For parents who are choosing a day care center or family care center, the next step is to schedule an onsite visit. Day care centers will usually have a set process for these visits that include a tour, and a question and answer session during which materials such as the center handbook and major policies, fee schedule, and enrollment forms are made available. In-home providers may have a more relaxed process. If possible, a visit to an in-home provider should take place in the evening after the children have left for the day so that the provider can give the prospective parents his or her full attention while discussing child-rearing philosophies and policies. If the parents continue to be interested in the in-home provider, they can return for a second visit during the day to see the home with children present.
Whether parents are considering a day care center or a family care setting, there are a number of issues and areas to look at during a tour or discussion with a provider. These include:
- Staffing and Ratios. The permitted ratios for day care centers and family care homes vary by state, but in general for infants and young toddlers, the ratio of staff to children should be one to four with no more than a total of eight children per room. For older toddlers and preschoolers, the ratio is generally around one to ten with no more than twenty children in the group. A family care home should generally have no more than two children under two years of age and no more than eight children total unless there are multiple caregivers present. It is important to make sure that the caregivers will be able to focus their attention on all the children present and that a situation will not occur where one child is left to wait on eating or changing because the caregiver is unable to get away from another child.
- Caregiver Training. The next area to inquire about is whether caregivers have received adequate training, and what ongoing training is offered to them to insure that their knowledge remains up-to-date. At a minimum, all staff should have up-to-date CPR and first aid training, as well as basic child development classes. Day care centers should provide ongoing training to their staff members. Family care providers should be able to document classes at local community colleges and similar training organizations as part of their ongoing licensure requirements. In many states, the requirements for training and experience are very clearly spelled out for teachers, assistant teachers, and aides in day care centers and licensed family care providers. By choosing a licensed care facility, parents can know with some assurance that caregivers will have at least the minimal mandated level of appropriate training and credentials necessary for providing adequate care to their child.
- Safety and Emergency Guidelines. All day care centers and family care providers should have established guidelines and policies covering facility and equipment safety, as well as transportation and severe weather. In addition to verifying that such policies are in place and accessible at each site visited, look for visible manifestations that these policies are taken seriously. Child safety features should be installed on electrical outlets and other hazards such as drawers, bathrooms, etc., and exit routes should be well signed in case of fire or severe weather. The center or home should conduct regular drills with the children and staff. The center or home should also be able to provide copies of any inspections that have been done by an applicable state or city organization that shows that the facility is up to code in all areas, as well as proof that the facility is properly insured and permitted with the idea that children will be present. Areas where children are cared for in should be clearly separated from areas used for the operation of the facility or home (offices, kitchens, family spaces, etc).
- Sick Exclusion Policies. The center or home should have written sick child and staff exclusion policies that list the illnesses that require a child or caregiver to not attend the facility and the conditions that must be met before the child or caregiver may return to the facility for care or work. These policies should include the procedures that caregivers will take to reduce the likelihood that infectious diseases will be spread, and for complying with state, city, and/or county rules for reporting infectious disease occurrences to both regulatory agencies and all parents whose children are cared for at the center or home. Finally, written procedures should be in place for the storage and administration of medications to children. In most cases, only medication prescribed by a doctor for which there is a written note will be permitted in the center or home.
- Immunization and Child Records. Along with the sick exclusion policy, there should also be a policy requiring immunizations of the children in the center or home and a documentation procedure for establishing that these immunizations have occurred. In most cases, a doctorâ€™s note or copy of the medical immunization record will be required for enrollment and then again at each subsequent well child check that requires an immunization under state law. Parents of children being cared for at the facility in question should provide adequate documentation of immunizations to the care providers who should keep these materials in the childâ€™s records. Child records should also include developmental reports that the caregiver completes, documentation of all issues that have arisen during care, and family information including up-to-date emergency contact information.
- Pick-up and Drop-off Policies. There should be set policies on pick-up and drop-off times, including flexibility and what money charges will occur for tardiness. Parents will be required in almost all cases to pay for care even when the child is not present (sick or on vacation) and will also generally be required to pay stiff fines for late pick-ups. Facility policies should also include a clear process for signing the child in and out of the center or home, indicate which staff members are allowed to do this custody documentation for each child, and establish the circumstances under which parental visits are permitted at other times throughout the day.
- Financial Policies and Operating Hours. All financial costs of care, acceptable payment procedures and hours of operation (daily and holiday) should be documented in writing. Financial documentation should include payment frequency, payment method (cash, check, charge, etc.), and the circumstances under which payment will be due when a child is absent, whether sick or on vacation. Holiday and vacation pay for the caregiver or center staff should also be documented along with list of days when care will not be available throughout the year.
- Food and Nutrition Practices. For infants, the food and nutrition practice should generally be to feed the child as often as desired by the child and to operate on the childâ€™s schedule rather than trying to establish a predetermined feeding schedule. The center or home should also be supportive of breastfeeding if practiced by the parent. Most often mothers will express (pump) milk ahead of time and will provide this breast milk to the center or home in either a frozen or fresh state. Arrangements should be made in advance as to what to do should this supply of breast milk run low (for example, whether supplemental formula should be offered or not).
Older infants will most likely require a general eating schedule. Proper high chairs should be available for feeding older infants, and parents should arrange in advance the types of baby food their child is allowed to have, and who will provide that food.
Times for breakfast, lunch, and snack periods will likely be set in advance for toddlers and preschoolers. Appropriate tables and chairs should also be available at the home or center for children to use. Set menus for each meal and snacks offered to this age group should be provided in advance to parents on a regular basis. Parents should have the ability to let care providers know of foods that they do not wish their child to receive for various reasons (e.g., due to allergies, special diets, or personal preferences).
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