Part 5.1 Medical Officer of Health Directions, Inspections

Ontario Regulation 137/15 s. 32

Intent 

Subsection 32(1) is in place to support the health, safety and well-being of children and others in the child care centre by requiring centres to follow the direction of a medical officer of health. Medical officers of health are public health experts in Ontario. 

Subsections 32(2) and 32(3) are in place to make sure that ministry program advisors are aware of situations when local authorities are requiring centres to do something and to make sure that program advisors can look at any paperwork from local authorities if they need to. 

Clarifying guidance 

The term medical officer of health is the formal way to refer to a local public health unit. 

While the ministry has a relationship with other ministries and other levels of government, on the ground, public health units and fire departments may not have a direct relationship with ministry directors and program advisors. Subsection 32(2) is in place to ensure that ministry staff have important information about the centre or its operations by requiring licensees of centres to share any significant and relevant information with the ministry. 

Public health units and fire departments have the power to enforce the laws and standards that they are responsible for. If a licensee is given an order or direction from a public health unit and /or the local fires department has taken enforcement action against the licensee, the licensee must provide their program advisor with copies of all the paperwork (in other words, the records) related to the order, direction or enforcement action that happened. 

Licensees are only required to provide formal orders and/or directions issued by the local public health unit or fire department which are made under the authority of the Health Protection and Promotion Act or the Fire Prevention and Protection Act. This does not include regular inspection reports, even if the inspection report includes a non-compliance that must be rectified.

This section also requires licensees to keep records of inspections done by staff of the Ministry of Education as well as inspections done by the medical officer of health or local fire department. Per subsection 32(3), all reports (even those that are not provided to the program advisor) must be kept on site and made available for inspection if a ministry official requests to see them.

If there is a suspected outbreak of a communicable disease, the licensee, supervisor or staff should contact their local public health unit right away and await instructions. If an unplanned closure of a child care centre happens because a local public health official requires a centre to shut down for a period of time because of an outbreak, licensees need to follow the requirements around reporting a serious occurrence for an unplanned disruption of the normal operations of a child care centre that poses a risk to the health, safety or well-being of children receiving child care at the child care centre.

Cross-reference

The regulation has requirements around record retention. See subsection 82(1).

Best practices

Contact information for local medical officers of health is available here Health Services in Your Community - Public Health Units.

Compliance Indicators

  • Any direction provided to the centre in a written report from the local medical officer of health have been carried out, if applicable.
  • The licensee verbally confirms that no reports have been made by a local medical officer of health, the fire department, a program advisor and/or any inspector.
  • Where a report has been made by the local medical officer of health or the local fire department, the report is kept on the premises.

Or

  • Where there are no reports made by the local medical officer of health or the local fire department, the licensee verbally confirms that no reports have been made by the local medical officer of health or the local fire department.
  • Where a report includes any direction or order made by the local medical officer of health or the local fire department, a copy of the report was sent to the program advisor within 2 business days.

And

  • Where a report includes any enforcement action or order taken against the licensee made by the local medical officer of health or the local fire department, the program advisor was notified immediately (i.e., within one business day).

Part 5.2 First Aid Kit and Manual

Ontario Regulation 137/15 s.34

Intent

Even with the training child care providers have and the requirements in the CCEYA that are there to prevent harm or injury, accidents and injuries can still happen. It is normal and expected that, while exploring the world around them and figuring out what things they can do physically, children sometimes get minor injuries as they engage in active exploration and play space, learn about their environment, and work on their fine and gross motor skills.

Section 34 is in place because having a well-stocked and accessible first-aid kit means staff can quickly help an injured child to help improve the outcome of the injury (while waiting for emergency medical help, if required).

Best practices

When deciding where to put first-aid kits, licensees should think about the layout of the child care centre and how easily and quickly staff would be able to reach the first-aid kit when needed.

It is recommended that there be first-aid supplies in every room in the child care centre where children spend time, staff rooms, and kitchens and in or near the centre’s outdoor play space. When figuring out how many first-aid supplies should be in these areas of the centre, licensees should consider how many children are in the child care centre and how many staff, volunteers and students are typically there.

Cross-reference

There are requirements and rules around first-aid kits for employers in a provincial law called the Workplace Safety and Insurance Act, 1997. Licensees should check the Workplace Safety and Insurance Board website for information about this law.

Compliance Indicators

  • There is a first-aid kit and manual on the premises.

And

  • Staff verbally confirm that the first-aid kit and manual are readily available to them by promptly identifying the location of the first-aid kit and manual.

Part 5.3 Immunization of Children

Ontario Regulation 137/15 s. 35

Intent

Section 35(1) is in place to protect children and others at the child care centre from getting and spreading vaccine-preventable diseases. Some of these diseases spread the easiest in children and children are at high risk of getting very sick if they get infected with a vaccine-preventable disease.

Child care centres are places where it is very easy to pick up vaccine-preventable diseases because children are interacting with a lot of other people, toys and other objects are being shared, and there is a lot of close contact amongst everyone in the centre.

Clarifying guidance

Immunization is another way to say vaccination.

Local medical officer of health is the formal way to refer to a local public health unit.

Section 35 does not apply to children who are in school (either public or private) because they are already subject to immunization requirements set out in the Immunization of School Pupils Act.

For children who are not yet in school, to attend a child care centre, they must be vaccinated as recommended the by the local medical officer of health that serves the area of the province where the child care centre is located. The licensee must keep any direction provided by the local medical officer of health for the purposes of ss. 35 (1) on file.

A child would not be subject to the health assessment and immunization requirements in either of these circumstances:

  • there is a medical reason why the child cannot be immunized

OR

  • the parent of the child objects to immunization of the child based on their religious beliefs or conscience

If either of these circumstances apply, the parent needs to give the licensee paperwork that documents this. The paperwork has to be done on one of two ministry-issued standard forms. Each form has two versions one for employees, volunteers and students and one for parents of children.

The forms are public and available in both English and French on the Government of Ontario’s Central Forms Repository.

Important Information: 

Parents need to use the parent of a child version of the form that they will be submitting to the child care centre. The chart on the following page shows how to make sure parents provide the right information.

The standard ministry-issued form for religious/conscience objections must be completed by a commissioner for taking affidavits (for example, a notary public). Commissioners for taking affidavits can be located by searching the internet or looking in a local business directory. Licensees should refer parents to Ontario’s Find a notary public or commissioner of oaths for taking affidavits website.

Statement of medical exemption forms must be completed by a doctor or nurse practitioner.

Examples:

Is the child in public or private school?

Is the child in public or private school?

  • if no,
    • Does the child have a reason why the immunization requirements under O. Reg. 137/15 do not apply?
      • If no, then immunization requirements in O. Reg. 137/5 apply to this child
      • If yes, then the child need to use one of the following standard forms:

Clarification about what is required in a children’s record that a licensee must keep

For children who are not in school:

  • all paperwork around immunization – either proof of immunization or one of the two completed standard forms – must be kept in a child’s record and ideally should be on file by the time the child begins attending the licensed program.

For children who go to school:

  • the child’s record for the child care centre should not contain paperwork around immunization because the child’s school would already maintain this paperwork as required under the Immunization of School Pupils Act, 1990. Licensees should note in a child’s record that they go to school in order to explain why there is no immunization paperwork in the child’s record.

Cross-references:

The regulation has requirements around children’s records and records retention. See section 72 and section 82.

A medical officer of health (or their designate), once they have shown their identification, is allowed to inspect and ask for copies of certain information in a child’s record in a child care centre, including immunization paperwork for the child. See subsection 72(6) of the regulation.

This means that both Ministry of Education officials and the local public health unit can ask to see paperwork around immunization in a child’s record in a children care centre.

Best practices

If a child’s parents need to provide a completed standard form around reasons why the child cannot be immunized, licensees should make sure that the parents understand what is required and make sure the parents have access to the internet so they can get the form they need.

Licensees and their staff should not provide their own personal opinions about a child’s vaccination status because this information is personal and private. Should a licensee wish to obtain further information in relation to human rights in Ontario, they may wish to seek independent legal advice.

Compliance Indicators

Children who are not in school identified as not having been immunized have a completed and where applicable notarized Ministry approved form in their records of either:

  • The Statement of Conscience or Religious Belief form

Or

  • The Statement of Medical Exemption form

Part 5.4 Daily Observation of Children

Ontario Regulation 137/15 s. 36

Note: There is a ministry developed standard template for this requirement. It is available in the Tools and Resources section in CCLS.

Intent

Subsection 36(1) is in place to help prevent or minimize the spread of illness/infection by requiring children coming into the child care centre to be observed for symptoms that indicate they are sick before they start playing with or being around other children.

Subsections 36(2) and 36(3) are in place to make sure children who appear to be sick are separated from other children and are picked up by a parent or that they receive medical attention if a parent cannot pick up the child immediately.

Clarifying Guidance

Cross-references:

The regulation requires licensees to ensure that their staff follow the direction of a medical officer of health with respect to any health/well-being matter. See subsection 32(1).

The regulation requires licensees to ensure that, where a report is made by the local medical officer of health or any person designated by the local medical officer of health a copy of the report is kept on the premises of the child care centre or home child care agency. If the report includes any direction or order, a copy of the direction or order is sent immediately to a program adviser, and a program adviser is immediately notified of any enforcement action taken against the licensee in relation to the direction or order. See subsection 32(2).

Best practices

Licensees should check with their local public health unit and/or go to Public Health Ontario to get information about different diseases/infections and their symptoms and post this information in the centre. Staff should be familiar with this information and pay close attention to any signs/symptoms of illness, changes in children’s behaviour, daily routine or their personality.

Understanding different symptoms of being ill

It is important for those who interact with children in the child care program to know when a child has symptoms due to a chronic (in other words, long-standing and potentially permanent) condition versus symptoms due to a new, temporary condition. For instance, if a child is coughing, it may be due to an existing chronic condition such as asthma or it may be a symptom of an illness such as a cold. Licensees should discuss the importance of monitoring symptoms with parents when they are enrolling their child in the child care centre. If the licensee chooses to collect any health information from a parent about their child, they must follow all applicable legislation regarding personal health information and privacy.

Sudden changes in behaviour

In addition to looking for and documenting signs/symptoms of ill health such as fever, rash or symptoms related to digestion, throughout the day, child care centre staff should be aware of and look for any sudden or gradual changes in a child’s behaviour, sleeping or eating patterns, or signs that a child has lost some previously acquired skill(s) (for example, stopped being able feed themself, stopped using language and more). Child care centre staff should talk to the parents of a child who has had a sudden and dramatic change in behaviour parents immediately, since this can be a sign of a change in the child’s health status.

Licensees should encourage parents to share information about their child’s restless night, lack of appetite or other atypical behaviour when they drop off their child at the centre for the day. This information should be recorded in the daily written record and children who have demonstrated atypical behaviour should be monitored more closely for potential signs of sickness.

Staff should pay extra attention to the following signs/symptoms in children:

  • higher than normal body temperature, flushing, becoming “clammy” and/or slowing down of movement/activity
  • a sudden appearance that may be related to a cold such as coughing and/or discharge coming from the nose
  • vomiting or diarrhea
  • red eyes or ears and/or discharge coming out of eyes or ears
  • skin rashes or infections that have suddenly appeared
  • unusual irritability, fussiness and restlessness

Staff should also pay extra attention to younger children whose language skills are not fully developed and to children with special needs as these children may have a harder time explaining to an adult that they are not feeling well.

Licensees should also develop policies and procedures related to when ill children will not be permitted to attend child care. These policies and procedures should be developed in consultation with the local medical officer of health and should include information on when parents will be notified of atypical behaviour or signs/symptoms of ill health as well as information on when parents will be asked to pick up their children.

Staff should communicate with parents as soon as it’s obvious that the child has signs/symptoms of being sick, particularly with younger children who have developed a fever, even if the threshold for asking that the child be taken home has not yet been met. Parents then have the choice to pick up their child if they are concerned.

Communicable diseases

When a child has been exposed to a communicable disease in a centre such as measles (for instance, the child was in the child care centre when a person with a communicable disease was also there), licensees are to notify their local public health unit immediately and follow the direction provided by the local public health unit. Both staff and parents should observe all children who were exposed to the communicable disease for any signs and symptoms during the incubation period.

Ontario Regulation 135/18, made under the Health Protection and Promotion Act, specifies which communicable diseases must be reported to the local medical officer of health (which is the formal way to refer to a local public health unit). Licensees should check with their local medical officer of health to determine when and how these diseases, or suspected occurrences of these diseases, should be reported.

Compliance Indicators

  • Staff are seen to observe children to detect symptoms of ill health as they enter the child care centre and before the children interact with other children

Or

  • Staff verbally confirm that children are observed daily in order to detect symptoms of ill health as they enter the child care centre and before the children interact with other children. 

     
  • Symptoms of ill health identified during the daily observation are recorded in the child's records, including any information about symptoms provided by parents.
  • Children with symptoms of illness are observed to be separated from other children

Or

  • Staff verbally confirm that children with symptoms of illness are separated from other children. 

     
  • Where a child is observed to have symptoms of illness, the child is taken home

Or

  • Staff verbally confirm that children with observed symptoms of illness are taken home by parents. 

     
  • Where it appears that a child requires immediate medical attention, or the child's parent(s) cannot take the child home, arrangements are made to have the child examined by a legally qualified medical practitioner or registered nurse

Or

  • Staff verbally confirm that arrangements have been made to have children with symptoms of illness and who require immediate medical attention to be examined by a legally qualified medical practitioner or registered nurse.

Part 5.5 Accident Reporting

Ontario Regulation 137/15 ss. 36(4)

Note: there is a ministry developed standard template for this requirement. It is available in the Tools and Resources section in CCLS.

Intent

Subsection 36(4) is in place to ensure that when injuries happen, there is a record of what happened because this information may be important in the future and parents need to know what happened. For example, if a child falls when in the playground and bumps their head, if the child later has symptoms of a concussion, it is important that parents and doctors know about the circumstances of the fall.

Additionally, staff who were not present during the accident which led to the child being injured need to know about the accident so they can support the child or know to watch for additional symptoms.

The centre must make an accident report and let the child’s parents know about the child’s injury by providing the parent with a copy of the accident report.

Clarifying guidance

Any time an accident report is completed, it must be noted in the daily written record.

Licensees must be able to demonstrate that parents have been provided with either a hard copy or electronic copy of the accident report.

The CCEYA or its regulations do not define what is considered to be an “injury” that requires an accident report be completed. It is up to each licensee to determine what type of events would reasonably constitute an “injury” such that an accident report must be filled out and to ensure all of their staff are aware of the criteria for what needs to be reported in an accident report. Licensees can consult with their insurance provider, lawyer and/or local health authorities to determine what constitutes an “injury” for this purpose.

Important Information: Sometimes there are no signs/symptoms in the child that an accident happened. Situations where children have sustained a hard hit to their head or are struck by something hard/heavy on their head should be recorded as an accident even if there are no signs/symptoms present. Hits to a child’s head can sometimes result in a concussion, which is very serious.

Cross-references:

An accident report is a record. The regulation has requirements around record retention. See subsection 82(1) of the regulation.

The regulation requires a daily written record be maintained. See section 37.

Best practices

Tips for completing an accident report.

Licensees should include, at a minimum, the following information in an accident report:

  • the child's name
  • who filled-out the accident report
  • date and time of the accident
  • location of accident
  • description of accident
  • description of the injury that happened because of the accident and how bad the injury was
  • what the staff did to respond to the accident and, if first aid was administered, what that first aid was
  • how the copy of the accident report was provided to the parent (for example, the accident report should note that a copy of the report was given to the parent as a hard copy or a copy of the accident report was sent over an email)
  • when the report was provided to the parent (this serves as confirmation that the report was given to the parent)

Compliance Indicators

  • There is an accident report on the premises for any child that was injured while receiving care

And

  • The accident report describes the circumstances of injuries and any first aid administered, where applicable.

And

  • There is evidence (such as a parent signature on the form, email verification) that a copy of any accident report has been provided to the child's parents.

Part 5.6 Daily Written Record

Ontario Regulation 137/15 s. 37

Intent

Section 37 is in place to support the health, safety and well-being of staff and children by requiring centres to maintain a daily written record and, as part of that daily written record, there must be a brief description of any incident that may have happened that affected the health, safety and well-being of someone in the child care centre.

Having a summary of an incident is important; staff who were not present during the incident that needs to be in the daily written records need to have access to information about the incident so they can support the child or know to watch for additional symptoms.

Clarifying guidance

The daily written record needs to be filled out every day, no exceptions, even if nothing unusual happened.

If a serious occurrence takes place or there is an accident report provided to a parent, this needs to be noted in the daily written record but the note in the daily written record does not need to go into a lot of detail. For example, if a serious occurrence took place, staff can note that this happened in the daily written record by writing down “a serious occurrence occurred involving X. See file for details”.

Anytime there is a fire drill, this is to be recorded in the daily written record.

Licensees can choose what their daily written record looks like and what is in it but, at a minimum, the daily written record must contain a dated entry for each day the program operates. If there is nothing to report for that day, the entry can simply say that the day was uneventful. If daily written records are kept in each room where the children are getting child care, licensees must ensure that each daily written record in each room is completed by the staff each day.

Subsection 37(2) requires staff to let the parent of a child know when any incident that affected the child’s health, safety or well-being has happened. If the parent already knows about the incident because they were given an accident report, the staff don’t need to tell them about the incident for a second time.

Cross-reference: the regulation has requirements around accident reporting, including a requirement to give parents a copy of an accident report. See subsection 36(4).

Important Information:

An accident and incident affecting the health, safety or well-being of a child are not always the same thing.

  • an accident is a situation where a child is injured. For example, if a child falls and scrapes their knees and their knees are bleeding, this is an accident.
  • an incident affecting the health, safety or well-being of children can be:
    • an accident or when something happens that could make a child sick in the future or the child has become sick (in other words, the child is unwell but it’s not because of an accident). For example, if the child develops a fever and starts vomiting when at the centre, this is an incident affecting the health, safety or well-being of the child.
    • a situation that affects more than one child. For example, a gas leak resulting in an evacuation affects everyone and should be noted in the daily written record.

An incident is not always an accident, but an accident is always an incident. That is why every time an accident happens, it needs to be documented with an accident report and noted in the daily written record.

Differences between an accident and an incident 

Accident
  • what:
    • an accident report is required when a child is injured. A copy of an accident report needs to be provided to the parent of the child who was injured
  • who:
    • only required for children
  • when:
    • as soon as possible after the accident happens
  • is parent notification required?
    • yes. Parent must be notified of an accident that resulted in their child being injured
  • how must notification be done?
    • parents must be notified by giving them a copy of the accident report
  • intersection with a daily written record:
    • accidents must be noted in the daily written record in addition to filling out an accident report. The note in the daily written record about an accident doesn’t need to go into a lot of detail. Staff can write “child X had an accident on the playground. See child’s file for the accident report”.
  • examples:
    • child fell and scraped their elbows
    • something hard/heavy fell on the child’s head or the child hit their head hard on something
    • a child was accidentally scratched by another child.
Incident
  • what:
    • an incident is when something happens that affects the health, safety or well-being of a person at the centre. The something can be an accident or it can be about a child getting sick or otherwise hurt or harmed. If the incident is not accident, parents need to be notified but an accident report wouldn’t be filled out
  • who:
    • required for an incident that affected a child and/or a staff person at the child care centre
  • when:
    • as soon as possible after the incident happens
  • is parent notification required?
    • it depends. If the parent has already been given an accident report, this is considered notifying the parents. Otherwise, the parents must be notified
  • how must parent notification be done?
    • there is no rule about how to notify a parent about an incident that happened. It can be verbal, over email/text or parents can be given a copy of the notes about the incident that were included as part of the daily written record
  • intersection with a daily written record:
    • incidents (including accidents) must be noted in the daily written record
  • examples:
    • there was a flood in the building and everyone had to evacuate
    • a child began coughing and developed a fever
    • a child chokes on food
    • a child broke out into hives after eating
    • a staff person cut themselves badly while preparing the lunch meal in the kitchen

Best Practices

Licensees may choose to have a single daily written record for the entire child care centre or an individual daily written record for each group of children in each age category.

Compliance Indicators

  • There is a daily written record

And

  • The daily written record contains a summary of any incident affecting the health, safety or well-being of children and staff (for example, accident reports, ill children, and more).
  • Where a parent has not been notified of an incident under section 36, there is written evidence that parents are notified when there is an incident that affects the health, safety or well-being of their child (for example, in accident reports, in the child's records, or in the daily written record)

Or

  • Where a parent has not been notified of an incident under section 36, the licensee or staff confirm that parents are notified when there is an incident that affects the health, safety or well-being of their child.

Part 5.7 Serious Occurrences

Ontario 137/15 s. 38 

Note: there is a ministry developed standard template for this requirement. It is available in the Tools and Resources section in CCLS.

Intent

Section 38 is in place to make sure that child care centres report serious occurrences to ministry program advisors so they are aware of the situation and, if necessary, program advisors can help the centre address the serious occurrence in the best and most appropriate way possible.

Additionally, in some situations, information collected about serious occurrences can help to reduce the chance of a similar serious occurrence from happening again in the future.

Clarifying Guidance

Licensees must have a serious occurrence policy and procedures to deal with serious occurrences (which are defined in Section 1 of the regulation), including how they are to be identified, responded to and reported to both third parties (for example, a Children’s Aid Society) and the ministry.

The licensee can develop their own written policies and procedures with respect to serious occurrences or they can choose to adopt the standard policy developed by the ministry.

A licensee’s serious occurrence policy and procedures document must, at a minimum, include:

  • what is considered a “serious occurrence” (this is the list of categories under the definition of “serious occurrence” in section 1 of the regulation)
  • the step-by-step instructions (in other words, the procedures) on how staff are to respond to a serious occurrence (for example, immediate medical attention must be provided) and who to notify (for example, call fire and police services, Children’s Aid Society, etc.)
  • information on how to report a serious occurrence (namely, the licensee’s policy and procedures document must say that all serious occurrences must be reported to the ministry through CCLS within 24 hours of the licensee or supervisor becoming aware of the serious occurrence)

Required procedures should set out the specific steps that staff need to take when a serious occurrence happens.

Procedures for missing children

A child going missing is very dangerous and serious.

The procedures for what to do when a child has gone missing need to be very clear and speak to how parents will be contacted.

When developing protocols around missing children, licensees should take into consideration if any steps need to be modified based on the age of the missing child.

Procedures around missing children should include who does what and when including:

  • alerting all staff, volunteers and students at the centre that a child is missing
  • immediately searching the entire child care premises, including outdoor play areas such as playgrounds
  • telling a staff person who is not searching the premises to immediately alert the child’s parents (in case parents have additional information about child’s whereabouts)
  • calling 911 (or local emergency services if the centre is in an area of the province which does not have 911)

Important information: licensees or their designates or supervisors are required to report serious occurrences to their program advisor through CCLS within 24 hours. There may however be situations when CCLS is not accessible (for example, because of an internet outage).

If after a serious occurrence a licensee, designate or supervisor cannot access CCLS for some reason, they must still notify their program advisor via telephone or email within 24 hours of becoming aware of the occurrence and complete a serious occurrence report in CCLS as soon as the system becomes available. Licensees, their designate and supervisors should make sure they know the contact information including the phone number, for the ministry program advisor assigned to the centre.

Serious Occurrence Summary of the Report (in CCLS this is called the “Serious Occurrence Notification Form”)

In addition to the requirement that licensees must report to the ministry any serious occurrence within 24 hours of the licensee becoming aware of the occurrence, they must also post a summary of the serious occurrence for a minimum of 10 business days in an obvious, visible place in the centre. Parents must be able to see the summary. The summary must:

  • describe what happened (essentially, a brief description of the serious occurrence) without using any information that could identify any persons involved in the serious occurrence
  • explain what action was taken to address the serious occurrence
  • be updated if any new information becomes available about the serious occurrence.

Helpful information: when counting “business days”, Saturdays and Sundays and a weekday that is a statutory holiday are not to be counted.

Important information: the serious occurrence categories in CCLS are more detailed than the definition in the regulation. See Appendix A: Reportable Serious Occurrences for more information.

In addition to needing to meet the requirements around serious occurrences under the CCEYA, any suspicion of abuse of a child or neglect of a child triggers requirements under the Child, Youth and Family Services Act, 2017 (CYFSA).

If a licensee or their staff, volunteers or students suspects that a child is, or may be, in need of protection from abuse and/or neglect, they must report this suspicion to the local children’s aid society in accordance with section 125 of the CYFSA. Subsection 125(1) of the CYFSA lists all of the situations that must be reported to a Children’s Aid Society.

All licensees, staff, students and volunteers should read the following documents: Reporting Child Abuse and Neglect: It’s Your Duty and Submit a complaint about child welfare services.

Important information: under the CYFSA, certain people who work with or around children, including an operator or employee of a child care centre or provider of licensed child care, have a heightened responsibility to report suspicions of child neglect and/or abuse. If such a person does not report a suspicion and the information on which it was based was obtained in the course of the person’s professional or official duties, the failure to report the suspicion is considered an offence under the CYFSA and the individual may be fined up to $5,000.

Professional misconduct - registered early childhood educators

Registered early childhood educators (RECEs) are subject to the College of Early Childhood Educators’ Code of Ethics and Standards of Practice as well as all applicable statutes, regulations, bylaws and legally binding policies that are relevant to their professional practice.

The Early Childhood Educators Act, 2007 and its Professional Misconduct Regulation set out that it is an act of professional misconduct to “[contravene] a law, if the contravention has caused or may cause a child who is under the member’s professional supervision to be put at or remain at risk.”

Employer’s mandatory reporting obligations

The Early Childhood Educators Act, 2007 (ECEA) requires employers of early childhood educators to submit reports to the College of Early Childhood Educators (CECE) in certain circumstances. The ECEA sets out what kind of situations warrant such a report to be made to the College. In addition, the ECEA specifies the required timelines for such reporting and sets out information the College must provide to employers in response to any reports that are received. Licensees should familiarize themselves with the ECEA, especially the content around requirements for employers. For more information, please visit Ontario’s e-Laws website to view the ECEA and visit the College of Early Childhood Educators’ website.

Administrative Penalty

Contravention of clause 38(1)(b) of the regulation may lead to an administrative penalty of $2,000. See section 78 of O. Reg. 137/15 and item 1 of Table 2 under that section.

The amount of the administrative penalty increases if the contravention of clause 38(1)(b) is repeated in the next three years.

An administrative penalty can be up to $100,000.

Cross-references:

Licensees must implement and ensure that the written policies and procedures relating to serious occurrences are implemented by staff, volunteers and students and are monitored for compliance and contraventions. See section 6.1.

In addition to requirements around serious occurrences, the regulation has requirements around emergency management including a definition of what is an “emergency” and requirements about what needs to be done after the emergency is over. See section 68.1.

Important information: Most of the time, an emergency as defined in section 68.1 which affects all children in a centre or the centre’s operations (such as a flood) is also considered a serious occurrence.

Best Practices

If appropriate given the nature of the serious occurrence, the licensee or supervisor of the centre should explain what happened to everyone in the centre, including explaining to children if they are old enough to understand.

If the serious occurrence was an emergency as defined in section 68.1, there are requirements about debriefing with those in the child care centre, including children.

Licensees and supervisors should also look at what led to the serious occurrence and figure out if there are any steps that can be taken to reduce the chance that something similar will happen again. If there were hazards or other risks that played a role in the serious occurrence, they should be identified and quickly addressed.

Compliance Indicators

  • The licensee has developed written serious occurrence policies and procedures that address at a minimum, how to identify, respond to and report a serious occurrence

Or

  • The licensee has adopted and completed all customizable areas of the standard policy provided by the Ministry. 
  • A review of CCLS confirms that all serious occurrences were reported within 24 hours of the licensee or supervisor becoming aware of the incident

Or

  • There is evidence that the program advisor was notified of the serious occurrence within 24 hours of the licensee or supervisor becoming aware of the incident. 
     
  • If a serious occurrence was reported within the last ten business days, a notification form is posted in a conspicuous place at the child care centre (including any allegation of abuse or neglect)

Or

  • Where a serious occurrence was reported more than 10 business days ago, the licensee or supervisor confirms that notification form(s) were posted in a conspicuous place at the centre for 10 business days.

Part 5.8 Anaphylactic Policy

Ontario 137/15 s. 39 

Note: there is a ministry developed standard template for this requirement. It is available in the Tools and Resources section in CCLS.

Intent

Anaphylaxis is a serious allergic reaction that can be life-threatening.

Section 39 is in place to help support the needs of children with anaphylactic allergies and reduce the chances that a child will have an anaphylactic reaction while at the child care centre.

The requirements in section 39 of the regulation were made to align with similar requirements which apply to publicly-funded schools under a different law called Sabrina’s Law, 2005.

Clarifying Guidance

There are no exceptions to the requirements in section 39. Licensees must develop policies and procedures with respect to anaphylactic allergies (or adopt the standard policy developed by the ministry) even if:

  • there are currently no children in the centre that have an anaphylactic allergy
  • the centre is in a school
  • the centre only operates for a few hours a day

Cross-references:

Licensees must implement and ensure that all individualized plans, including those for children with anaphylaxis and including the emergency procedures in that individualized plan, are implemented by staff, volunteers and students and are monitored for compliance and contraventions. See section 6.1.

The regulation has requirements around drugs/medication including that drugs/medication must be inaccessible to children and they must be kept in a locked container. See subclause 40(1)(b)(iii) and subclause 40(1)(b)(iv).

The regulation has a requirement that child care centres post a list of children with allergies (including anaphylactic ones) and what causes the allergy in a particular child in various parts of the centre. See subsection 43(3).

The regulation requires child care centres to have a parent handbook and that the handbook must contain the centre’s anaphylactic policy (as well as other things). See clause 45(1)(a.1.1).

The regulation requires child care centres to maintain a “children’s record” for every child in the centre. As part of a child’s record, there must be written instructions signed by a parent of the child for any medical treatment or drug/medication that could be given to the child when at the centre. See paragraph 72(1)(10).

Exception: asthma medication and emergency allergy medications containing epinephrine (such as “EpiPens”) 

For children who can give themselves medication

There is an exception to the requirement for medication to be inaccessible to children and kept in a locked container. See subsection 40 (2) of the Regulation.

Licensees can allow children who have the skills and independence to give themselves medication (also called self-administer) to carry their own emergency allergy medication for anaphylactic allergies such as an “EpiPen”.

This exception is allowed as long as:

  • allowing children to carry emergency allergy medication is not in conflict with the child care centre’s medication administration policy

And

  • the child’s parents have given permission for the child to give themselves their own medication and that permission is included as required in the child’s record at the centre

And

  • staff make sure that when the child is going on a field trip or leaving to go to school, the child has their medication with them

For children who cannot give themselves emergency allergy and asthma medication

For children who are not old enough or don’t have the skills to self-administer asthma or emergency allergy medication, staff must ensure it is always easy to grab but still out of children’s reach.

Emergency allergy and asthma medication should not be locked up with other medication.

Staff must also ensure that emergency asthma and allergy medication is in the staff’s possession when leaving the child care centre (for example, walking children to school or going on a field trip).

Best Practices

Child care centre staff may want to provide opportunities for children enrolled at the child care centre to learn about allergies and things that cause allergies and that are not permitted at the centre.

Additional information on anaphylaxis can be obtained through Health Canada’s Food allergies and gluten-related disorders website.

Compliance Indicators

  • The licensee has developed a written anaphylactic policy that includes the items listed in subsection 39 (1)

Or

  • The licensee has adopted and completed all customizable areas of the standard policy provided by the Ministry. 
     
  • Each child with an anaphylactic allergy has an individualized plan developed with input from the child's parent that includes emergency procedures

And

  • Each child with an anaphylactic allergy has an individualized plan that includes a description of the procedures to be followed in the event of an allergic reaction or other medical emergency.

Part 5.9 Children with Medical Needs

Ontario 137/15 s. 39.1

Note: there is a ministry developed standard template for this requirement. It is available in the Tools and Resources section in CCLS.

Intent

Section 39.1 in place so there is a plan to support children with medical needs and to maximize their inclusion in all activities in the child care centre.

Clarifying Guidance

A child with medical needs has a specific meaning in the regulation.

For example, a child with diabetes may require that an adult checks the child’s blood sugar levels with a glucose monitor several times a day – this child is considered a child with medical needs.

Individualized plans for a child with medical needs must be in place when a child starts attending the child care centre; licensees should talk with parents about any needs a child may have related to a medical condition before the child starts attending the centre.

An individualized medical plan must be developed in consultation with the parent of the child and any regulated health professional (such as doctors, speech-language pathologists, physiotherapists and more) and are involved in the child’s health care if the parent advises that one of these types of professionals is to be consulted.

Licensees are required to maintain the confidentiality of a child’s medical history including any diagnosis. Sensitive or confidential medical information and detailed reports from medical professionals should not be included in the individualized plan required by section 39.1 unless parents agree to this (provide consent) in writing.

Support persons hired by parents

Where a parent chooses to hire an individual to support their child while in care at the child care program, the child’s individualized support plan must also include information pertaining to the support this individual will be providing the child, including whether the parent has provided consent for the individual to be left alone with the child.

Important information: if a child has an anaphylactic allergy and no other medical condition and an individualized plan for the anaphylactic allergy is already in place per section 39, licensees do not have to also develop an individualized medical plan as required by section 39.1.

Best Practices

It is best for the licensee to include information in the parent handbook about the requirement for individualized plans for children with medical needs and how frequently these plans will be reviewed and updated.

Tips for writing an individualized plan for a child with medical needs

The following examples may assist the licensee in developing the individualized medical plan:

  • steps to reduce risk of exposure to causative agents or situations that may exacerbate medical condition or cause an allergic reaction or other medical emergency
    • examples:
      • limiting child’s outdoor time and exposure to sun
      • use of protective clothing
      • pureeing food to minimize choking
         
  • description of medical devices and instructions related to use
    • examples:
      • blood glucose reader: prep, storage and sanitation of device
      • insulin injections: use of needles, storage of insulin, disposal of needles
      • feeding tube: prep, storage and sanitation of device
         
  • procedure to be followed in the event of an allergic reaction or other medical emergency
    • examples:
      • administer Benadryl or other allergy medication such as epinephrine, contact parents and seek immediate medical attention
      • administer fever reliever and contact parent
      • seek emergency medical attention and contact parent
  • description of supports available to the child
    • examples:
      • adaptive feeding chair
      • occupational therapist or other person providing support
         
  • procedures to be followed in the event of an evacuation or participation in an off site field trip
    • examples:
      • ice pack for medication or items that require refrigeration
      • carrying case for devices
         

Compliance Indicators

  • The licensee has developed an individualized plan for each child with medical needs

Or

  • The licensee has adopted and completed all customizable areas of the template provided by the Ministry.
  • There is written evidence that the plan was developed in consultation with the child’s parent/guardian and any regulated health professional involved in the child’s care

Or

  • Staff verbally confirms that the plan has been developed in consultation with the child’s parent and any regulated health professional involved in the child’s care.
  • Each individualized plan includes:
     
    • steps to be followed to reduce the risk of the child being exposed to any causative agents or situations that may exacerbate a medical condition or cause an allergic reaction or other medical emergency 

                    And

  • a description of any medical devices used by the child and any instructions related to use

                    And

  • description of the procedures to be followed in the event of an allergic reaction or other medical emergency

                    And

  • a description of the supports that will be made available to the child while in care 

                    And

  • any additional procedures to be followed when a child with a medical condition is part of an evacuation or participating in an off-site field trip.

Part 5.10 Administration of Drugs

Ontario 137/15 s. 40

Intent

Important information: licensees are not required to administer medication to children, however, if a licensee determines that staff can administer medication to children, specific requirements must be met. If the licensee does not allow the administration of medication in the program, no one at the centre can give children medication.

Mistakes around storing and/or the giving (also called administration) of drugs/medication (which will be referred to as medicine in this part of the manual) can seriously hurt a child and/or can worsen the condition that requires the medicine.

Section 40 is in place to make sure that, if a licensee agrees to give medicine to a child, this is done in a safe and appropriate way to reduce the chance of the child, or other children, being harmed.

  • so it works the way it’s supposed to and to prevent children from eating medicine or otherwise hurting themselves with medicine, subclause 40 (1) (b) requires medicine to be stored properly and in a way that children cannot get to the medicine.
  • to reduce the chance of making mistakes with the giving of medicine, subclause 40 (1) (c) requires that only one staff person or a designate be in charge of the giving of medicine to children.
  • to make sure children are given the right amount of medicine at the right time, subclause 40 (1) (d) requires parents to give written permission before a child care centre can give medicine to children. The written permission must include detail on the amount of medicine (dose) to be given and when the dose is to be given.
  • to make sure children get the right dose, to avoid mix-ups in situations where more than one child is getting the same medicine and to make sure medicine is still usable, subclause 40 (1) (e) requires that medicine be stored in original containers and labelled with the child’s name, the name of the medicine, the dosage, the date of purchase and the date of expiration, if applicable, and instructions for storage and administration.

Exemption: to prevent the need for parents to give written permission every time their child needs to be given over-the-counter sunscreen, moisturizing skin lotion, lip balm, insect repellant, hand sanitizer or diaper cream), subsection 40 (4) allows licensees to give these products to children as long as parents have given their written permission one time (this is called blanket authorization).

Clarifying Guidance

40(1)(a)(i) – requirement to have a written procedure about giving medicine

Guidance/detail: the licensee must develop written procedures for the administration of any drug or medication. The ministry has a template that licensees can use or licensee can write their own procedures.

A drug or medication does not have to be prescribed by a doctor or other health professional. A drug or medication has a Drug Identification Number.

  • a Drug Identification Number (DIN) is an eight digit number assigned by Health Canada to a drug product prior to being marketed in Canada. It uniquely identifies all drug products sold in a dosage form in Canada and is located on the label of prescription and over-the-counter drug products that have been evaluated and authorized for sale in Canada.

The written procedures should note what to do if a child is given the wrong dose of their medicine or if a child takes/is given medicine that is not theirs (this can be referred to as accidental administration of medicine).

Cross-reference: the regulation requires child care centres to have policies and procedures about serious occurrences, which are defined in the regulation. See section 38 and subsection 1(1).

40(1)(a)(ii) – requirement to have a written procedure about keeping records of medicine being given

Guidance/details: a licensee’s procedure around record-keeping must always address:

  • how and where staff will note down in writing every time that a child was given medicine
    • the procedures must indicate that writing down when medicine/product is taken by a child must always be completed. This includes when:
      • staff give a child medicine that is not covered by blanket authorization
      • staff give a child a product that is covered by a blanket authorization (these are over-the-counter [so not prescription] products listed in ss. 40(3)
      • a child gives themselves asthma medication or emergency allergy information
  • how any accidental administration of medicine will be recorded
  • how the records around given medicine will be maintained

Cross-references

The regulation requires child care centres to maintain a “children’s record” for every child in the centre; as part of a child’s record, there must be written instructions signed by a parent of the child for any medical treatment or drug/medication that could be given to the child when at the centre. See subparagraph 72(1)(10)

Paperwork needed because of subclause 40(1). The regulation has requirements around record retention and also clarifies that a record can be either a hard-copy (in other words, paper) or electronic. See section 82

Important Information

Section 40 applies to all products containing a Drug Identification Number (DIN). A DIN is an eight digit number assigned by Health Canada to a drug product. It uniquely identifies all drug products sold in a dosage form in Canada and is located on the label of prescription and over-the-counter drug products that have been evaluated and authorized for sale in Canada. Many different types of products including vitamins, medicated ointments, prescription medication and over-the-counter products such as pain medicine have a DIN.

If a parent is asking a licensee to give a child medicine or other product, licensees must ask to see what the medicine/product is to check to see if it has a DIN before deciding.

40(1)(b) (i) and (iii), (iv) rules/requirements around storing medicine and making sure medicine is inaccessible to children

Example/details: clarification on medicine that needs to be refrigerated

Drugs and medications that must be kept in a fridge must be inaccessible to children at all times and locked in a box and should be separate from food and beverages in the fridge if possible.

40(1)(b) (ii) – how to administer the medicinefootnote 1

Examples/details: subsection 40(1)(b)(ii) requires medicine to be given to a child in agreement with the instructions on the label and with the instructions about the when the medicine is to be given and how much is to be given in the parent’s written authorization that they have to give the licensee because that’s the requirement in 40(1)(d).

40(1)(c) – only one person in charge of giving medicine

Examples/details: the licensee’s written procedures must document the person or position in charge of giving medicine. If another individual or person is responsible for giving medicine in certain circumstances, this must also be documented in the procedures.

40(1)(d) – parents must give written authorizationfootnote 2

If the dosage on the label is correct, the licensee must have the parent correct the information on the form. If the dosage on the medical authorization form is correct, the licensee must obtain a doctor’s note from the parent that clearly indicates the child’s name, the name of the drug or medication and the instructions to be followed by the licensee. In cases where the difference is clearly due to the amount of time the child spends at the centre vs. at home, the above documentation is not required. For example, if the label indicates that the child is to receive 4 doses of an antibiotic each day, but the medication authorization form indicates that the centre is to administer antibiotics once at 11am daily, compliance is met.

Examples/details: medicine can only be given to children if the licensee agrees to do so and the child’s parent gives permission in writing (this is called written authorization). The parent’s written authorization needs to include:

  • a schedule for when (for example, give the child medicine at lunch) and/or how frequently (for example, give the child the medicine every 2 hours)
  • how much a dose of medicine is

If medicine needs to be taken on an as needed basis, the parent’s written instructions must clearly explain what “as needed” means. For example, the parent’s written instruction can say that when a child begins wheezing, the child must take two puffs from their asthma medication. If a parent’s written instructions say “take as needed”, this is not enough. The parent has to include information about the signs and symptoms that indicate that it’s time for the child to take their medicine.

Parent’s written instructions are also needed for asthma medication or emergency allergy medication that children carry and can give themselves.

Parents may also wish to provide specific written instructions for products that are listed in subsection 40(3). For example, a parent may wish diaper cream to only be applied after certain diaper changes instead of at every diaper change. This information should be provided in writing so that any staff working with that child is aware of the instructions.

40(1) (e) – requirements around original containers and labelling

Examples/details: licensees cannot accept medicine in anything other than the original container. For example, loose pills cannot be provided in a zip-lock bag or a generic pill box.

All of the following must be labelled and stored in a way that is consistent with the instructions on the label. Instructions on the label and the parent’s instructions must be followed:

  • medicine that is not covered by blanket authorization
  • products that are covered by a blanket authorization (these are over-the-counter [so not prescription] products listed in ss. 40(3): sunscreen, moisturizing skin lotion, lip balm, insect repellant, hand sanitizer and diaper cream)
  • asthma medication or emergency allergy medication that children carry and can give themselves

Staff must check that the parent’s written instructions match any instructions printed on the original container of medicine. Confirming that the two sets of instructions match will prevent any confusion as to which instructions should be followed and support staff to give the medication correctly.

If parents of children in a centre have authorized use of a shared product, such as hand sanitizer, the ministry’s program advisors will not require the product to include the names of children on it (unless necessary).

Staff can only give a dosage of medicine to a child while at the child care centre that the staff themselves measured out at the centre from the original container the medicine was in. It is not acceptable for staff to give a dosage that a parent has brought in from home because the staff have no way of knowing whether the dosage is the right amount and the staff cannot be sure that the dosage came out of the original container the medicine came in.

If staff notice that a child’s medicine has expired, they must notify the child’s parent as soon as possible.

40(3) and (4) – certain products can have blanket authorization.

Examples/details: most children, at one point or another while at the child care centre, will need to use one of the six products that are covered by a blanket authorization (these are the products listed in ss. 40(3): sunscreen, moisturizing skin lotion, lip balm, insect repellant, hand sanitizer and diaper cream).

Licensees must ensure that staff are aware when a parent does not provide written authorization for the use of these items at the child care centre in order to avoid accidental administration of the product to the child. If the explanation is due to an allergy, the rules respecting allergies apply.

Children with medical needs with an individualized plan that speaks to medication

If a child in the child care program is a child with medical needs and has an individualized plan in place per in the case of a child having an individualized plan per section 39.1, the written authorization from a parent to administer drugs and medication to a child, along with required details (such as the name of the medication, dosage, schedule, signs and symptoms and parent signature), may be set out in a written authorization form or in the individualized plan; in other words, the written authorization only needs to be documented once. Where licensees use an individualized plan for this purpose but use ministry templates that make reference to a medical authorization form, licensees must amend the applicable written policies and procedures to reflect this practice.

Exception

For children who can give themselves medication

There is an exception to the requirement for medication to be inaccessible to children and kept in a locked container.

Licensees can allow children who have the skills and independence to give themselves medication (also called self-administer) to carry their own:

  • asthma medication (usually called a “puffer” or “inhaler”) 
  • emergency allergy medication such as an “EpiPen”

No other medication may be carried by a child.

This exception is allowed as long as licensees have written procedures about self-administration of medicine by children which includes the following:

  • Allowing children to carry their own asthma or emergency allergy medication is not in conflict with the child care centre’s medication administration policy

And

  • The child’s parents have to give written permission for the child to give themselves their own medication and that permission is included as required in the child’s record at the centre

And

  • Staff make sure that when the child is going on a field trip or leaving to go to school, the child has their medication with them

And

  • Anytime a child self-administers medicine, staff need to note this in the daily written record

Administrative Penalty

Contravention of subclause 40 (1) (b) (ii) and clause 40 (1) (d) of the regulation may lead to an administrative penalty of $2,000. See section 78 of O. Reg. 137/15 and item 2 of Table 2 under that section.

The amount of the administrative penalty increases if the non-compliance is repeated in the next three years. An administrative penalty can be up to $100,000.

Best practices

Whenever possible, parents should be encouraged to give their children medicine at home if it makes sense and is safe to do so. For example, if a child needs to take medicine only once a day with food, parents should try to give the child the medicine when they are at home and having breakfast or dinner.

If a child must receive medicine while they are at the child care centre, it is best to take the child to a quiet, well-lit area. This approach can limit the chance of interruption/distraction and help staff ensure the appropriate dose is provided. It may also help the child stay calm.

Unused medicine

Any leftover or extra medicine should be returned in the original container to a parent of the child or safely thrown out with parental permission. In Canada, all drugstores accept unused and expired medicine for safe disposal. For more information see Safe Disposal of Prescription Drugs.

Accidental administration of medicine

While the requirements in section 40 are in place to prevent any harm to children, accidents can still happen. If at any time medicine is given to the wrong child or a child has been given the wrong dose of their medicine, this should be reported to the supervisor, who should then notify a parent of the child right away. Licensees should follow any instructions on the label related to accidental administration, including calling 911 or going to the nearest emergency room if required.

If a child has any symptoms of ill health and/or says they are not feeling well after accidental administration of medicine, staff should call emergency services and follow the child care centre’s serious occurrence policy. The incident should be recorded as required by the regulation.

Compliance Indicators

Where a licensee agrees to the administration of drugs or medication,

  • The licensee has developed a written procedure for the administration of any drug or medication to a child receiving care that includes information about record keeping practices when drugs or medications are administered to a child.

Or

  • The licensee has adopted and completed all customizable areas of the standard policy provided by the Ministry.
  • All drugs or medications are stored according to the storage instructions on the label.
  • All drugs or medications are inaccessible to children at all times (with the exception of asthmas or emergency allergy medication that a child may self-administer).
  • All drugs or medications are kept in a locked container, with the exception of asthma or emergency allergy medication.
  • All drugs or medications are administered according to the instructions on the label and written parental authorization.

Or

  • Staff confirm and describe how drugs or medications are administered, and this aligns with the label instructions and written parental authorization.
     
  • The written procedures document a designated position that is in charge of drugs or medications.

And

  • Drugs and medications are observed to be dealt with by the designated position, or the person designated by the designated position.
     
  • There is written authorization from the child's parent(s) that includes a schedule that sets out the when the drug or medication is to be given, which includes either specific times of the day or specific symptoms that must be observed, as well as the dosage to be given.
  • Drugs or medications are administered from their original containers or as supplied by a pharmacist.

And

  • The container or package containing the drugs or medications is clearly labelled with the child's name, the name of the drug or medication, the dosage of the drug or medication, the date of purchase and expiration, if applicable, and instructions for storage and administration.
  • Where a licensee agrees to the administration of items listed under section 40(3), there is written authorization from a child’s parent(s) for the administration of these items.
  • Where a licensee agrees to the administration of items listed under section 40(3), the items are stored in accordance with the instructions for storage on the label.

And

  • The container or package is clearly labelled with the child’s name and the name of the item. 
     
  • Where a licensee agrees to the administration of items listed under section 40(3), the items are only administered from the original container or package.

And

  • In accordance with any instructions provided by the parent of the child.

Part 5.11 Animals

Ontario Regulation 137/15 s. 41

Intent

Section 41 is in place to protect the health of persons in a child care centre by aligning the rules for rabies vaccination of animals in child care centres with Ontario Regulation 567 (Rabies Immunization) made under the Health Protection and Promotion Act.

Clarifying guidance

Inoculated is another way of saying vaccinated.

Being kept at means the animal lives at the centre or is visiting one time or is visiting over and over again.

Important information: there is no exemption to the requirement for all dogs, cats and ferrets kept at the premises to be inoculated against rabies. If a dog, cat or ferret is unable to receive the rabies vaccination, the animal cannot live at or visit the child care centre.

Cross-references:

The regulation requires licensees to ensure that their staff follow the direction of a medical officer of health with respect to any health/well-being matter. See subsection 32(1).

The regulation requires that certain people (including people who are entertainers or animal handlers) be subject to staff screening measures before coming in to a child care centre; see section 61.1

Best practices 

Helpful information: the Ministry of Health’s Recommendations for the Management of Animals in Child Care Settings, 2018 includes a list of animals not recommended in child care.

Compliance Indicators

  • Where applicable, there is a certificate on the premises that indicates that each dog, cat and/or ferret has been inoculated against rabies.

Part 5.12 Sleep Policies and Supervision

Ontario Regulation 137/15 s. 33.1

Intent

Section 33.1 is in place to reduce the risk of very young children (under age 12 months) being hurt, or even dying, when they are sleeping. Major health and children’s safety groups and Health Canada agree that placing infants on their back for sleep is best to reduce this risk.

In addition, monitoring sleeping children can reduce the risk of something bad happening because caregivers can look for any troubling signs in the child (such as a change in skin colour, change in breathing, signs of overheating, etc.) and react as needed.

Clarifying guidance

The licensee must review the recommendations in the most current version of the Joint Statement on Safe Sleep: Reducing Sudden Infant Deaths in Canada (the “Joint Statement’).

The current recommendation in the Joint Statement is that children younger than 12 months of age be placed on their backs for sleep. This has been Health Canada’s recommendation since 1993, as a means to reduce the risk of Sudden Infant Death Syndrome (SIDS).

Exception: the only exception to the requirement to place a child on their back for sleep is if a child’s doctor writes a medical note that says that the child should not sleep on their back. This is what “unless the child’s physician recommends otherwise in writing” in paragraph 33.1(1) means.

Important information: it is important to note that the Joint Statement says that once infants can roll from their backs to their stomachs or sides, those looking after them don’t need to put them on their back even if they started off that nap/sleep time on their back (see page 3 of the Joint Statement).

The requirements in the regulation about how to supervise sleeping children in a child care centre (such as those around sleep position and the performance and documentation of direct visual checks) also apply to centres that provide overnight or extended hours care.

Where the licensee provides extended hours or overnight care, the licensee must outline in their sleep policy how frequently direct visual checks will be completed and documented during extended hours and overnight care.

Cross-reference: licensees must implement and ensure that the written policies and procedures relating to sleep supervision are implemented by staff, volunteers and students and are monitored for compliance and contravention. See section 6.1 of the regulation.

Best practices

For children 0-12 months of age, the Joint Statement (page 4) sets out the following additional principles of safe sleep:

  • other than a firm mattress and a fitted sheet, there should not be any extra items such as pillows, duvets, blankets and bumper pads in the crib, cradle or bassinet to reduce the risk of suffocation.
  • infants are safest when placed to sleep in fitted one-piece sleepwear that is comfortable at room temperature to reduce the risk of overheating and minimize the use of blankets. If a blanket is used, only a thin blanket of breathable fabric should be used.
  • strollers, swings, bouncers and car seats are not intended for infant sleep. An infant’s head, when sleeping in a seated position, can fall forward and cause their airway to become constricted. Once an infant falls asleep, the child should be moved as soon as possible or as soon as the destination is reached to the sleep equipment required under the regulation.

Compliance Indicators

  • Each child who is younger than 12 months who receives child care at a child care centre is observed to be placed for sleep in a manner consistent with the recommendations set out in the Joint Statement on Safe Sleep.

Or

  • Staff verbally confirm that each child who is younger than 12 months is placed for sleep in a manner consistent with the recommendations set out in the Joint Statement on Safe Sleep.

Or

  • Where children under 12 months are observed to be placed in a position other than on their back, there is a written recommendation from the child’s doctor regarding an alternate sleep position.
  • An employee is observed to periodically perform a direct visual check of each sleeping child in a licensed infant or toddler age group or is in a licensed family age group and is younger than 24 months by physically going over to the child while the child is sleeping.

Or

  • Staff verbally confirm that they perform periodically direct visual checks of each sleeping child in a licensed infant or toddler age group or is in a licensed family age group and is younger than 24 months by being physically going over to the child while the child is sleeping and look for indicators of distress or unusual behaviours.

Or

  • There is documentation of direct visual checks being conducted on every child in a licensed infant or toddler age group or is in a licensed family age group and is younger than 24 months. 


     
  • It is observed there is sufficient light in the sleeping area or room to conduct direct visual checks.

Or

  • Staff verbally confirm there is sufficient light in the sleeping area or room to conduct direct visual checks.
  • The licensee has developed a written policy that includes the items listed in 33.1(2) (c).

Or

  • The licensee has adopted and completed all customizable areas of the standard policy provided by the Ministry.
  • It is observed there is a system in place to immediately identify which children are present in the area or room.

Or

  • Staff verbally confirm there is a system in place to immediately identify which children are present in the area or room. 

Part 5.13 Electronic Monitoring Devices

Ontario Regulation 137/15 ss. 31(5)

Intent

Subsection 33.1(5) is in place to reduce risk of harm and injury, including death, when children are sleeping. If the licensee chooses to use electronic monitoring devices, they need to ensure the devices are working properly and picking up the sounds and/or images of all sleeping children.

Clarifying guidance

Electronic monitoring devices must be checked each day to confirm that they are functioning properly.

Important information: electronic monitoring devices cannot be used instead of direct visual checks of sleeping children. It does not matter if a centre does or does not use electronic monitoring devices. Staff must conduct direct visual checks of all sleeping children as required by the regulation.

Best practices

The licensee should develop a procedure for the monitoring of electronic devices that addresses, at a minimum:

  • who will check the electronic monitors (will the staff or centre supervisor do the monitoring?)
  • what steps staff will take if a monitoring device does not work, including reporting the malfunction to their supervisor

The procedures for monitoring electronic devices should be explained to all staff before they start working in the infant room of the centre.

Compliance Indicators

  • If electronic sleep monitoring devices are being used, it is observed that each device is functioning properly, is able to detect and monitor the sounds, and if applicable, video images of every sleeping child.
  • The receiver unit of the electronic sleep monitoring device is actively monitored by employees at the child care centre.
  • It is observed that electronic monitoring devices are checked daily to ensure that it is working properly

Or

  • Staff confirm that the electronic monitoring devices are checked daily to ensure that it is working properly

And

  • It is observed that electronic monitoring devices are used in conjunction with the direct visual checks.

Footnotes

  • footnote[1] Back to paragraph This requirement needs to be read together with 40(1)(d).
  • footnote[2] Back to paragraph Where there is misalignment or contradiction between the dosage on a medicine’s label and the dosage on the medical authorization form provided by the parent (for example, the label indicates that the dosage is 12 ml but the medical authorization provided by the parent indicates that the dosage is 20 ml), the licensee is to confirm with the parent which dosage should be administered to the child.