Tenn. Comp. R. & Regs. 0940-05-31-.08

Current through June 10, 2024

Section 0940-05-31-.08 - SUPERVISION AND GROUPING OF CHILDREN IN MENTAL HEALTH THERAPEUTIC NURSERY PROGRAM FACILITIES

A group is a number of children who interact with each other and with the caregiver to whom they are assigned in a space, which is divided from the space of other groups by a recognizable barrier to define limits and to reduce distraction.

(1) Each group of children must have adult supervision at all times

(2) Arrangements must be made so that, in an emergency, a caregiver can call a second adult for help without having to leave the group.

(3) If more than one adult is assigned to a group, one must be designated as the lead caregiver. The facility must provide at least one (1) staff person on-duty/on-site for each eight (8) children present. Staff persons counted in the adult: child ratio may only be persons who are assigned to provide direct therapeutic nursery program services as described by written job description. Support staff, such as clerical, housekeeping, van and bus driver staff, and students involved in an on-site practicum for academic credit may not be counted in the staff-to-client ratio. While the auxiliary staff must not be included in the adult: child ratio, they can be used as emergency substitutes if their duties and qualifications permit.

(4) If meals are served, the person who is responsible for preparing meals and washing the dishes must not be included in the adult: child ratio while preparing these meals.

(5) The maximum group size for children ages 2-3 years is ten (10). The maximum group size for children ages 4-6 years is fifteen (15). Groups can be combined for short periods for a regularly scheduled activity of no more than thirty minutes duration per day as long as adult: child ratios are met.

(6) All children for whom care is provided by the program at any one time must be included in the program's enrollment and square footage allowance.

(7) If one room has enough floor space based on licensing requirements, it can be divided and used for more than one group.

(8) When children are swimming, the number of adults must be double the required adult: child ratio [see 0940-5-31-.08(4) ]. One adult at the water site must have a current certificate in Advanced Lifesaving Skills. On field trips off premises, the number of adults must be double the requirements stated.

(9) Children Health Records

(a) Before a toddler (up to thirty months) or preschooler is accepted for care, the child must have proof of immunization (or having begun immunizations) against these diseases: diphtheria, tetanus, polio, measles, rubella, hemophilus influenza type B (Hib), and pertussis by having a certification form signed or stamped by the physician or by a certified health care provider. If a child has any know allergies, they must be indicated in the child's health record. Foreign-born children must also present evidence of tuberculosis screening.

(b) A copy of each toddler's or preschool child's health history and immunization record must be on file at the center and available to the appropriate staff. The health record must state whether immunizations required are complete and, if not complete, when future immunizations must be given so that the child will be protected. If immunizations are not continued by the parent, the child must not remain in the program. The health record will be returned to the parent upon request when the child leaves the program.

(c) Before a child is accepted for care, the parent must show proof of the child's physical examination within three months prior to admission, signed or stamped by a physician or health care agency. Exceptions to this may be made at the discretion of the Therapeutic Nursery Coordinator.

(d) Exceptions to requirements (a) and (b) of this section may be made only if:

1. The child's physician or the health department provides a signed and dated statement, giving a medical reason that the child should not be given a specified immunization; or

2. The child's parent provides a signed, written statement that such immunizations conflict with his/her religious tenets and practices.

(e) If a child with a physical or sensory impairment or with a medical disorder is enrolled, his or her health records must include a physician's statement which identifies the condition and which gives the physician's special instructions for the child's care.

Tenn. Comp. R. & Regs. 0940-05-31-.08

Original rule filed January 11, 1996; effective March 26, 1996.

Authority: T.C.A. §§ 4-4-103, 33-2-504 and 33-1-205(b)(5).