free of obstacles that could cause injuries, such as overhanging tree branches, wires, tree stumps and/or roots, rocks, bricks/concrete.

9.2 Play equipment is clean and in good condition (no broken pieces, sharp edges, choking hazards, splinters, cracks, rusted area, and screws.

9.3 Walkways should be clear of trash and clutter to prevent tripping.

9.4 Play areas are clear of debris and small or potentially harmful objects.

9.5 Play equipment is developmentally appropriate; securely anchored and has adequate protective surfacing under/around playground equipment to help absorb the shock if a child falls.

9.6 There are no openings in equipment that can trap a child's head or neck, such as openings in guardrails or ladders.

9.7 Elevated surfaces such as platforms and ramps have guardrails to prevent falls.

9.8 Slides have decks and hand rails at the top.

9.9 Merry-go-rounds have solid, flat riding surfaces and handholds.

9.10 Sandbox is clean and free of organic, toxic or harmful material.

9.11 Public restrooms are available/accessible, clean and adequately supplied.

9.12 There are no physical conditions that are potentially hazardous to children during the delivery of services.

Standards For EI Services Delivered In The Community

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Community Standard 1

Providers deliver EI services in physical environments that are maintained in a manner that protects the health and safety of children while they are receiving EI services.

1.1 Providers are responsible to ensure that all community settings where EI services are provided are safe environments for service delivery. It is required that the provider directly observe and assess all sites that will be used to provide EI services on a regular basis, and where the parent will not be present during service delivery, when selecting community-based settings for EI service delivery, to ensure there are no potential hazards to the health and safety of children during provision of services. The provider can be accompanied by the parent to observe the community site. If the parent is not able or chooses not to participate, when the assessment is completed, the provider may collaborate with the parent to discuss the results of the assessment, if it is not appropriate for the provision of EI services. The Community Health and Safety Survey that is provided in Appendix A is required to be used for this assessment. It is required that a completed survey describing the date and results of the evaluation, be maintained on file with the provider, for each community-based setting where services will be provided on a regular basis without the presence of the parent during service delivery. If the parent will be (or is) present during service delivery, the provider is still responsible to ensure that the community setting's physical environment is maintained in a manner that protects the health and safety of children during the provision of EI service. The provider must have policies and procedures in place to ensure that all sites are reviewed which are accessed on a regular basis to provide EI services. If a community setting is accessed to provide EI services on rare occasions (e.g., the grocery market), the provider should take a common sense approach in judgment of potential health and safety hazards. It is recommended that the following concerns be addressed during the review of community-based settings that are accessed on a regular basis to provide EI services.

Items that are required for assessment for indoor areas include, as applicable:

  • the environment appears to be free of potential fire, construction and other types of structural hazards;
  • restrooms are available accessible, clean with necessary products available;
  • hallways and/or exits are not obstructed and are free from clutter;
  • stairs are lighted;
  • stairs, decks, walkways, porches, and ramps are free of ice, snow, and other hazards and have railings or other barriers to prevent children from falling;
  • pets on premises do not pose a potential threat to children;
  • areas where children are receiving EI services have entrances and exits that prevent children from wandering out of the immediate areas;
  • there are no other physical conditions that are potentially hazardous to children (e.g., peeling or chipping paint, leaking ceilings or hanging electrical wires);
  • evacuation procedures and routes are prominently posted;
  • providers are aware of the current emergency evacuation plan and evacuation routes in the community-based setting, location of telephones on premises and up-to-date emergency telephone numbers.

Items that are required for assessment for outdoor areas include, as applicable:

  • Site is free of obstacles that could cause injuries such as overhanging tree branches, wires, tree stumps and/or roots, rocks, bricks/concrete;
  • Play equipment is clean and in good condition (no broken pieces, sharp edges, choking hazards, splinters, cracks, rusted areas, screws, etc.);
  • Walkways should be clear of trash and clutter to prevent tripping;
  • Play areas are clear of debris and small or potentially harmful objects;
  • Play equipment is developmentally appropriate, securely anchored and has adequate protective surfacing under/around playground equipment to help absorb the shock if a child falls;
  • There are no openings in equipment that can trap a child's head or neck, such as openings in guardrails or ladders;
  • Elevated surfaces such as platforms and ramps have guardrails to prevent falls;
  • Slides have large decks and hand rails at the top;
  • Merry-go-rounds have solid, flat riding surfaces and handholds;
  • Sandbox is clean and free of organic, toxic or harmful material;
  • Public restrooms are available/accessible, clean and are supplied with toilet paper, soap, and disposable towels;
  • There are no other physical conditions that are potentially hazardous to children during the delivery of services.

1.2 Use of hot tubs, spas, or saunas is prohibited. Only public swimming pools that are subject to the oversight of Chapter 1, Subpart 6-1 of NY State Sanitary Code may be used for the provision of EI services. When a public swimming pool is used, the provider should assess the conditions of the pool for each therapy session to ensure that the use of the pool would not pose a health or safety risk to the child.5, 6

1.3 If after the Community Health and Safety Survey is completed, it is determined that service provision at this site may pose a health and safety risk to the child, the provider must notify the EIO and the parent, and recommend an alternate service location.

Community Standard 2

Providers protect the general health, safety, and welfare of children with respect to the direct supervision of and interaction with children while receiving EI services.

2.1 Adequate staffing, procedures or physical controls such as fencing must ensure that children are maintained securely within the designated service areas and prevent children from wandering into unsafe areas.

2.2 The provider knows the location of EI children in the community setting at all times, and daily attendance and sign-out procedures are utilized.

2.3 Children receiving services in groups are supervised by direct visual contact at all times, to ensure they remain in the location of service delivery;

2.4 Children are directly supervised at all times, including during toileting, when parents are not present.

Community Standard 3

Providers protect the general health, safety and welfare of children during transportation provided as part of the EIP.

3.1 Smoking is not permitted in vehicles during the transportation of children for purposes of EI service delivery, when the provider is responsible for such transportation.

3.2 Vehicles used for transporting children for purposes of EI service delivery shall meet the licensing requirements of New York State Department of Motor Vehicles law and be insured for the type of transportation being provided.

3.3 Provider ensures that preventative maintenance of transportation vehicles is carried out in accordance with the manufacturers' specifications.

3.4 All providers who drive children directly and all drivers utilized by providers, including transportation monitors and assistants, utilize proper procedures in the following:

  • use of developmentally appropriate safety restraints;
  • proper placement of children in motor vehicles;
  • handling of emergency situations, including medical conditions of children being transported and possession of child health summary, and emergency parent contacts;
  • child supervision during transport, including never leaving children unattended in vehicles;
  • appropriate child-to-staff ratio during transport.

Community Standard 4

Providers protect the general health and safety of children with respect to illness, injury, and emergencies while receiving EI services.

Providers have the following:

  • readily available, portable first aid kits that minimally include disposable gloves, soap, hydrogen peroxide, tweezers, various sized bandages, nonallergic tape, sterile gauze, scissors, and thermometer;
  • readily available working flashlights;
  • readily available Infant/Toddler Choking First Aid instructions;
  • readily available emergency system contact numbers for medical assistance and transportation;
  • readily available, up-to-date information for contacting parents in the event of emergencies;
  • readily available, up-to-date emergency consents;
  • an available telephone to report emergency situations;
  • a plan in case of natural disaster (fire, tornado, and earthquake) or other disasters (power failure, bomb threat, biological agent) which includes reporting the incident to the EIO and the parent; evacuation procedures; and a staff training plan;
  • any child that has a food allergy shall have a plan worked out among the parent, primary care provider, EI provider and EIO, which includes identification and documentation of the allergy, prevention of exposure, and required plan to treat an allergic reaction. The treatment plan should include training of EI providers in administration of medications (e.g., epinephrine) that are provided by the child's parents and prescribed by the child's primary care provider.

Standards For EI Services Delivered In the Home

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Home Standard 1

Providers have policies and procedures in place to ensure the home environment is maintained in a manner that protects the health and safety of children during the provision of EI services.

1.1 Provider policies and procedures are in place to address unsafe conditions encountered in the home environment that would pose harm to children during service delivery (e.g., peeling or chipping paint, leaking ceilings, or hanging electrical wires). Providers should observe the setting to ensure that safe conditions exist for each therapy session. If the provider determines the home setting may pose harm to children, the provider may refer the parent to the EIO or the service coordinator to provide educational resources available in the county, and/or may potentially recommend an alternate service location to the parent and EIO. If the provider determines the home setting may pose imminent danger to the child, the provider should take action to notify the EIO, and provide parent education. The provider should consult with the EIO to determine an alternate service location and, if circumstances warrant, make a report to the child abuse hotline.

Examples of abuse and maltreatment, including neglect, which would require a report to the child abuse hotline include, but are not limited to the following:

  • when a parent or other person legally responsible for care inflicts serious physical injury upon a child or commits a sex offense against a child;
  • situations where a parent or other persons legally responsible knowingly allows someone else to inflict such harm on a child;
  • failure to provide sufficient food, clothing, or shelter;
  • failure to provide proper supervision, guardianship, or care;
  • misusing alcohol or other drugs to the extent that the child is placed in imminent danger.

1.2 If children are exposed to secondhand smoke from individuals in their immediate environment during the delivery of EI services, the provider should consider referral to the EIO or the service coordinator to provide educational resources available in the county, to the parent or care giver regarding the consequences of secondhand smoke. The provider should consider collaborating with the service coordinator for referral of the parent or care giver to smoking cessation programs.

Appendix A Community Health and Safety Survey

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For Services Provided in the Community Setting

One of the primary goals of the EIP is to create opportunities for full participation of children with disabilities and their families in their communities by ensuring that services are delivered in natural environments to the maximum extent appropriate. While a child's home is usually considered to be their "natural environment," young children have other locations that are natural for them as well. Community-based settings may include play groups, library story hour, swim program, neighborhood playground, recreation programs, or other community activities. A natural environment must be safe and nurturing, encourage child development, and be accessible to the child and his/her family.

The Community Health and Safety Survey is required to be used by EI providers in conducting an initial and periodic observation of community settings that are accessed on a regular basis where the parent will not be present, to provide EI services. The observation of the setting is meant to determine whether the location that is used regularly, is suitable for the delivery of EI services. This will ensure that safe conditions exist and that procedures are in place to notify the parent, EIO, remediate unsafe conditions, and/or, if necessary, discuss an alternate location for services.

In some cases, a visual assessment of the area(s) where services are delivered can identify obvious signs of potential health and safety hazards. Providers must work with the family to identify and/or create a safe environment to provide EI services. If the site is inadequate, providers may discuss with the parent and EIO a recommendation of alternate locations for consideration for service delivery.

The surveys that follow provide areas that are required for evaluation to observe the community site where EI services will be delivered on a regular basis. It is required that this survey describing the date and results, be maintained on file with the provider. Each area that is assessed should be designated by filling in the checkbox, next to the area. Any comments that should be noted regarding the assessed area can be documented in the comment area at the end of the survey.

Community Health and Safety Survey - Indoor Areas

  • The environment where EI services are provided is safe from chemicals, contaminants, toxic materials, and other hazards.
  • The environment is free of potential fire, construction, and other structural hazards.
  • Public restrooms are available/accessible, clean, and adequately supplied.
  • Hallways and/or exits are not obstructed and are free from clutter.
  • Stairs are lighted.
  • Stairs, walkways, porches, and ramps are free of ice, snow, and other hazards, and have railings or other barriers to prevent children from falling.
  • Pets on premises do not pose a potential threat to children.
  • Areas where EI children are receiving services have entrances and exits that prevent children from wandering out of the immediate area.
  • There are no other physical conditions that are potentially hazardous to children during the delivery of services.
  • Evacuation procedures and routes are prominently posted.
  • Providers are aware of the current emergency evacuation plan and evacuation routes in the community-based setting, location of telephones on premises and up-to-date emergency telephone numbers.
  • Public swimming pools used are only those subject to the oversight of Chapter 1, Subpart 6-1 of NY Sanitary Code and do not pose a health risk to children.

Comments:

I (parent/guardian), was present and participated in the assessment of the Community location where my child will receive EI services, along with my child's service provider on (date of completed survey) and I agree that my child receive services at this location.

Community Health and Safety Survey - Outdoor Areas

  • Site is free of obstacles that could cause injuries such as overhanging tree branches, wires, tree stumps, and/or roots, rocks, bricks/concrete.
  • Play equipment is clean and in good condition (no broken pieces, sharp edges, choking hazards, splinters, cracks, rusted areas, screws, etc.).
  • Walkways should be clear of trash and clutter to prevent tripping.
  • Play areas are clear of debris and small or potentially harmful objects.
  • Play equipment is developmentally appropriate.
  • Play equipment is securely anchored.
  • There is adequate protective surfacing under/around playground equipment to help absorb the shock if a child falls.
  • There are no openings in equipment that can trap a child's head or neck, such as openings in guardrails or ladders.
  • Elevated surfaces such as platforms and ramps have guardrails to prevent falls.
  • Slides have large decks and hand rails at the top.
  • Merry-go-rounds have solid, flat riding surfaces and handholds.
  • Sandboxes are clean and void of organic, toxic, or harmful material.
  • Public restrooms are available/accessible, clean, and are adequately supplied.
  • Public swimming pools used are only those subject to the oversight of Chapter 1, Subpart 6-1 of NY Sanitary Code and do not pose a health risk to children.
  • There are no other physical conditions that are potentially hazardous to children during the delivery of services.

Comments:

I (parent/guardian), was present and participated in the assessment of the Community location where my child will receive EI services, along with my child's service provider on (date of completed survey) and I agree that my child receive services at this location.

Appendix B: EIO Responsibilities

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Potential actions that the EIO should consider for when serious health and safety concerns exist may include the following:

  • Meet with providers individually or as a group to ensure their understanding of the municipality's standards for health and safety.
  • Conduct interviews with providers and other personnel responsible for the administration and provision of early intervention services.
  • Visit the provider's site to observe whether a dangerous situation exists and remediation is required.
  • Review internal quality assurance procedures of the provider.
  • Review organizational structure and staffing patterns, including supervision of personnel and participation of personnel in training activities.
  • Review provider's records to determine the provider's implementation of the requirement to screen new employees and contractors through the State Central Register of Child Abuse and Maltreatment.
  • Review contracts with the provider to determine whether a requirement was violated.
  • Review the status of a provider licensure, certification, or registration.
  • Review the provider's corrective actions to address the unsafe condition and/or deficiency.
  • Ensure the provider has initiated appropriate remediation, which includes immediate correction of a dangerous situation.
  • Consider transferring children to another site or approved provider.
  • Immediate notification to the NYSDOH for possible disqualification of the provider.
  • Consider referral of the child for lead testing and to the lead program.
  • Consider making a referral to the Healthy Neighborhoods Program for counties where this resource is available.
  • Consider the referral to Local Department of Social Services for the removal of children from the home or care giver's residence.
  • Discuss situations of health and safety concerns with parents.

Appendix C Record of Injury

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When an injury occurs in the service area that requires first aid or medical treatment for the child, the provider shall complete a report, using a form the provider has developed, that includes the following information:

  1. Name, sex, and age of the injured person;
  2. Date and time of injury;
  3. Location where injury took place;
  4. Description of how the injury occurred, including who (name, address, and telephone number) witnessed the incident and what they reported, as well as what was reported by the child;
  5. Body parts(s) involved;
  6. Description of any consumer product involved or used when injury occurred;
  7. Name and location of provider responsible for supervising the child at the time of injury;
  8. Actions taken on behalf of the injured child following the injury;
  9. Recommendations of preventive strategies that could be taken to avoid future occurrences of this type of injury;
  10. Name of person who completed the report;
  11. Name, signature and address of the agency, individual, or subcontracted provider who was present or who was providing service.

Four copies of the injury report form shall be completed. One copy shall be given to the child's parent or legal guardian. The second copy shall be forwarded to the EIO of the county with which the agency or individual is contracted. The third copy shall be kept in the child's record. The fourth copy shall be kept in an injury log that is periodically reviewed by a staff member for injury patterns. This fourth copy shall be retained by the agency or individual provider for the period required by the state's statute of limitations.

Endnotes

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1http://public.leginfo.state.ny.us/menugetf.cgi
Public Health Law and Social Service Law

2http://www.nyhealth.gov/nysdoh/phforum/nycrr10.htm
New York State Department of Health
Bureau of Early Intervention
Corning Tower Building, Room 287
Empire State Plaza
Albany, New York 12237-0660
Phone: (518) 473-7016
Fax: (518) 486-1090
http://www.nyhealth.gov/community/infants_children/early_intervention/

3http://www.ocfs.state.ny.us/main/becs/regs/418-1_CDCC_regs.asp
New York State Office of Children & Family Services
Capital View Office Park
52 Washington Street
Rensselaer, New York 12144-2796
Phone: (518) 473-7793
Fax: (518) 486-7550
http://www.ocfs.state.ny.us/main/

4http://www.dos.state.ny.us/code/part1203.htm
New York State Department of State
Division of Code Enforcement and Administration
1 Commerce Plaza
99 Washington Avenue
Albany, New York 12231
Phone: (518) 474-4073
Fax: (518) 486-4487
http://www.dos.state.ny.us

5http://www.nyhealth.gov/nysdoh/phforum/nycrr10.htm
New York State Department of Health
Center for Environmental Health
Bureau of Community Sanitation and Food Protection
Flanigan Square, 547 River Street
Troy, New York 12180-2216
1-800-458-1158, extension 27600

6http://www.dos.state.ny.us/info
New York State Department of State
Division of Administrative Rules
1 Commerce Plaza
99 Washington Avenue, Suite 16
Albany, New York
Phone: (518) 474-6785
Fax: (518) 473-9055

Glossary

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For the purposes of this document, the words set forth below are defined as follows:

Child
An eligible or a referred infant or toddler, as appropriate in the context, receiving early intervention services.
Early Intervention Services
Services designed to meet the needs of the family related to enhancing the child's development in accordance with the functional outcomes specified in the Individualized Family Service Plan. Professionals provide services under Title II-A of Article 25 of the New York State Public Health Law (NYS PHL). This includes service coordination, evaluation, and general services.
Early Intervention Official Designee (EIO/D)
An appropriate municipal official (or designee) named by the chief executive officer of a municipality who is the responsible person for the Early Intervention Program in that municipality.
EIP
The Early Intervention Program.
Individualized Family Service Plan (IFSP)
A written plan for providing early intervention services to a child eligible for the Early Intervention Program and the child's family. This plan is developed under Section 2545 or Section 2546 of Article 25 of the New York State Public Health Law (NYS PHL).
Monitoring
A program review conducted by the county or New York Sate Department of Health or appropriate designee for determining regulatory compliance and areas for quality improvement.
Municipality
a) A county outside the City of New York, or
b) The City of New York when referring to a county within the City of New York.
Natural Environments
Settings that are normal or natural for the child's age peers who have no disability, including the home, a relative's home when care is delivered by the relative, child care setting, or other community settings where children without disabilities are typically found.
NYSDOH or Department
The New York State Department of Health.
Parent
Parent or other person authorized to give parental consent under Article 25 of the NYS PHL or the Official Compilation of Codes, Rules, and Regulations of the State of New York (10 NYCRR) on behalf of an eligible or referred child, including parent by birth, adoption, or person in parental relation to the child. Person in parental relation means the child's legal guardian, standby guardian, custodian, or person acting in place of a parent who has legal responsibility for the child's welfare.
PHL
New York State Public Health Law.
Provider
An individual or agency, including municipalities, approved by NYSDOH to perform screenings, evaluations, service coordination, and/or early intervention services as required under Article 25 of the NYS PHL.
Qualified Personnel
Individuals approved to deliver services to the extent authorized by their licensure, certification, and registration as defined in the regulations, are approved under Article 25 of the NYS PHL and are under contract with a municipality for the provision of services to children in the EIP.
Regulations
The New York State Department of Health's regulations related to early intervention, found in Subpart 69-4 of Part 69 of Subchapter H of Chapter II of Title 10 of the Official Compilation of Codes, Rules, and Regulations of the State of New York (10 NYCRR)
Transportation
Travel provided by a taxi, carrier, or other means, including the service provider, necessary to enable an eligible child and the child's family to receive early intervention services.